Medicare Part B Competitive Acquisition Program (CAP) · 2019. 9. 13. · Medicare Part B...

Medicare Part B Competitive Acquisition Program (CAP) 2008 Drug List Bioscrip, Inc. Vendor Identification (VIN): Q103 January 1, 2008 Update – additions and changes are indicated by light blue highlight and a double asterisk (**). When used as a part of Medicare claims, NDCs must be submitted in a HIPAA compliant format.

HCPCS CAP NDCs Long Description **Not currently available. Please

J0128 contact vendor for ABARELIX INJECTION, 10 MG information about availability.

00703-8771-03 00703-8773-01

J0150 55390-0067-10 55390-0068-01

INJECTION, ADENOSINE FOR THERAPEUTIC USE, 6 MG

63323-0651-02 63323-0651-04

J0152 00469-0871-20 00469-0871-30 INJECTION, ADENOSINE FOR DIAGNOSTIC USE, 30 MG

00409-4901-18 00409-4921-34 00409-7241-01

J0170 00548-1014-00 00548-1016-00 INJECTION, ADRENALIN, EPINEPHRINE, 1 ML AMPULE

00548-2016-00 00548-3316-00 00548-9061-00

J0180 58468-0040-01 58468-0041-01 AGALSIDASE BETA INJECTION, 1 MG

J0207 58178-0017-03 INJECTION, AMIFOSTINE, 500 MG

J0215 59627-0021-03 59627-0021-04 INJECTION, ALEFACEPT, 0.5 MG

CAP Jan 2007 NDC Update of 24

HCPCS CAP NDCs Long Description

J0278

00409-1955-01 00409-1956-01 00703-9032-03 00703-9040-03 55390-0225-02 55390-0226-02 55390-0226-04

AMIKACIN, 100MG

J0280

00409-5921-01 00409-5922-01 00409-7385-01 00409-7386-01 00517-3810-25 00517-3820-25

INJECTION, AMINOPHYLLIN, 250 MG

J0290

00781-3408-95 63323-0387-10 63323-0388-10 63323-0389-10 63323-0399-23

INJECTION, AMPICILLIN SODIUM, 500 MG

J0475 58281-0560-01 58281-0561-02 58281-0563-01

INJECTION, BACLOFEN, 10 MG

J0540 61570-0140-10 61570-0141-10

INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, 1,200,000 UNITS

J0550 61570-0142-10 61570-0144-10

INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, 2,400,000 UNITS

J0570 61570-0147-10 **60793-0701-10

INJECTION, PENICILLIN G BENZATHINE, 1,200,000 UNITS

J0585 00023-1145-01 BOTULINUM TOXIN TYPE A, PER UNIT

J0587 10454-0710-10 10454-0711-10 59075-0712-10

BOTULINUM TOXIN TYPE B, PER 100 UNITS

J0600 00089-0510-06 INJECTION, EDETATE CALCIUM DISODIUM, 1000 MG

J0637 00006-3822-10 00006-3823-10 INJECTION, CASPOFUNGIN ACETATE, 5 MG



J0640

00703-5140-01 00703-5145-01 55390-0009-01 55390-0051-10 55390-0052-10 55390-0053-01 55390-0054-01

INJECTION, LEUCOVORIN CALCIUM, PER 50 MG

J0670

00074-1038-50 00074-1041-30 00074-1067-20 00074-2047-50 00186-0410-01 00186-0412-01 00186-0418-01 00186-0420-01 00186-0422-01

INJECTION, MEPIVACAINE HYDROCHLORIDE, PER 10 ML

J0690

00074-4732-03 00143-9923-90 00143-9924-90 00591-2365-69 00591-2366-68 00781-3157-96 00781-3346-95 10019-0610-01 10019-0611-03 63323-0236-10 63323-0237-10 63323-0238-61 63323-0446-61 66860-0001-03 66860-0002-03 66860-0003-02

INJECTION, CEFAZOLIN SODIUM, 500 MG

J0692

51479-0053-10 51479-0054-10 51479-0054-20 51479-0054-30 51479-0055-10 51479-0055-20 51479-0055-30

INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG



00409-7332-01 00409-7333-04 00409-7335-03 00409-7336-04 00409-7337-01 00409-7338-01 00781-3206-95 00781-3207-95 00781-3208-95 00781-3209-95 00781-3210-46 10019-0685-01

J0696 10019-0686-02 INJECTION, CEFTRIAXONE SODIUM, PER 250 MG 10019-0687-03 10019-0688-04 60505-0679-05 60505-0750-04 60505-0751-04 60505-0752-04 60505-0753-04 63323-0344-10 63323-0345-10 63323-0346-10 63323-0347-20 63323-0348-61

00039-0017-10 00039-0018-10 00039-0018-11 00039-0018-25 00039-0018-50 00039-0019-10 00039-0019-11 00039-0019-25 00039-0019-50

J0698 00039-0020-01 INJECTION, CEFOTAXIME SODIUM, PER GM 00039-0023-25 00039-0023-50 00039-0024-25 00039-0024-50 63323-0331-15 63323-0332-15 63323-0333-61 63323-0334-61 63323-0335-10



J0702 00085-0566-05 INJECTION, BETAMETHASONE ACETATE & BETAMETHASONE SODIUM PHOSPHATE, PER 3 MG

J0704

Not currently available. Please contact vendor for information about availability.

INJECTION, BETAMETHASONE SODIUM PHOSPHATE, PER 4 MG

J0735 66591-0965-41 66591-0975-41 INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG

J0800 63004-7731-01 INJECTION, CORTICOTROPIN, 40 UNITS

J0878 67919-0011-01 DAPTOMYCIN INJECTION, 1 MG



J0881

55513-0002-04 55513-0003-04 55513-0004-04 55513-0005-04 55513-0006-01 55513-0010-04 55513-0011-04 55513-0012-04 55513-0013-04 55513-0014-01 55513-0015-01 55513-0021-04 55513-0023-04 55513-0025-04 55513-0027-04 55513-0028-01 55513-0032-01 55513-0037-04 55513-0039-04 55513-0041-04 55513-0043-04 55513-0044-01 55513-0046-01 55513-0048-01 55513-0053-04 55513-0054-04 55513-0057-04 55513-0058-04 55513-0110-01 55513-0111-01 55513-037-04 55513-039-04 55513-041-04 55513-043-04 55513-044-01 55513-046-01 55513-048-01

INJECTION, DARBEPOETIN ALFA, 1 MCG (NON-ESRD USE)

59676-0302-01 59676-0302-02 59676-0303-01 59676-0303-02

J0885 59676-0304-01 59676-0304-02 59676-0310-01

INJECTION, EPOETIN ALPHA, (FOR NON ESRD USE), PER 1000 UNITS

59676-0310-02 59676-0312-01 59676-0320-01 59676-0340-01

J0894 58063-0600-50 INJECTION, DECITABINE, 1MG



J0895 00409-2336-10 00409-2337-25 INJECTION, DEFEROXAMINE MESYLATE, 500 MG

J1000 00009-0271-01 INJECTION, DEPO-ESTRADIOL CYPIONATE, 5 MG

J1020 00009-0274-01 INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG

00009-0280-02 00009-0280-03 00009-0280-51

J1030 00009-0280-52 00009-3073-01 INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG

00009-3073-03 00703-0031-04

00009-0306-02

J1040 00009-0306-12 00703-0051-01 INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG

00703-0051-04

J1051 00009-0626-01 INJECTION, MEDROXYPROGESTERONE ACETATE, 50 MG

Not currently available. Please

J1094 contact vendor for INJECTION, DEXAMETHASONE ACETATE, 1 MG information about availability.

00517-4901-25 00517-4905-25 00641-0367-25

J1100 63323-0165-01 63323-0165-05

INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG

63323-0165-30 63323-0506-01 63323-0516-10

J1190 55390-0014-02 55390-0060-02

INJECTION, DEXRAZOXANE HYDROCHLORIDE, PER 250 MG

J1200 00409-2290-31 00641-0376-25 INJECTION, DIPHENHYDRAMINE HCL, 50 MG

00433-0433-05 J1212 67457-0145-50 INJECTION, DMSO, DIMETHYL SULFOXIDE, 50%, 50 ML

**67457-0177-50



J1245 55390-0555-90 INJECTION, DIPYRIDAMOLE, PER 10 MG

J1250 00409-2025-54 55390-0560-90

INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG

J1260 00088-1206-32 00088-1209-26 INJECTION, DOLASETRON MESYLATE, 10 MG

J1335 00006-3843-71 INJECTION, ERTAPENEM SODIUM, 500 MG

J1440 55513-0530-10 55513-0924-10 INJECTION, FILGRASTIM (G-CSF), 300 MCG

J1441 55513-0209-10 55513-0546-10 INJECTION, FILGRASTIM (G-CSF), 480 MCG

J1450

00703-1019-09 55390-0012-01 55390-0046-01 59762-5035-02 59762-5036-02 59762-5037-02 61703-0414-63 61703-0414-64

INJECTION FLUCONAZOLE, 200 MG

J1580

00074-3402-01 00409-1207-03 63323-0010-02 63323-0010-20 63323-0513-02

INJECTION, GARAMYCIN, GENTAMICIN, 80 MG

J1600

11098-0533-01 11098-0533-10 66758-0011-02 66758-0011-03

INJECTION, GOLD SODIUM THIOMALATE, 50 MG

J1626 00004-0239-09 00004-0240-09 00004-0242-08

INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG



J1631

00703-7011-03 00703-7013-01 00703-7021-03 00703-7023-01 55390-0412-01 55390-0412-05 55390-0413-01 55390-0413-05 60505-0702-01 60505-0703-01 63323-0469-01 63323-0469-05 63323-0471-01 63323-0471-05

INJECTION, HALOPERIDOL DECANOATE, PER 50 MG

J1644

00409-1316-32 00409-1316-66 00641-0400-25 00641-0410-25 00641-2440-45 00641-2450-45 00641-2470-45 63323-0047-10 63323-0262-01 63323-0540-11 63323-0540-31 63323-0542-01 63323-0542-07 63323-0915-01

INJECTION, HEPARIN SODIUM, PER 1000 UNITS

J1645

00013-2406-91 00013-2426-01 00013-2426-91 00013-5190-01 00013-5191-01

INJECTION, DALTEPARIN SODIUM, PER 2500 IU



J1650

00075-0620-40 00075-0621-60 00075-0622-80 00075-0623-00 00075-0624-30 00075-0626-03 00075-2912-01 00075-2915-01

INJECTION, ENOXAPARIN SODIUM, 10 MG

J1655 67211-0342-08 67211-0342-53 INJECTION, TINZAPARIN SODIUM, 1000 IU

J1720

00009-0825-01 00009-0900-13 00009-0900-20 00009-0909-08 00009-0909-16 00009-0912-05 00009-0920-03

INJECTION, HYDROCORTISONE SODIUM SUCCINATE, 100 MG

J1745 57894-0030-01 INJECTION INFLIXIMAB, 10 MG

J1751 52544-0931-02 IRON DEXTRAN 165, 50MG

J1752 00517-0134-10 00517-0234-10 IRON DEXTRAN 267, 50MG

J1756 00517-2340-10 INJECTION, IRON SUCROSE, 1 MG

J1885

00409-3795-01 00409-3796-01 10019-0029-02 10019-0030-03 10019-0030-04 55390-0480-01 55390-0481-02 55390-0481-10 63323-0162-02

INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG



J1931 58468-0070-01 LARONIDASE INJECTION, 0.1 MG

J1940 00409-6102-10 00517-5710-25 63323-0280-10

INJECTION, FUROSEMIDE, 20 MG

J1956 00045-0065-55 00045-0069-51 INJECTION, LEVOFLOXACIN, 250 MG

J2001

00264-9594-10 00264-9594-20 00338-0409-02 00338-0409-03 00409-7931-24

INJECTION, LIDOCAINE HCL FOR INTRAVENOUS INFUSION, 10 MG

J2010 00009-0555-02 INJECTION, LINCOMYCIN HCL, 300 MG

J2150 00409-4031-01 00517-4050-25 63323-0024-25

INJECTION, MANNITOL, 25% IN 50 ML

J2260

00703-8005-03 00703-8006-03 10019-0070-01 10019-0070-02 61703-0242-50 67457-0160-20

INJECTION, MILRINONE LACTATE, 5 MG

J2300

00409-1463-01 00409-1464-01 00409-1465-01 00409-1467-01

INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG

**J2323 **59075-730-15 **INJECTION, NATALIZUMAB, 1 MG



J2325 65847-0205-25 INJECTION, NESIRITIDE, 0.1 MG

J2353 00078-0340-61 00078-0341-61 00078-0342-61

INJECTION, OCTREOTIDE, DEPOT FORM FOR INTRAMUSCULAR INJECTION, 1 MG

00078-0181-01 00078-0182-01 00078-0183-25 00078-0184-25

J2354 00703-3301-04 00703-3333-01 00703-3343-01

INJECTION, OCTREOTIDE, NON-DEPOT SUBCUTANEOUS OR INTRAVENOUS INJECTION, 25 MCG

55390-0161-10 55390-0162-10 55390-0163-01 55390-0164-01

J2357 50242-0040-62 OMALIZUMAB INJECTION, 5 MG

J2405 00173-0442-00 00173-0442-02 00173-0461-00

INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG

00703-4075-59 00703-4085-51

J2430 00781-3147-84 55390-0129-01

INJECTION, PAMIDRONATE DISODIUM, PER 30 MG

61703-0324-39

J2469 58063-0797-25 PALONOSETRON HCL, 25MCG

J2503 68782-0001-01 PEGAPTANIB, 0.3MG J2505 55513-0190-01 INJECTION, PEGFILGRASTIM, 6 MG

00641-0928-25 00641-0929-25

J2550 00641-1495-35 00641-1496-35

INJECTION, PROMETHAZINE HCL, 50 MG

00703-2201-04



J2680 00703-5003-01 55390-0465-05 INJECTION, FLUPHENAZINE DECANOATE, 25 MG

60977-0451-02 60977-0451-03

J2765 61703-0210-11 61703-0210-21

INJECTION, METOCLOPRAMIDE HCL, 10 MG

61703-0210-35

**INJECTION, RANIBIZUMAB, 0.1 MG **J2778 **50242-080-01

**[Formerly Q4082 – Drug/bio NOC part B drug CAP, billed in 0.5mg increments]

J2780 55390-0616-01 55390-0616-10 INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG

50458-0306-11 J2794 50458-0307-11 RISPERIDONE, LONG ACTING, 0.5MG

50458-0308-11

J2820 50419-0002-33 50419-0595-05 INJECTION, SARGRAMOSTIM (GM-CSF), 50 MCG

J2916 52544-0922-26 INJECTION, SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE INJECTION, 12.5 MG

J2920 00009-0113-19 00409-5684-01

INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, 40 MG

J2930

00009-0190-16 00009-0698-01 00009-0758-01 00009-0796-01 00009-3389-01

INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, 125 MG

50242-0041-64 J2997 50242-0044-13 INJECTION, ALTEPLASE RECOMBINANT, 1 MG

50242-0085-27



J3240 58468-1849-04 INJECTION, THYROTROPIN ALPHA, 0.9 MG, PROVIDED IN 1.1 MG VIAL

J3260

00409-3578-01 00409-3590-02 63323-0306-30 63323-0307-51

INJECTION, TOBRAMYCIN SULFATE, 80 MG

J3301 00003-0293-28 00003-0494-20 INJECTION, TRIAMCINOLONE ACETONIDE, PER 10MG

J3302


INJECTION, TRIAMCINOLONE DIACETATE, PER 5MG

J3303 54643-1054-00 54643-1056-00

INJECTION, TRIAMCINOLONE HEXACETONIDE, PER 5MG

J3315 52544-0153-76 52544-0154-76 INJECTION, TRIPTORELIN PAMOATE, 3.75 MG

J3370

00409-4332-01 00409-6509-01 00409-6533-01 63323-0221-10 63323-0284-20 63323-0314-61

INJECTION, VANCOMYCIN HCL, 500 MG

J3396 58768-0150-15 00078-0437-61 INJECTION, VERTEPORFIN, 0.1 MG

J3410

00517-4201-25 00517-5602-25 00517-5610-25 63323-0021-01

INJECTION, HYDROXYZINE HCL, 25 MG

J3420 00517-0032-25 00517-0130-05

INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG



J3475

00409-2168-02 00409-2168-03 00409-6729-03 00409-6729-09 00517-2610-25 00517-2650-25 63323-0064-10 63323-0064-20 63323-0064-50

INJECTION, MAGNESIUM SULFATE, PER 500 MG

J3480

00074-3934-02 00409-1513-02 00409-6636-01 00409-6651-06 00409-6653-05 63323-0965-10 63323-0965-15 63323-0965-20 63323-0967-30

INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ

ACID **(ZOMETA), 1 MG J3487 00078-0387-25 INJECTION, ZOLEDRONIC

**J3488 **00078-0435-61 **INJECTION, ZOLEDRONIC ACID (RECLAST), 1 MG



J7030

00264-4000-55 00264-4001-55 00264-7800-00 00264-7800-10 00264-7800-20 00338-0049-02 00338-0049-03 00338-0049-04 00409-7101-02 00409-7983-02 00409-7983-03 00409-7983-09 00409-7983-53 00409-7983-55

INFUSION, NORMAL SALINE SOLUTION , 1000 CC

J7040

00264-1400-10 00264-7800-00 00264-7800-10 00338-0049-04 00409-7983-09

INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML=1 UNIT)

J7042 00264-7610-00 00338-0089-04 00409-7941-09

5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT)

J7050

00264-1400-10 00338-0049-02 00338-0049-03 00338-0049-04 00409-1583-02 00409-7983-03 00409-7983-09 00409-7983-53

INFUSION, NORMAL SALINE SOLUTION , 250 CC

J7060

00338-0017-04 00409-1522-02 00409-1522-03 00409-7922-03 00409-7922-09

5% DEXTROSE/WATER (500 ML = 1 UNIT)



00264-7510-00 00264-7510-10

J7070 00338-0017-03 INFUSION, D5W, 1000 CC 00338-0017-04 00409-7922-09

00264-1350-10

J7120 00264-1750-00 00338-0117-03 RINGERS LACTATE INFUSION, 1000 CC

00338-0117-04

08024-0724-12 **HYALURONAN OR DERIVATIVE, HYALGAN OR

**J7321 08024-0724-20 08363-7761-01

SUPARTZ, FOR INTRA-ARTICULAR INJECTION, Per Dose

08363-7765-01

**J7322 58468-0090-01 66267-0921-03 68115-0535-03

**HYALURONAN OR DERIVATIVE, SYNVISC, FOR INTRA-ARTICULAR INJECTION, PER DOSE

**J7323 55566-4100-01 **HYALURONAN OR DERIVATIVE, EUFLEXXA, FOR INTRA-ARTICULAR INJECTION, PER DOSE

**J7324 **59676-0360-01 **HYALURONAN OR DERIVATIVE, ORTHOVISC, FOR INTRA-ARTICULAR INJECTION, PER DOS

10019-0920-01

J9000 10019-0921-02 55390-0232-10 DOXORUBICIN HCL, 10 MG

55390-0238-01

J9001 17314-9600-01 17314-9600-02

DOXORUBICIN HYDROCHLORIDE, ALL LIPID FORMULATIONS, 10 MG



J9010 50419-0357-03 ALEMTUZUMAB, 10 MG

J9031 49281-0880-01 BCG (INTRAVESICAL) PER INSTILLATION

J9035 50242-0060-01 50242-0061-01 BEVACIZUMAB INJECTION, 10MG

J9040

00703-3154-01 00703-3155-01 55390-0005-01 55390-0006-01 61703-0323-22 61703-0332-18

BLEOMYCIN SULFATE, 15 UNITS

J9041 63020-0049-01 BORTEZOMIB INJECTION, 0.1MG

J9045

00703-3244-11 00703-3246-11 00703-3249-11 00703-3264-01 00703-3266-01 00703-3278-01 10019-0915-01 55390-0153-01 55390-0154-01 55390-0155-01 61703-0339-18 61703-0339-22 61703-0339-50 61703-0339-56

CARBOPLATIN, 50 MG

J9050 00015-3012-38 CARMUSTINE, 100 MG

J9055 66733-0948-23 CETUXIMAB INJECTION, 10MG



J9060 55390-0099-01 55390-0112-50 55390-0112-99

CISPLATIN, POWDER OR S0LUTION, PER 10 MG

J9062

00703-5747-11 00703-5748-11 55390-0099-01 55390-0112-50 55390-0112-99

CISPLATIN, 50 MG

J9065 55390-0124-01 63323-0140-10 INJECTION, CLADRIBINE, PER 1 MG

J9070


CYCLOPHOSPHAMIDE, 100 MG

J9080


CYCLOPHOSPHAMIDE, 200 MG

J9090 00015-0502-41 10019-0955-01 CYCLOPHOSPHAMIDE, 500 MG

J9091 10019-0956-01 CYCLOPHOSPHAMIDE, 1.0 GRAM

J9092 00015-0506-41 10019-0957-01 CYCLOPHOSPHAMIDE, 2.0 GRAM

J9093


CYCLOPHOSPHAMIDE, LYOPHILIZED, 100 MG

J9094



J9095




HCPCS CAP NDCs Long Description Not currently available. Please

J9096 contact vendor for information about

CYCLOPHOSPHAMIDE, LYOPHILIZED, 1.0 GRAM

availability. Not currently available. Please

J9097 contact vendor for information about

CYCLOPHOSPHAMIDE, LYOPHILIZED, 2.0 GRAM

availability.

J9098 57665-0331-01 CYTARABINE LIPOSOME, 10 MG

J9100 55390-0131-10 CYTARABINE, 100 MG

J9110 55390-0133-01 55390-0134-01 CYTARABINE, 500 MG

J9130 63323-0127-10 DACARBAZINE, 100 MG 00703-5075-01

J9140 00703-5075-03 55390-0090-10 DACARBAZINE, 200 MG

61703-0327-22 00703-5233-13

J9150 55390-0108-01 55390-0108-10 DAUNORUBICIN, 10 MG

55390-0281-10

J9160 64365-0503-01 DENILEUKIN DIFTITOX, 300 MCG

J9170 00075-8001-20 00075-8001-80 DOCETAXEL, 20 MG

J9178 00009-5091-01 00009-5093-01 INJECTION, EPIRUBICIN HCL, 2 MG

00703-5653-01 00703-5657-01

J9181 55390-0291-01 55390-0292-01

ETOPOSIDE, 10 MG

55390-0293-01 00703-5653-01 00703-5656-01

J9182 00703-5657-01 55390-0291-01 ETOPOSIDE, 100 MG

55390-0292-01 55390-0293-01



J9185 00703-4852-11 00703-5854-01 50419-0511-06

FLUDARABINE PHOSPHATE, 50 MG

J9190

00703-3015-13 00703-3018-12 00703-3019-12 63323-0117-20 63323-0117-51 63323-0117-61

FLUOROURACIL, 500 MG

J9200 61703-0331-09 63323-0145-07 FLOXURIDINE, 500 MG

J9201 00002-7501-01 00002-7502-01 GEMCITABINE HCL, 200 MG

J9202 00310-0950-36 00310-0951-30 GOSERELIN ACETATE IMPLANT, PER 3.6 MG

J9206 00009-7529-01 00009-7529-02 IRINOTECAN, 20 MG

J9208 10019-0925-01 63323-0142-10 IFOSFAMIDE, 1 GM

J9209 10019-0953-01 10019-0953-02 MESNA, 200 MG

J9211 00703-4156-11 IDARUBICIN HYDROCHLORIDE, 5 MG

J9213 00004-2015-07 00004-2015-09 00004-2016-09

INTERFERON, ALFA-2A, RECOMBINANT, 3 MILLION UNITS

J9214

00085-0539-01 00085-0571-02 00085-1110-01 00085-1133-01 00085-1168-01 00085-1179-02 00085-1235-01 00085-1242-01 00085-1254-01

INTERFERON, ALFA-2B, RECOMBINANT, 1 MILLION UNITS



J9219 00026-9711-01 LEUPROLIDE ACETATE IMPLANT, 65 MG

J9225 55592-0500-01 HISTRELIN IMPLANT, 50MG

J9245 59572-0301-01 INJECTION, MELPHALAN HYDROCHLORIDE, 50 MG

J9250 55390-0033-10 55390-0034-10 METHOTREXATE SODIUM, 5 MG

J9260

55390-0032-10 55390-0033-10 55390-0034-10 61703-0408-41

METHOTREXATE SODIUM, 50 MG

J9263 00024-0590-10 00024-0591-20 INJECTION, OXALIPLATIN, 0.5 MG

J9264 68817-0134-50 PACLITAXEL PROTEIN BOUND PARTICLES, 1MG

J9265 55390-0114-05 55390-0114-20 55390-0114-50

PACLITAXEL, 30 MG

J9268 62701-0800-01 PENTOSTATIN, PER 10 MG

J9280 63323-0190-20 MITOMYCIN, 5 MG

J9290 55390-0252-01 63323-0191-40 MITOMYCIN, 20 MG

J9291 55390-0253-01 MITOMYCIN, 40 MG

J9293 44087-1520-01 44087-1525-01 44087-1530-01

INJECTION, MITOXANTRONE HYDROCHLORIDE, PER 5 MG

J9305 00002-7623-01 PEMETREXED INJECTION, 10MG



J9310 50242-0051-21 50242-0053-06 RITUXIMAB, 100 MG

J9320 00703-4636-01 STREPTOZOCIN, 1 GM

J9340 55390-0030-10 THIOTEPA, 15 MG

J9350 00007-4201-01 00007-4201-05 TOPOTECAN, 4 MG

J9355 50242-0134-68 TRASTUZUMAB, 10 MG

J9360 63323-0278-10

00703-4402-11

VINBLASTINE SULFATE, 1 MG

J9370 00703-4412-11 61703-0309-06 61703-0309-16 00703-4402-11

VINCRISTINE SULFATE, 1 MG

J9375 00703-4412-11 61703-0309-06 61703-0309-16 00703-4182-01 00703-4183-01

VINCRISTINE SULFATE, 2 MG

J9390 55390-0069-01 55390-0070-01 61703-0341-09

VINORELBINE TARTRATE, PER 10 MG

J9395 00310-0720-25 00310-0720-50 INJECTION, FULVESTRANT, 25 MG

J9600 58914-0155-75 PORFIMER SODIUM, 75 MG

Q3025 59627-0001-03 59627-0002-05

INJECTION, INTERFERON BETA-1A, 11 MCG FOR INTRAMUSCULAR USE


CAP NOC DRUGS - Supplied under Q4082- Drug/bio NOC part B drug CAP Please note that ranibizumab (Lucentis®) is now billed under J2778

CAP NDCs Drug Name and billing amount

none


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