| HCPCS | Generic Name | Brand Name | Strength | SEER*Rx Category | Major Drug Class | Minor Drug Class | Oral (Y/N) | FDA Approval Year | FDA Discontinuation Year | CMS Effective Date | CMS Discontinuation Date | Status |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C9483 | Atezolizumab | Tecentriq | 10 mg | Immunotherapy | Checkpoint Inhibitor | PD-1 | No | 2016 | Oct 1, 2016 | In Use | ||
| C9492 | Durvalumab | Imfinzi | 10 mg | Immunotherapy | Checkpoint Inhibitor | PD-L1 | No | 2017 | Oct 1, 2017 | In Use | ||
| J9329 | Tislelizumab-jsgr | Tevimbra | 1mg | Immunotherapy | Checkpoint Inhibitor | PD-1 | No | 2024 | Sep 11, 2024 | In Use | ||
| J9113 | Cemiplimab-rwlc | Libtayo | 1mg | Immunotherapy | Checkpoint Inhibitor | PD-1 | No | 2018 | Oct 1, 2019 | In Use | ||
| J9228 | Ipilimumab | Yervoy | 1mg | Immunotherapy | Checkpoint Inhibitor | CTLA-4 | No | 2011 | Jan 1, 2012 | In Use | ||
| J9275 | Cosibelimab-ipdl | UNLOXCYT | 2mg | Immunotherapy | Checkpoint Inhibitor | PD-L1 | No | 2025 | Jul 9, 2025 | In Use | ||
| C9284 | Ipilimumab | Yervoy | 1mg | Immunotherapy | Checkpoint Inhibitor | CTLA-4 | No | 2011 | Jul 1, 2011 | Dec 31, 2011 | No Longer Used | |
| C9027 | Pembrolizumab | Keytruda | 1 mg | Immunotherapy | Checkpoint Inhibitor | PD-1 | No | 2014 | Jan 1, 2015 | Dec 31, 2015 | No Longer Used | |
| J3263 | Toripalimab-tpzi | Loqtorzi | 1mg | Immunotherapy | Checkpoint Inhibitor | PD-1 | No | 2023 | Jun 10, 2024 | In Use | ||
| J9289 | Nivolumab and hyaluronidase-nvhy | OPDIVO QVANTIG | 2mg | Immunotherapy | Checkpoint Inhibitor | PD-1 | No | 2025 | Jul 9, 2025 | In Use | ||
| J9272 | Dostarlimab-gxly | Jemperli | 10mg | Immunotherapy | Checkpoint Inhibitor | PD-1 | No | 2021 | Jan 26, 2022 | In Use | ||
| J0641 | Levoleucovorin | Fusilev, Levoleucovorin | 0.5 mg | Ancillary Therapy | Chemoprotective | Antidote | No | 2008 | Oct 1, 2019 | In Use | ||
| J9209 | Mesna | Mesna rescue, Mesnex, Mesna Novaplus, Uromitexan | 200 mg | Ancillary Therapy | Chemoprotective | Detoxifying Agent | No | 1988 | Jan 1, 1990 | In Use | ||
| C9428 | Mesna | Mesna rescue, Mesnex, Mesna Novaplus, Uromitexan | 200 mg | Ancillary Therapy | Chemoprotective | Detoxifying Agent | No | 1988 | Jan 1, 2004 | Dec 31, 2005 | No Longer Used | |
| NA | Uridine Triacetate | Xuriden | 2 g | Ancillary Therapy | Chemoprotective | Antidote | Yes | 2015 | In Use | |||
| J1190 | Dexrazoxane | Zinecard | 250 mg | Ancillary Therapy | Chemoprotective | Detoxifying Agent | No | 1995 | Jan 1, 2007 | In Use | ||
| J0640 | Leucovorin Calcium | Calcium leucovorin, Lederfoline, Leucosar, Leucovorin rescue, Wellcovorin | 50 mg | Ancillary Therapy | Chemoprotective | Antidote | No | 1952 | Jan 1, 1997 | In Use | ||
| J0207 | Amifostine | Ethyol | 500 mg | Ancillary Therapy | Chemoprotective | Detoxifying Agent | No | 1995 | Jan 1, 1998 | In Use | ||
| NA | Uridine Triacetate | Vistogard | 10 g | Ancillary Therapy | Chemoprotective | Antidote | Yes | 2015 | In Use | |||
| NA | Mesna | Mesnex | 400 mg | Ancillary Therapy | Chemoprotective | Detoxifying Agent | Yes | 2002 | In Use | |||
| NA | Leucovorin Calcium | Calcium leucovorin, Lederfoline, Leucosar, Leucovorin rescue, Wellcovorin | 15 mg | Ancillary Therapy | Chemoprotective | Antidote | Yes | 1952 | Jan 1, 1997 | In Use | ||
| N/A | Calcium folinate | Lederle Leucovorin | 5mg | Ancillary Therapy | Chemoprotective | Antidote | Yes | 2025 | In Use | |||
| NA | Leucovorin Calcium | Calcium leucovorin, Lederfoline, Leucosar, Leucovorin rescue, Wellcovorin | 15 mg | Ancillary Therapy | Chemoprotective | Antidote | Yes | 1952 | Jan 1, 1997 | In Use | ||
| NA | Leucovorin Calcium | Calcium leucovorin, Lederfoline, Leucosar, Leucovorin rescue, Wellcovorin | 10 mg | Ancillary Therapy | Chemoprotective | Antidote | Yes | 1952 | Jan 1, 1997 | In Use | ||
| NA | Leucovorin Calcium | Calcium leucovorin, Lederfoline, Leucosar, Leucovorin rescue, Wellcovorin | 25 mg | Ancillary Therapy | Chemoprotective | Antidote | Yes | 1952 | Jan 1, 1997 | In Use |
The use of NA indicates that the HCPCS code was Not Available. NA may mean that a) the HCPCS code has
not yet been created (new drug), b) the drug is given as an oral drug or alternative route (only in
specific instances are HCPCS assigned to these medications), or c) the HCPCS could not be found or is
truly not available.
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