| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| J0642 | Levoleucovorin | Khapzory | 0.5mg | Ancillary Therapy | Chemoprotective | Antidote | No | 2018 | Oct 1, 2019 | In Use | ||
| J1446 | Tbo-filgrastim | Granix | 5 mcg | Ancillary Therapy | Immunostimulant | Granulocyte Colony-Stimulating Factor | No | 2015 | Jan 1, 2016 | Dec 31, 2015 | No Longer Used | |
| J1447 | Tbo-filgrastim | Granix | 1 mcg | Ancillary Therapy | Immunostimulant | Granulocyte Colony-Stimulating Factor | No | 2015 | Jan 1, 2016 | In Use | ||
| NA | Cyclosporine | NeOral | 25mg, 100mg | Ancillary Therapy | Immunomodulator | Calcineurin Inhibitor | Yes | 1995 | In Use | |||
| Q0162 | Ondansetron with active chemotherapy treatment adminstration | Zofran, Zofran ODT, Zuplenz | 1 mg | Ancillary Therapy | Antiemetic | 5HT3 Receptor Antagonist | Yes | 1991 | Jan 1, 2012 | In Use | ||
| J2425 | Palifermin | Kepivance | 50 mcg | Ancillary Therapy | Epithelial Growth Factor | Keratinocyte Growth Factor/rHuKGF | No | 2004 | Jan 1, 2006 | In Use | ||
| S0174 | Dolasetron Mesylate | Anzemet | 50 mg | Ancillary Therapy | Antiemetic | 5HT3 Receptor Antagonist | Yes | 1997 | Jan 1, 2002 | In Use | ||
| C9448 | Netupitant/Palonosetron | Akynzeo | 300mg/0.5 mg | Ancillary Therapy | Antiemetic | 5HT3 Receptor Anatagonist/Substance P/Neurokinin 1 | Yes | 2014 | Apr 1, 2015 | Jun 30, 2015 | No Longer Used | |
| NA | Leucovorin Calcium | Calcium leucovorin, Lederfoline, Leucosar, Leucovorin rescue, Wellcovorin | 25 mg | Ancillary Therapy | Chemoprotective | Antidote | Yes | 1952 | Jan 1, 1997 | In Use | ||
| J1260 | Dolasetron Mesylate | Anzemet | 10 mg | Ancillary Therapy | Antiemetic | 5HT3 Receptor Antagonist | No | 1997 | Jan 1, 2000 | 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 | Cyclosporine | Sandimmune | 25mg, 50mg, 100mg | Ancillary Therapy | Immunomodulator | Calcineurin Inhibitor | Yes | 1983 | 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 | ||
| NA | Naldemedine | Symproic | 0.2mg | Ancillary Therapy | Opioid Antagonist | Yes | 2018 | In Use | ||||
| J2277 | Motixafortide | Motixafortide | 0.25mg | Ancillary Therapy | Immunostimulant | Stem cell mobilizer | No | 2023 | Apr 17, 2024 | In Use | ||
| J2820 | Sargramostim | Leukine | 50 mcg | Ancillary Therapy | Immunostimulant | Granulocyte Colony-Stimulating Factor | No | 1991 | Jan 1, 1998 | In Use | ||
| J8655 | Netupitant/Palonosetron | Akynzeo | 300mg/0.5 mg | Ancillary Therapy | Antiemetic | 5HT3 Receptor Anatagonist, Substance P/Neurokinin 1 | Yes | 2014 | Jan 1, 2016 | In Use | ||
| NA | Gardasil-9 | Human papillomavirus vaccine | Ancillary Therapy | Protective Agent | HPV Vaccine | No | 2016 | In Use | ||||
| NA | Ribociclib and letrozole | Kisqali Femara Co-pack | 200 mg/ 2.5 mg | Chemotherapy, Hormonal Therapy | Cyclin dependent kinase inhibitor/ aromatase inhibitor | CDK 4/6 | Yes | 2017 | In Use | |||
| NA | Belumosudil | Rezurock | 200mg | Chemotherapy | Rho Kinase Inhibitor | ROCK1, ROCK2 | Yes | 2021 | In Use | |||
| J9052 | Carmustine (Accord) | Carmustine | 100mg | Chemotherapy | Alkylating Agent | Nitrosurea | No | 2022 | Dec 7, 2023 | In Use | ||
| J9999 | Chemotherapy - non specific | Not otherwise classified, antineoplastic drugs | NA | Chemotherapy | No | In Use | ||||||
| J9021 | Asparaginase Erwinia Chrysanthemi (recombinant)-rywn | Rylaze | 0.1mg | Chemotherapy | Miscellaneous Agent | Enzyme | No | 2021 | Jan 26, 2022 | In Use | ||
| J9020 | Asparaginase | Erwinaze | 10, 000 units (I.U.) | Chemotherapy | Miscellaneous Agent | Enzyme | No | 1994 | Jan 1, 1984 | Jan 1, 2026 | In Use | |
| Q2017 | Teniposide | Teniposide | 50 mg | Chemotherapy | Plant Alkaloid | Epipodophyllotoxins | No | 1992 | Jul 1, 2000 | Jan 1, 2026 | 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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