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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 (Ascending)
J1626 Granisetron Hydrochloride Granisol [DSC], Sancuso, Sustol, Kytril 100 mcg Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist No 1993 Jan. 1, 2009 In Use
Q0166 Granisetron Hydrochloride Granisol [DSC], Sancuso, Sustol, Kytril 1 mg Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Yes 1993 Jan. 1, 2009 In Use
S0091 Granisetron Hydrochloride Granisol [DSC], Sancuso, Sustol, Kytril 1 mg Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Yes 1993 Jan. 1, 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
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 15 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
J0640 Leucovorin Calcium Calcium leucovorin, Lederfoline, Leucosar, Leucovorin rescue, Wellcovorin 50 mg Ancillary Therapy Chemoprotective Antidote No 1952 Jan. 1, 1997 In Use
J0641 Levoleucovorin Fusilev, Levoleucovorin 0.5 mg Ancillary Therapy Chemoprotective Antidote No 2008 Oct. 1, 2019 In Use
NA Mesna Mesnex 400 mg Ancillary Therapy Chemoprotective Detoxifying Agent Yes 2002 In Use
J9209 Mesna Mesna rescue, Mesnex, Mesna Novaplus, Uromitexan 200 mg Ancillary Therapy Chemoprotective Detoxifying Agent No 1988 Jan. 1, 1990 In Use
J8650 Nabilone Cesamet 1 mg Ancillary Therapy Antiemetic Cannabinoid Yes 1985 Jan. 1, 2007 In Use
J8655 Netupitant/palonostron Akynzeo 300mg/0.5 mg Ancillary Therapy Antiemetic 5HT3 Receptor Anatagonist/Substance P/Neurokinin 1 Yes 2014 Jan. 1, 2016 In Use
J2405 Ondansetron Zofran, Zofran ODT, Zuplenz 1 mg Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist No 1991 Jan. 1, 1993 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
S0119 Ondansetron Zofran, Zofran ODT, Zuplenz 4 mg Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist Yes 1991 Jan. 1, 2012 In Use
NA oxymetholone Anadrol-50 50 mg Ancillary Therapy Anabolic Steroid Androgen Yes 1972 In Use
J2425 Palifermin Kepivance 50 mcg Ancillary Therapy Epithelial Growth Factor Keratinocyte Growth Factor/rHuKGF No 2004 Jan. 1, 2006 In Use
J2469 Palonosetron Aloxi 25 mcg Ancillary Therapy Antiemetic 5HT3 Receptor Antagonist No 2003 Jan. 1, 2005 In Use
J2562 Plerixafor Mozobil 1 mg Ancillary Therapy Immunostimulant Stem Cell Mobilizer No 2008 Jan. 1, 2010 In Use
J2783 Rasburicase Elitek, Fasturtec 0.5 mg Ancillary Therapy Metabolic Agent Enzyme No 2002 Jan. 1, 2004 In Use
J8670 Rolapitant Varubi 1 mg Ancillary Therapy Antiemetic Substance P/Neurokinin 1 Yes 2015 Jan. 1, 2017 In Use
J2820 Sargramostim Leukine 50 mcg Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor No 1991 Jan. 1, 1998 In Use
NA Uridine Triacetate Xuriden 2 g Ancillary Therapy Chemoprotective Antidote Yes 2015 In Use
NA Uridine Triacetate Vistogard 10 g Ancillary Therapy Chemoprotective Antidote Yes 2015 In Use

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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.