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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 (Descending) CMS Discontinuation Date Status
C9058 Pegfilgrastim-bmez Ziextenzo 0.5mg Ancillary Therapy immunomodulatorne Granulocyte Colony Stimulating Factor No 2019 March 31, 2020 July 1, 2020 No Longer Used
J9309 Polatuzumab Vedotin Polivy 1mg Immunotherapy Drug Antibody Conjugate CD79b No 2019 Jan. 1, 2020 In Use
J0641 Levoleucovorin Fusilev, Levoleucovorin 0.5 mg Ancillary Therapy Chemoprotective Antidote No 2008 Oct. 1, 2019 In Use
J9313 Moxetumomab-pasudotox-tdfk Lumoxiti 0.01mg Immunotherapy Drug Antibody Conjugate CD22 No 2018 Oct. 1, 2019 In Use
J9269 Tagraxofusp-erzs Elzonris 10mcg Immunotherapy Recombinant Fusion Protein IL3/CD123 No 2018 Oct. 1, 2019 In Use
J9113 Cemiplimab-rwlc Libtayo 1mg Immunotherapy Checkpoint Inhibitor PD-1 No 2018 Oct. 1, 2019 In Use
J9204 Mogamulizumab-kpkc Poteligeo 1mg Immunotherapy Monoclonal Antibody CCR4 No 2018 Oct. 1, 2019 In Use
J9118 Calaspargase pegol-mknl Asparlas 10 units Chemotherapy Miscellaneous Agent Enzyme No 2018 Oct. 1, 2019 In Use
Q5117 Trastuzumab-anns Kanjinti 10mg Immunotherapy Monoclonal Antibody HER2 No 2019 Oct. 1, 2019 In Use
Q5118 Bevacizumab-bvcr Zirabev 10mg Immunotherapy Monoclonal Antibody VEGFR No 2019 Oct. 1, 2019 In Use
J0642 Levoleucovorin Khapzory 0.5mg Ancillary Therapy Chemoprotective Antidote No 2018 Oct. 1, 2019 In Use
Q5116 Trastuzumab-qyyp Trazimera 10mg Immunotherapy Monoclonal Antibody HER2 No 2020 Oct. 1, 2019 In Use
Q5113 Trastuzumab-pkrb Herzuma 10mg Immunotherapy Monoclonal Antibody HER2 No 2018 July 1, 2019 In Use
Q5114 Trastuzumab-dkst Ogivri 10mg Immunotherapy Monoclonal Antibody HER2 No 2017 July 1, 2019 In Use
Q5115 Rituximab-abbs Truxima 10mg Immunotherapy Monoclonal Antibody CD20 No 2018 July 1, 2019 In Use
J9036 Bendamustine HCL Belrapzo 1mg Chemotherapy Alkylating Agent Nitrogen Mustard No 2018 July 1, 2019 In Use
J9030 Bacillus calmette-guerin BCG Vaccine, Tice BCG 1mg Immunotherapy Biological Response Modifier Live Vaccine No 1990 July 1, 2019 In Use
J9356 Trastuzumab and Hyaluronidase-oysk Herceptin hylecta 10mg Immunotherapy Monoclonal Antibody HER2 No 2019 July 1, 2019 In Use
Q5112 Trastuzumab-dttb Ontruzant 10mg Immunotherapy Monoclonal Antibody HER2 No 2021 July 1, 2019 In Use
Q2041 Axicabtagene Ciloleucel Yescarta Up to 200 million Immunotherapy CAR-T CD19 No 2017 Jan. 1, 2019 In Use
Q5111 Pegfilgrastim-cbqv Udenyca 0.5mg Ancillary Therapy Immunostimulant Granulocyte Colony-Stimulating Factor No 2019 Jan. 1, 2019 In Use
J9311 Rituximab and Hyaluronidase Rituxan Hycela 10mg Immunotherapy Monoclonal Antibody CD20 No 2017 Jan. 1, 2019 In Use
Q5107 Bevacizumab-awwb Mvasi 10mg Immunotherapy Monoclonal Antibody VEGFR No 2018 Jan. 1, 2019 In Use
J9173 Durvalumab Imfinzi 10mg Immunotherapy Checkpoint Inhibitor PD-L1 No 2017 Jan. 1, 2019 In Use
J9203 Gemtuzumab ozogamicin Mylotarg 0.1 mg Immunotherapy Drug Antibody Conjugate CD33 No 2000 Jan. 1, 2018 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.