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HCPCS Generic Name Brand Name Strength SEER*Rx Category Major Drug Class (Descending) Minor Drug Class Oral (Y/N) FDA Approval Year FDA Discontinuation Year CMS Effective Date CMS Discontinuation Date Status
C9293 Glucarpidase Voraxaze 10 units Ancillary Therapy Chemoprotective Antidote No 2012 Jan. 1, 2012 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
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
NA Uridine Triacetate Vistogard 10 g Ancillary Therapy Chemoprotective Antidote Yes 2015 In Use
J0642 Levoleucovorin Khapzory 0.5mg Ancillary Therapy Chemoprotective Antidote No 2018 Oct. 1, 2019 In Use
C9491 Avelumab Bavencio 10 mg Immunotherapy Checkpoint Inhibitor PD-1 No 2017 Oct. 1, 2017 In Use
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
J9228 Ipilimumab Yervoy 1mg Immunotherapy Checkpoint Inhibitor CTLA-4 No 2011 Jan. 1, 2012 In Use
C9284 Ipilimumab Yervoy 1mg Immunotherapy Checkpoint Inhibitor CTLA-4 No 2011 July 1, 2011 Dec. 31, 2011 No Longer Used
J9299 Nivolumab Opdivo 1 mg Immunotherapy Checkpoint Inhibitor PD-1 No 2014 Jan. 1, 2016 In Use
C9453 Nivolumab Opdivo 1 mg Immunotherapy Checkpoint Inhibitor PD-1 No 2014 July 1, 2015 In Use
C9027 Pembrolizumab Keytruda 1 mg Immunotherapy Checkpoint Inhibitor PD-1 No 2014 Jan. 1, 2015 Dec. 31, 2015 No Longer Used
J9271 Pembrolizumab Keytruda 1 mg Immunotherapy Checkpoint Inhibitor PD-1 No 2014 Jan. 1, 2016 In Use
J9113 Cemiplimab-rwlc Libtayo 1mg Immunotherapy Checkpoint Inhibitor PD-1 No 2018 Oct. 1, 2019 In Use
NA Dostarlimab Jemperli 50mg Immunotherapy Checkpoint Inhibitor PD-1 Yes 2021 In Use
C9082 Dostarlimab-gxly Jemperli 100mg Immunotherapy Checkpoint Inhibitor PD-1 No 2021 Sept. 27, 2021 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.