Skip to main content
COVID-19

Injectable Medication Codes Subject to MRxM Claim Review/Editing

Magellan Rx Management will review submitted claims that include the HCPCS codes representing injectable medications listed in this section to help ensure that the billing details are appropriate per Horizon BCBSNJ medical policy guidelines.

This list is organized alphabetically by brand name.

The injectable medications in this section DO NOT require MNAR as part of the Horizon BCBSNJ Medical Injectables Program (MIP).

Medication Brand Name

Generic Medication Name

HCPCS Code

Alimta®

pemetrexed

J9305

Beovu®

brolucizumab-dbll

J0179

Botox®

onabotulinumtoxina

J0585

Dysport®

abobotulinumtoxina

J0586

Eligard®

leuprolide acetate (for depot suspension)

J9217

Emend®

aprepitant

J1453

Euflexxa®

1% sodium hyaluronate

J7323

Eylea®

aflibercept

J0178

Faslodex®

fulvestrant

J9395

Fensolvi®

leuprolide acetate (for depot suspension)

J1950

Firmagon®

degarelix

J9155

Halaven®

eribulin

J9179

Lucentis®

ranibizumab

J2778

Lupron Depot®

leuprolide acetate (for depot suspension)

J1950

Macugen®

pegaptanib sodium

J2503

Monovisc®

high molecular weight hyaluronan injection

J7327

Myobloc®

rimabotulinumtoxinb

J0587

PemfexyTM

pemetrexed

J9304

Orthovisc®

hyaluronic acid

J7324

Supprelin LA®

histrelin

J9226

Synvisc®/Synvisc-One®

hylan G-F 20

J7325

Trelstar®

triptorelin pamoate

J3315

Triptodur®

triptorelin

J3316

Vantas®

histrelin acetate

J9225

Xeomin®

incobotulinumtoxina

J0588

Zolodex®

goserelin acetate implant

J9202

Fensolvi and Pemfexy are effective 7/12/2021 as part of this program