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