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, which is organized alphabetically by brand name, was last revised on September 25, 2023..
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(s) |
NDC |
Alimta® |
pemetrexed |
J9305 |
|
Beovu® |
brolucizumab-dbll |
J0179 |
|
Botox® |
onabotulinumtoxina |
J0585 |
|
Byooviz™ |
ranibizumab-nuna |
Q5124 |
|
Camcevi™ |
leuprolide |
J1952 |
|
Cimerli™ |
ranibizumab-eqrn |
Q5128 |
|
Dextenza® |
dexamethasone ophthalmic insert |
J1096 |
|
Durysta Implant® |
bimatoprost implant |
J7351 |
|
Dysport® |
abobotulinumtoxina |
J0586 |
|
Eligard® |
leuprolide acetate (for depot suspension) |
J9217 |
|
Emend® |
fosaprepitant |
J1453 |
|
Euflexxa® |
1% sodium hyaluronate |
J7323 |
|
Eylea® |
aflibercept |
J0178 |
|
Faslodex® |
fulvestrant |
J9395, J9393 |
|
Fensolvi® |
leuprolide acetate (for depot suspension) |
J1951 |
|
Firmagon® |
degarelix |
J9155 |
|
Fosaprepitant (generic mfd. by Teva) |
fosaprepitant |
J1456 |
|
Fulvestrant (generic mfd. by Teva) |
fulvestrant (Teva) |
J9393 |
|
Granix® |
bo-filgrastim |
J1447 |
|
Halaven® |
eribulin |
J9179 |
|
Ilaris® |
canakinumab |
J0638 |
|
Iluvien® |
fluocinonide acetonide intravitreal implant |
J7313 |
|
Lucentis® |
ranibizumab |
J2778 |
|
Lupron Depot® |
leuprolide acetate (for depot suspension) |
J1950 |
|
Lutrate Depot |
leuprolide acetate (for depot suspension) |
J1954 |
|
Macugen® |
pegaptanib sodium |
J2503 |
|
Monovisc® |
high molecular weight hyaluronan injection |
J7327 |
|
Myobloc® |
rimabotulinumtoxinb |
J0587 |
|
Orthovisc® |
hyaluronic acid |
J7324 |
|
Ozurdex® |
dexamethasone intravitreal implant |
J7312 |
|
Pemetrexed (generic mfd by Accord) |
pemetrexed (Accord) |
J9296 |
|
Pemetrexed (generic mfd. by Bluepoint) |
pemetrexed (Bluepoint) |
J9322 |
|
Pemetrexed (generic mfd. by Hospira) |
pemetrexed (Hospira) |
J9294 |
|
Pemetrexed (generic mfd. by Sandoz) |
pemetrexed (Sandoz) |
J9297 |
|
Pemetrexed-ditromethamine (generic mfd. by Hospira) |
pemetrexed-ditromethamine (Hospira) |
J9323 |
|
Retisert® |
fluocinonide acetonide intravitreal implant |
J7311 |
|
Rystiggo® |
rozanolixizumab-noli |
J3590 |
50474-980-79 |
Sunlenca® |
lenacapavir |
J1961 |
|
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 |
|
Xiaflex® |
Collagenase clostridium histolyticum |
J0775 |
|
Xipere™ |
Triamcinolone acetonide injectable suspension |
J3299 |
|
Velcade® |
bortezomib |
J9041 |
|
Yutiq® |
fluocinonide acetonide intravitreal implant |
J7314 |
|
Zarxio® |
filgrastim-sndz |
Q5101 |
|
Zolodex® |
goserelin acetate implant |
J9202 |
Recent/Upcoming program changes:
- Effective October 1, 2023 Granix and Zarxio will be reviewed as part of this program
- Effective September 25,2023, Sunlenca will be reviewed as part of this program
- Effective September 28, 2023, Velcade will be reviewed as part of this program.
- Effective September 28, 2023, MRxM will perform Medical Necessity and Appropriateness Review (MNAR) of Pemfexy.
- Effective September 22, 2023, Rystiggo will be reviewed as part of this program.
- Effective July 14, 2023, pemetrexed (mfd. by Bluepoint), pemetrexed (mfd. By Shilpa) and pemetrexed-ditromethamine (mfd. by Hospira) will also be reviewed as part of this program.
- Effective June 18, 2023, Cimerli, generic pemetrexed (mfd. by Hospira), generic pemetrexed (mfd. by Accord) and generic pemetrexed (mfd. by Sandoz) will also be reviewed as part of this program.
- Effective January 1, 2023, generic fosaprepitant (mfd. by Teva), generic fosaprepitant (mfd. by Teva) and Lutrate Depot will also be reviewed as part of this program.