Drugs & Biologicals: Self-Administered Drug Exclusions

Drugs and Biologicals furnished incident to a Physician's service and subject to the Medicare Self-Administered Drug Exclusion

The list published here will be updated continuously, as soon as new determinations are available.
Only those drugs and biologicals which are determined to be "usually self-administered by the patient", and therefore not eligible for Medicare coverage, will be listed.

Generic Name	Brand Names (Include, but are not limited to listed)	HCPC Codes	Rationale	Date of Notice	Effective Date	Revision/ Updates	Other
Alprostadil	Caverject, Edex, Muse	J0270, J0275	Intracavernosal or intraurethral by patient, up to 3 times/week Apparent on Face / Local Utilization Data	01/27/2003	03/13/2003
Calcitonin	Miacalcin, Calcimar	J0630	Subcutaneous injection or nasal spray by patient every day or every other day for prolonged period Frequent Use for Chronic Conditions	01/27/2003	03/13/2003
Etanercept	Enbrel	J1438	Subcutaneous injection by patient, twice/week for prolonged period Frequent Use for Chronic Condition	01/27/2003	03/13/2003
Insulin	Regular, NPH, Lente, Ultralente, Lispro, Humalog, etc.	J1815, J1817	Subcutaneous injection by patient once or more daily for prolonged period Frequent Use for Chronic Conditions	01/27/2003	03/13/2003
Interferon alpha-2a, recombinant	Roferon-A	J9213	Subcutaneous or intramuscular injection by patient, several times/week for prolonged period Frequent Use for Chronic Conditions / Local Utilization Data	01/27/2003	03/13/2003
Interferon alpha-2b, recombinant	Intron-A	J9214	Subcutaneous injection by patient, several times/week for prolonged period Frequent Use for Chronic Conditions / Local Utilization Data	01/27/2003	03/13/2003	05/13/2003 New data, discussion with CMS, Not usually self-administered, eligible for coverage as of 05/13/2003
Interferon beta-1b	Betaseron	J1830	Subcutaneous injection by patient, every other day for prolonged period Frequent Use for Chronic Conditions	01/27/2003	03/13/2003
Interferon gamma-1b	Actimmune	J9216	Subcutaneous injection by patient, every other day for prolonged period Frequent Use for Chronic Conditions	01/27/2003	03/13/2003
Liver derivative complex	Kutapressin	J1910	Daily subcutaneous or intramuscular injection by patient for prolonged period Frequent Use for Chronic Conditions code deleted - 1/1/2004	01/27/2003	03/13/2003
Somatrem, Somatropin	Protopin, Genotropin, Humatrope, Norditropin, Nutropin, Saizen, Serostim	J2940, J2941	Subcutaneous injection by patient, several times/week for prolonged period Frequent Use for Chronic Conditions	01/27/2003	03/13/2003
Sumatriptan	Imitrex	J3030	Subcutaneous injection by patient at onset of symptoms, up to twice in a 24 hour period Apparent on Face	01/27/2003	03/13/2003
Teriparatide	Forteo	J3110	Subcutaneous injection by patient, daily for prolonged period (up to 2 years); Frequent Use for Chronic Conditions	07/28/2003	09/11/2003

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