IMPORTANT: THIS DOCUMENT CONTAINS
OUTDATED INFORMATION.
Content provided on this page contains outdated information and instruction
and should not be considered current. CGS is providing this archived information
for research purposes only. This archived section contains previously issued
instructions that have since been updated or are no longer applicable for Medicare
billing purposes. To view all current Part B Medicare news, articles, and information, please visit our Part B site.
August 28, 2008
CIGNA Medicare Part B Carrier for Idaho, North Carolina, and Tennessee Usually Self Administered Drug Report 08/21/2008
| HCPCS | Descriptor | Effective Date of Exclusion | End Date of Exclusion | Comments |
|---|---|---|---|---|
| J0135 | Adalimumab (Humira) (Effective 01/01/05 bill under J0135, previously billed under J3490 - no change to coverage) | 09/21/2003 | N/A | Apparent on its face/USA/SC every other week |
| J0270 | Alprostadil (Caverject, Prostaglandins, Muse) | 01/01/1997 | N/A | Apparent on its face/USA/ Intracavernosal or Intraurethral/ Use as Needed |
| J0364 | Apomorphine Hydrochloride (Apokyn) New code for 2007 | 01/01/2007 | N/A | Frequency/Apparent on its face/USA/ SC Daily |
| J3490 | Becaplerim, a self-administered, non-autologous growth factor for chronic, nonhealing, subcutaneous wounds, is nationally non-covered. | 04/27/2006 | N/A | Based on CMS National Coverage Decisions Manual 100-03 section 270.3. |
| J0630 | Calcitonin Salmon | 01/01/1982 | N/A | Frequency/Apparent on its face/USA/ SC as needed |
| J3490 | Chorionic Gonadotropin Alfa, Recombinant (Ovidrel) | 01/01/2008 | N/A | Administered SC by the patient, based on labeled instruction from manufacturer |
| J1324 | Enfuvirtide (Fuzeon) New code for 2007 | 01/01/2007 | N/A | Frequency/Apparent on its face/USA/SC twice daily |
| J1438 | Etanercept (Enbrel) | 01/01/2003 | N/A | Apparent on its face/USA/SC twice a week |
| J1595 | Glatiramer Acetate (Copaxone) (previously billed under code Q2010, this code has been deleted - no change to coverage) | 01/01/2003 | N/A | Frequency/Apparent on its face/USA/ SC Daily |
| J1675 | Histrelin Acetate (effective 01/01/06 use J1675 - previously billed under HCPCS Q2020 - no change to coverage) | 01/01/2000 | N/A | Frequency/Apparent on its face/USA/ SC Daily |
| J1815 | Insulin | 01/01/2003 | N/A | Frequency/Apparent on its face/USA/ SC/Daily |
| J1817 | Insulin | 01/01/2003 | N/A | Frequency/Apparent on its face/USA/ SC/Daily |
| J3490 | Kutapressin (previously billed under code J1910, this code has been deleted) | 01/01/2003 | N/A | Frequency/USA/ SC or IM Daily |
| J9218 | Leuprolide Acetate Injection - 1 mg. daily subcutaneous | 01/01/1990 | N/A | Frequency/Apparent on its face/USA/ SC Daily |
| J2170 | Mecasermin (Increlex or Iplex) New code for 2007 | 01/01/2007 | N/A | Frequency/Apparent on its face/USA/SC Daily |
| J3490 | Pegvisomant for injection (Somavert) | 07/20/2003 | N/A | Frequency/Apparent on its face/USA/SC Daily |
| J2940 | Somatrem | 01/01/2003 | N/A | Frequency/Apparent on its face/USA/ SC or IM Daily |
| J2941 | Somatropin, Inj. (Genotropin, Humatrope, Norditropin, Nutropin AQ, Saizen, Serostim are all SC {Daily or 3 times weekly} and Nutropin Depot once monthly or twice monthly on same days {i.e., 1st & 15th}) | 01/01/2003 | N/A | Apparent on its face/Frequency/USA/SC Daily/SC or IM 3 times weekly |
| J3030 | Sumatriptan Succinate | 01/01/1995 | N/A | Apparent on its face/USA/SC as needed |
| J3110 | Teriparatide (Forteo) (effective 01/01/05 use J3110 - previously billed under HCPCS J3490 - no change to coverage) | 07/20/2003 | N/A | Frequency/Apparent on its face/USA/SC Daily |
Contractors must provide notice 45 days prior to the date a drug will be excluded/not covered. During the 45 day time period, contractors will maintain existing medical review and payment procedures. See our website http://www.cignagovernmentservices.com/partb/pubs/news/2002/1002/ws0351.html for more information on the determination process.
Comment Period: N/A Reviewed only no changes made as of 08/21/2008
Update Effective: 01/01/2008
