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P F
Aug 1, 2020

Codes added to Medicare MDR 10/1/20

The following codes are being added to Medicare MDR with a 10/1/20 effective date (effective 10/1/20 will require Prior Authorization through Prime).

Code
Brand Name
Generic Name
C9061
Tepessa
teprotumumab
C9063
Vyepti
eptinezumab
J0223
Givlaari
givosiran
J0791
Adakveo
crizanlizumab
J0896
Reblozyl
luspatercept
J1429
Vyondis
golodirsen
J1558
Xembify
immune globulin
J3399
Zolgensma
onasemnogene
J9177
Padcev
enfortumab
J9358
Enhertu
trastuzumab/dexruxtecan
Q5121
Avsola
infliximab axxq