Provider Alert! UPDATED: Latest JW-Modifier list for medical drugs (CADs)

Provider Alert!
25Jan

Provider Alert! UPDATED: Latest JW-Modifier list for medical drugs (CADs)

By OB/GYNs, Office Managers, Primary Care Providers, Provider Alert, Specialists , , , 0 Comments

Date: January 24, 2023

Attention: All Providers

Effective date: January 1, 2023

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action: The JW modifier is a Healthcare Common Procedure Coding System (HCPCS) modifier required to be reported on a claim to account for the amount of a drug that is discarded and eligible for payment. The modifier should only be used for claims that bill single-dose container drugs.

How this impacts providers: Provider reporting guidance:

  • Providers are required to report the JW modifier on all claims that bill for drugs and biological drugs separately payable under Medicaid. This includes unused and discarded amounts from single-dose containers or single- use packages/single-dose containers.
  • Providers must also document the amount of discarded drugs in the members’ medical records. Payers will use the JW modifiers to calculate discarded drug refunds.

Action providers must take: Providers and their billing offices/personnel should be aware of the most recent changes to the approved list of HCPCS codes eligible for JW-modifier billing. Failure to adhere to the list may result in potential waste/abuse investigations.

Summary of changes:

HCPCS CodeHCPCS Short DescriptionStart DateEnd DateStatus
90281HUMAN IG, IM09/01/202001/15/4000Deleted
90283HUMAN IG, IV09/01/202001/15/4000Deleted
90396VARICELLA-ZOSTER IG, IM09/01/202001/15/4000Deleted
C9094INJ, SUTIMLIMAB-JOME, 10 MG07/01/202201/15/4000Deleted
C9095INJ, TEBENTAFUSP-TEBN, 1 MCG07/01/202201/15/4000Deleted
C9096INJ, RELEUKO, 1 MCG07/01/202201/15/4000Deleted
J0220ALGLUCOSIDASE ALFA INJECTION09/01/202001/15/4000Deleted
J1130INJ DICLOFENAC SODIUM 0.5MG09/01/202001/15/4000Deleted
J2941SOMATROPIN INJECTION09/01/202001/15/4000Deleted
J3365UROKINASE 250,000 IU INJ09/01/202001/15/4000Deleted
C9142 INJ, ALYMSYS, 10 MG10/01/202212/31/3999New
J1302 INJ, SUTIMLIMAB-JOME, 10 MG10/01/202212/31/3999New
J2020 INJECTION, LINEZOLID, 200 MG09/01/202012/31/3999New
J9274 INJ, TEBENTAFUSP-TEBN, 1 MCG10/01/202212/31/3999New

All coding information:

HCPCS CodeHCPCS Short DescriptionStart DateEnd DateStatus
90284HUMAN IG, SC09/01/202012/31/3999No Changes
90291CMV IG, IV09/01/202012/31/3999No Changes
90371HEP B IG, IM09/01/202012/31/3999No Changes
90376RABIES IG, HEAT TREATED09/01/202012/31/3999No Changes
90377RABIES IG HT&SOL HUMAN IM/SC01/01/202112/31/3999No Changes
C9142 INJ, ALYMSYS, 10 MG10/01/202212/31/3999New
C9257 BEVACIZUMAB INJECTION09/01/202012/31/3999No Changes
J0122 INJ., ERAVACYCLINE, 1 MG09/01/202012/31/3999No Changes
J0129 ABATACEPT INJECTION09/01/202012/31/3999No Changes
J0132 ACETYLCYSTEINE INJECTION09/01/202012/31/3999No Changes
J0133 ACYCLOVIR INJECTION09/01/202012/31/3999No Changes
J0171 ADRENALIN EPINEPHRINE INJECT09/01/202012/31/3999No Changes
J0172 INJ, ADUCANUMAB-AVWA, 2 MG01/01/202212/31/3999No Changes
J0180 AGALSIDASE BETA INJECTION09/01/202012/31/3999No Changes
J0207 AMIFOSTINE09/01/202012/31/3999No Changes
J0219 INJ AVAL ALFA-NQPT 4MG04/01/202212/31/3999No Changes
J0221 LUMIZYME INJECTION09/01/202012/31/3999No Changes
J0222 INJ., PATISIRAN, 0.1 MG09/01/202012/31/3999No Changes
J0223 INJ GIVOSIRAN 0.5 MG09/01/202012/31/3999No Changes
J0224 INJ. LUMASIRAN, 0.5 MG07/01/202112/31/3999No Changes
J0256 ALPHA 1 PROTEINASE INHIBITOR09/01/202012/31/3999No Changes
J0257 GLASSIA INJECTION09/01/202012/31/3999No Changes
J0278 AMIKACIN SULFATE INJECTION09/01/202012/31/3999No Changes
J0278 AMIKACIN SULFATE INJECTION09/01/202012/31/3999No Changes
J0280 AMINOPHYLLIN 250 MG INJ09/01/202012/31/3999No Changes
J0282 AMIODARONE HCL09/01/202012/31/3999No Changes
J0285 AMPHOTERICIN B09/01/202012/31/3999No Changes
J0287 AMPHOTERICIN B LIPID COMPLEX09/01/202012/31/3999No Changes
J0289 AMPHOTERICIN B LIPOSOME INJ09/01/202012/31/3999No Changes
J0290 AMPICILLIN 500 MG INJ09/01/202012/31/3999No Changes
J0291 INJ., PLAZOMICIN, 5 MG09/01/202012/31/3999No Changes
J0300 AMOBARBITAL 125 MG INJ09/01/202012/31/3999No Changes
J0330 SUCCINYCHOLINE CHLORIDE INJ09/01/202012/31/3999No Changes
J0360 HYDRALAZINE HCL INJECTION09/01/202012/31/3999No Changes
J0401 INJ ARIPIPRAZOLE EXT REL 1MG09/01/202012/31/3999No Changes
J0461 ATROPINE SULFATE INJECTION09/01/202012/31/3999No Changes
J0470 DIMECAPROL INJECTION09/01/202012/31/3999No Changes
J0475 BACLOFEN 10 MG INJECTION09/01/202012/31/3999No Changes
J0485 BELATACEPT INJECTION09/01/202012/31/3999No Changes
J0490 BELIMUMAB INJECTION09/01/202012/31/3999No Changes
J0500 DICYCLOMINE INJECTION09/01/202012/31/3999No Changes
J0515 INJ BENZTROPINE MESYLATE09/01/202012/31/3999No Changes
J0517 INJ., BENRALIZUMAB, 1 MG09/01/202012/31/3999No Changes
J0558 PENG BENZATHINE/PROCAINE INJ09/01/202012/31/3999No Changes
J0561 PENICILLIN G BENZATHINE INJ09/01/202012/31/3999No Changes
J0565 INJ, BEZLOTOXUMAB, 10 MG09/01/202012/31/3999No Changes
J0583 BIVALIRUDIN09/01/202012/31/3999No Changes
J0585 INJECTION,ONABOTULINUMTOXINA09/01/202012/31/3999No Changes
J0586 ABOBOTULINUMTOXINA09/01/202012/31/3999No Changes
J0587 INJ, RIMABOTULINUMTOXINB09/01/202012/31/3999No Changes
J0588 INCOBOTULINUMTOXIN A09/01/202012/31/3999No Changes
J0592 BUPRENORPHINE HYDROCHLORIDE09/01/202012/31/3999No Changes
J0594 BUSULFAN INJECTION09/01/202012/31/3999No Changes
J0596 INJECTION, RUCONEST09/01/202012/31/3999No Changes
J0599 INJ., HAEGARDA 10 UNITS09/01/202012/31/3999No Changes
J0600 EDETATE CALCIUM DISODIUM INJ09/01/202012/31/3999No Changes
J0610 CALCIUM GLUCONATE INJECTION09/01/202012/31/3999No Changes
J0636 INJ CALCITRIOL PER 0.1 MCG09/01/202012/31/3999No Changes
J0637 CASPOFUNGIN ACETATE09/01/202012/31/3999No Changes
J0638 CANAKINUMAB INJECTION09/01/202012/31/3999No Changes
J0640 LEUCOVORIN CALCIUM INJECTION09/01/202012/31/3999No Changes
J0641 INJ., LEVOLEUCOVORIN, 0.5 MG09/01/202012/31/3999No Changes
J0670 INJ MEPIVACAINE HCL/10 ML09/01/202012/31/3999No Changes
J0692 CEFEPIME HCL FOR INJECTION09/01/202012/31/3999No Changes
J0694 CEFOXITIN SODIUM INJECTION09/01/202012/31/3999No Changes
J0696 CEFTRIAXONE SODIUM INJECTION09/01/202012/31/3999No Changes
J0698 CEFOTAXIME SODIUM INJECTION09/01/202012/31/3999No Changes
J0706 CAFFEINE CITRATE INJECTION09/01/202012/31/3999No Changes
J0713 INJ CEFTAZIDIME PER 500 MG09/01/202012/31/3999No Changes
J0720 CHLORAMPHENICOL SODIUM INJEC09/01/202012/31/3999No Changes
J0725 CHORIONIC GONADOTROPIN/1000U09/01/202012/31/3999No Changes
J0735 CLONIDINE HYDROCHLORIDE09/01/202012/31/3999No Changes
J0740 CIDOFOVIR INJECTION09/01/202012/31/3999No Changes
J0770 COLISTIMETHATE SODIUM INJ09/01/202012/31/3999No Changes
J0780 PROCHLORPERAZINE INJECTION09/01/202012/31/3999No Changes
J0791 INJ CRIZANLIZUMAB-TMCA 5MG09/01/202012/31/3999No Changes
J0795 CORTICORELIN OVINE TRIFLUTAL09/01/202012/31/3999No Changes
J0800 CORTICOTROPIN INJECTION09/01/202012/31/3999No Changes
J0834 COSYNTROPIN CORTROSYN INJ09/01/202012/31/3999No Changes
J0850 CYTOMEGALOVIRUS IMM IV /VIAL09/01/202012/31/3999No Changes
J0878 DAPTOMYCIN INJECTION09/01/202012/31/3999No Changes
J0881 DARBEPOETIN ALFA, NON-ESRD09/01/202012/31/3999No Changes
J0882 DARBEPOETIN ALFA, ESRD USE09/01/202012/31/3999No Changes
J0883 ARGATROBAN NONESRD USE 1MG09/01/202012/31/3999No Changes
J0885 EPOETIN ALFA, NON-ESRD09/01/202012/31/3999No Changes
J0887 EPOETIN BETA ESRD USE09/01/202012/31/3999No Changes
J0888 EPOETIN BETA NON ESRD09/01/202012/31/3999No Changes
J0894 DECITABINE INJECTION09/01/202012/31/3999No Changes
J0896 INJ LUSPATERCEPT-AAMT 0.25MG09/01/202012/31/3999No Changes
J1000 DEPO-ESTRADIOL CYPIONATE INJ09/01/202012/31/3999No Changes
J1020 METHYLPREDNISOLONE 20 MG INJ09/01/202012/31/3999No Changes
J1030 METHYLPREDNISOLONE 40 MG INJ09/01/202012/31/3999No Changes
J1040 METHYLPREDNISOLONE 80 MG INJ09/01/202012/31/3999No Changes
J1071 INJ TESTOSTERONE CYPIONATE09/01/202012/31/3999No Changes
J1100 DEXAMETHASONE SODIUM PHOS09/01/202012/31/3999No Changes
J1120 ACETAZOLAMID SODIUM INJECTIO09/01/202012/31/3999No Changes
J1160 DIGOXIN INJECTION09/01/202012/31/3999No Changes
J1165 PHENYTOIN SODIUM INJECTION09/01/202012/31/3999No Changes
J1170 HYDROMORPHONE INJECTION09/01/202012/31/3999No Changes
J1190 DEXRAZOXANE HCL INJECTION09/01/202012/31/3999No Changes
J1200 DIPHENHYDRAMINE HCL INJECTIO09/01/202012/31/3999No Changes
J1201 INJ. CETIRIZINE HCL 0.5MG09/01/202012/31/3999No Changes
J1205 CHLOROTHIAZIDE SODIUM INJ09/01/202012/31/3999No Changes
J1212 DIMETHYL SULFOXIDE 50% 50 ML09/01/202012/31/3999No Changes
J1230 METHADONE INJECTION09/01/202012/31/3999No Changes
J1240 DIMENHYDRINATE INJECTION09/01/202012/31/3999No Changes
J1245 DIPYRIDAMOLE INJECTION09/01/202012/31/3999No Changes
J1250 INJ DOBUTAMINE HCL/250 MG09/01/202012/31/3999No Changes
J1265 DOPAMINE INJECTION09/01/202012/31/3999No Changes
J1267 DORIPENEM INJECTION09/01/202012/31/3999No Changes
J1270 INJECTION, DOXERCALCIFEROL, 1 MCG09/01/202012/31/3999No Changes
J1302 INJ, SUTIMLIMAB-JOME, 10 MG10/01/202212/31/3999New
J1305 INJ, EVINACUMAB-DGNB, 5MG10/01/202112/31/3999No Changes
J1322 ELOSULFASE ALFA, INJECTION09/01/202012/31/3999No Changes
J1324 ENFUVIRTIDE INJECTION09/01/202012/31/3999No Changes
J1325 EPOPROSTENOL INJECTION09/01/202012/31/3999No Changes
J1327 EPTIFIBATIDE INJECTION09/01/202012/31/3999No Changes
J1335 ERTAPENEM INJECTION09/01/202012/31/3999No Changes
J1364 ERYTHRO LACTOBIONATE /500 MG09/01/202012/31/3999No Changes
J1410 INJ ESTROGEN CONJUGATE 25 MG09/01/202012/31/3999No Changes
J1426 INJECTION, CASIMERSEN, 10 MG10/01/202112/31/3999No Changes
J1427 INJ. VILTOLARSEN04/01/202112/31/3999No Changes
J1428 INJ, ETEPLIRSEN, 10 MG09/01/202012/31/3999No Changes
J1429 INJ GOLODIRSEN 10 MG09/01/202012/31/3999No Changes
J1437 INJ. FE DERISOMALTOSE 10 MG04/01/202112/31/3999No Changes
J1438 ETANERCEPT INJECTION09/01/202012/31/3999No Changes
J1439 INJ FERRIC CARBOXYMALTOS 1MG09/01/202012/31/3999No Changes
J1442 INJ, FILGRASTIM G-CSF 1MCG09/01/202012/31/3999No Changes
J1447 INJ TBO FILGRASTIM 1 MICROG09/01/202012/31/3999No Changes
J1448 INJECTION, TRILACICLIB, 1MG10/01/202112/31/3999No Changes
J1450 FLUCONAZOLE09/01/202012/31/3999No Changes
J1451 FOMEPIZOLE, 15 MG09/01/202012/31/3999No Changes
J1458 GALSULFASE INJECTION09/01/202012/31/3999No Changes
J1459 INJ IVIG PRIVIGEN 500 MG09/01/202012/31/3999No Changes
J1460 GAMMA GLOBULIN 1 CC INJ09/01/202012/31/3999No Changes
J1551 INJ CUTAQUIG 100 MG07/01/202212/31/3999No Changes
J1554 INJ. ASCENIV04/01/202112/31/3999No Changes
J1555 INJ CUVITRU, 100 MG09/01/202012/31/3999No Changes
J1556 INJ, IMM GLOB BIVIGAM, 500MG09/01/202012/31/3999No Changes
J1557 GAMMAPLEX INJECTION09/01/202012/31/3999No Changes
J1559 HIZENTRA INJECTION09/01/202012/31/3999No Changes
J1561 GAMUNEX-C/GAMMAKED09/01/202012/31/3999No Changes
J1566 IMMUNE GLOBULIN, POWDER09/01/202012/31/3999No Changes
J1568 OCTAGAM INJECTION09/01/202012/31/3999No Changes
J1569 GAMMAGARD LIQUID INJECTION09/01/202012/31/3999No Changes
J1570 GANCICLOVIR SODIUM INJECTION09/01/202012/31/3999No Changes
J1571 HEPAGAM B IM INJECTION09/01/202012/31/3999No Changes
J1572 FLEBOGAMMA INJECTION09/01/202012/31/3999No Changes
J1573 HEPAGAM B INTRAVENOUS, INJ09/01/202012/31/3999No Changes
J1575 HYQVIA 100MG IMMUNOGLOBULIN09/01/202012/31/3999No Changes
J1580 GARAMYCIN GENTAMICIN INJ09/01/202012/31/3999No Changes
J1602 GOLIMUMAB FOR IV USE 1MG09/01/202012/31/3999No Changes
J1610 GLUCAGON HYDROCHLORIDE/1 MG09/01/202012/31/3999No Changes
J1626 GRANISETRON HCL INJECTION09/01/202012/31/3999No Changes
J1627 INJ, GRANISETRON, XR, 0.1 MG09/01/202012/31/3999No Changes
J1630 HALOPERIDOL INJECTION09/01/202012/31/3999No Changes
J1631 HALOPERIDOL DECANOATE INJ09/01/202012/31/3999No Changes
J1632 INJ., BREXANOLONE, 1 MG10/01/202012/31/3999No Changes
J1640 HEMIN, 1 MG09/01/202012/31/3999No Changes
J1642 INJ HEPARIN SODIUM PER 10 U09/01/202012/31/3999No Changes
J1644 INJ HEPARIN SODIUM PER 1000U09/01/202012/31/3999No Changes
J1645 DALTEPARIN SODIUM09/01/202012/31/3999No Changes
J1650 INJ ENOXAPARIN SODIUM09/01/202012/31/3999No Changes
J1652 FONDAPARINUX SODIUM09/01/202012/31/3999No Changes
J1670 TETANUS IMMUNE GLOBULIN INJ09/01/202012/31/3999No Changes
J1720 HYDROCORTISONE SODIUM SUCC I09/01/202012/31/3999No Changes
J1741 IBUPROFEN INJECTION09/01/202012/31/3999No Changes
J1742 IBUTILIDE FUMARATE INJECTION09/01/202012/31/3999No Changes
J1743 IDURSULFASE INJECTION09/01/202012/31/3999No Changes
J1745 INFLIXIMAB INJECTION09/01/202012/31/3999No Changes
J1750 INJ IRON DEXTRAN09/01/202012/31/3999No Changes
J1756 IRON SUCROSE INJECTION09/01/202012/31/3999No Changes
J1786 IMUGLUCERASE INJECTION09/01/202012/31/3999No Changes
J1790 DROPERIDOL INJECTION09/01/202012/31/3999No Changes
J1800 PROPRANOLOL INJECTION09/01/202012/31/3999No Changes
J1826 INTERFERON BETA-1A INJ09/01/202012/31/3999No Changes
J1830 INTERFERON BETA-1B / .25 MG09/01/202012/31/3999No Changes
J1885 KETOROLAC TROMETHAMINE INJ09/01/202012/31/3999No Changes
J1931 LARONIDASE INJECTION09/01/202012/31/3999No Changes
J1940 FUROSEMIDE INJECTION09/01/202012/31/3999No Changes
J1943 INJ., ARISTADA INITIO, 1 MG09/01/202012/31/3999No Changes
J1944 ARIPIRAZOLE LAUROXIL 1 MG09/01/202012/31/3999No Changes
J1953 LEVETIRACETAM INJECTION09/01/202012/31/3999No Changes
J1955 INJ LEVOCARNITINE PER 1 GM09/01/202012/31/3999No Changes
J1956 LEVOFLOXACIN INJECTION09/01/202012/31/3999No Changes
J1956 LEVOFLOXACIN INJECTION09/01/202012/31/3999No Changes
J1980 HYOSCYAMINE SULFATE INJ09/01/202012/31/3999No Changes
J2010 LINCOMYCIN INJECTION09/01/202012/31/3999No Changes
J2020 INJECTION, LINEZOLID, 200 MG09/01/202012/31/3999New
J2060 LORAZEPAM INJECTION09/01/202012/31/3999No Changes
J2150 MANNITOL INJECTION09/01/202012/31/3999No Changes
J2175 MEPERIDINE HYDROCHL /100 MG09/01/202012/31/3999No Changes
J2248 MICAFUNGIN SODIUM INJECTION09/01/202012/31/3999No Changes
J2250 INJ MIDAZOLAM HYDROCHLORIDE09/01/202012/31/3999No Changes
J2260 INJ MILRINONE LACTATE / 5 ML09/01/202012/31/3999No Changes
J2270 MORPHINE SULFATE INJECTION09/01/202012/31/3999No Changes
J2300 INJ NALBUPHINE HYDROCHLORIDE09/01/202012/31/3999No Changes
J2310 INJ NALOXONE HYDROCHLORIDE09/01/202012/31/3999No Changes
J2355 OPRELVEKIN INJECTION09/01/202012/31/3999No Changes
J2400 CHLOROPROCAINE HCL INJECTION09/01/202012/31/3999No Changes
J2405 ONDANSETRON HCL INJECTION09/01/202012/31/3999No Changes
J2425 PALIFERMIN INJECTION09/01/202012/31/3999No Changes
J2501 PARICALCITOL09/01/202012/31/3999No Changes
J2504 PEGADEMASE BOVINE, 25 IU09/01/202012/31/3999No Changes
J2550 PROMETHAZINE HCL INJECTION09/01/202012/31/3999No Changes
J2560 PHENOBARBITAL SODIUM INJ09/01/202012/31/3999No Changes
J2562 PLERIXAFOR INJECTION09/01/202012/31/3999No Changes
J2597 INJ DESMOPRESSIN ACETATE09/01/202012/31/3999No Changes
J2690 PROCAINAMIDE HCL INJECTION09/01/202012/31/3999No Changes
J2710 NEOSTIGMINE METHYLSLFTE INJ09/01/202012/31/3999No Changes
J2724 PROTEIN C CONCENTRATE09/01/202012/31/3999No Changes
J2765 METOCLOPRAMIDE HCL INJECTION09/01/202012/31/3999No Changes
J2770 QUINUPRISTIN/DALFOPRISTIN09/01/202012/31/3999No Changes
J2780 RANITIDINE HYDROCHLORIDE INJ09/01/202012/31/3999No Changes
J2786 INJECTION, RESLIZUMAB, 1MG09/01/202012/31/3999No Changes
J2788 RHO D IMMUNE GLOBULIN 50 MCG09/01/202012/31/3999No Changes
J2790 RHO D IMMUNE GLOBULIN INJ09/01/202012/31/3999No Changes
J2791 RHOPHYLAC INJECTION09/01/202012/31/3999No Changes
J2792 RHO(D) IMMUNE GLOBULIN H, SD09/01/202012/31/3999No Changes
J2796 ROMIPLOSTIM INJECTION09/01/202012/31/3999No Changes
J2820 SARGRAMOSTIM INJECTION09/01/202012/31/3999No Changes
J2840 INJ SEBELIPASE ALFA 1 MG09/01/202012/31/3999No Changes
J2920 METHYLPREDNISOLONE INJECTION09/01/202012/31/3999No Changes
J2930 METHYLPREDNISOLONE INJECTION09/01/202012/31/3999No Changes
J2997 ALTEPLASE RECOMBINANT09/01/202012/31/3999No Changes
J2998 INJ PLASMINOGEN TVMH 1MG07/01/202212/31/3999No Changes
J3000 STREPTOMYCIN INJECTION09/01/202012/31/3999No Changes
J3000 STREPTOMYCIN INJECTION09/01/202012/31/3999No Changes
J3010 FENTANYL CITRATE INJECTION09/01/202012/31/3999No Changes
J3030 SUMATRIPTAN SUCCINATE / 6 MG09/01/202012/31/3999No Changes
J3060 INJ, TALIGLUCERACE ALFA 10 U09/01/202012/31/3999No Changes
J3070 PENTAZOCINE HCL INJECTION09/01/202012/31/3999No Changes
J3095 TELEVANCIN INJECTION09/01/202012/31/3999No Changes
J3101 TENECTEPLASE INJECTION09/01/202012/31/3999No Changes
J3105 TERBUTALINE SULFATE INJ09/01/202012/31/3999No Changes
J3121 INJ TESTOSTERO ENANTHATE 1MG09/01/202012/31/3999No Changes
J3145 TESTOSTERONE UNDECANOATE 1MG09/01/202012/31/3999No Changes
J3230 CHLORPROMAZINE HCL INJECTION09/01/202012/31/3999No Changes
J3240 THYROTROPIN INJECTION09/01/202012/31/3999No Changes
J3241 INJ. TEPROTUMUMAB-TRBW 10 MG10/01/202012/31/3999No Changes
J3243 TIGECYCLINE INJECTION09/01/202012/31/3999No Changes
J3250 TRIMETHOBENZAMIDE HCL INJ09/01/202012/31/3999No Changes
J3260 TOBRAMYCIN SULFATE INJECTION09/01/202012/31/3999No Changes
J3262 TOCILIZUMAB INJECTION09/01/202012/31/3999No Changes
J3285 TREPROSTINIL INJECTION09/01/202012/31/3999No Changes
J3300 TRIAMCINOLONE A INJ PRS-FREE09/01/202012/31/3999No Changes
J3301 TRIAMCINOLONE ACET INJ NOS09/01/202012/31/3999No Changes
J3303 TRIAMCINOLONE HEXACETONL INJ09/01/202012/31/3999No Changes
J3304 INJ TRIAMCINOLONE ACE XR 1MG09/01/202012/31/3999No Changes
J3360 DIAZEPAM INJECTION09/01/202012/31/3999No Changes
J3370 VANCOMYCIN HCL INJECTION09/01/202012/31/3999No Changes
J3385 VELAGLUCERASE ALFA09/01/202012/31/3999No Changes
J3396 VERTEPORFIN INJECTION09/01/202012/31/3999No Changes
J3397 INJ., VESTRONIDASE ALFA-VJBK09/01/202012/31/3999No Changes
J3398 INJ LUXTURNA 1 BILLION VEC G09/01/202012/31/3999No Changes
J3410 HYDROXYZINE HCL INJECTION09/01/202012/31/3999No Changes
J3411 THIAMINE HCL 100 MG09/01/202012/31/3999No Changes
J3415 PYRIDOXINE HCL 100 MG09/01/202012/31/3999No Changes
J3420 VITAMIN B12 INJECTION09/01/202012/31/3999No Changes
J3430 VITAMIN K PHYTONADIONE INJ09/01/202012/31/3999No Changes
J3465 INJECTION, VORICONAZOLE09/01/202012/31/3999No Changes
J3470 HYALURONIDASE INJECTION09/01/202012/31/3999No Changes
J3471 OVINE, UP TO 999 USP UNITS09/01/202012/31/3999No Changes
J3472 OVINE, 1000 USP UNITS09/01/202012/31/3999No Changes
J3473 HYALURONIDASE RECOMBINANT09/01/202012/31/3999No Changes
J3475 INJ MAGNESIUM SULFATE09/01/202012/31/3999No Changes
J3480 INJ POTASSIUM CHLORIDE09/01/202012/31/3999No Changes
J3485 ZIDOVUDINE09/01/202012/31/3999No Changes
J3486 ZIPRASIDONE MESYLATE09/01/202012/31/3999No Changes
J7168 PROTHROMBIN COMPLEX KCENTRA07/01/202112/31/3999No Changes
J7170 INJ., EMICIZUMAB-KXWH 0.5 MG09/01/202012/31/3999No Changes
J7175 INJ, FACTOR X, (HUMAN), 1IU09/01/202012/31/3999No Changes
J7177 INJ., FIBRYGA, 1 MG09/01/202012/31/3999No Changes
J7178 HUMAN FIBRINOGEN CONC INJ09/01/202012/31/3999No Changes
J7179 VONVENDI INJ 1 IU VWF:RCO09/01/202012/31/3999No Changes
J7180 FACTOR XIII ANTI-HEM FACTOR09/01/202012/31/3999No Changes
J7181 FACTOR XIII RECOMB A-SUBUNIT09/01/202012/31/3999No Changes
J7182 FACTOR VIII RECOMB NOVOEIGHT09/01/202012/31/3999No Changes
J7183 WILATE INJECTION09/01/202012/31/3999No Changes
J7185 XYNTHA INJ09/01/202012/31/3999No Changes
J7186 ANTIHEMOPHILIC VIII/VWF COMP09/01/202012/31/3999No Changes
J7187 HUMATE-P, INJ09/01/202012/31/3999No Changes
J7188 FACTOR VIII RECOMB OBIZUR09/01/202012/31/3999No Changes
J7189 FACTOR VIIA09/01/202012/31/3999No Changes
J7190 FACTOR VIII09/01/202012/31/3999No Changes
J7192 FACTOR VIII RECOMBINANT NOS09/01/202012/31/3999No Changes
J7193 FACTOR IX NON-RECOMBINANT09/01/202012/31/3999No Changes
J7194 FACTOR IX COMPLEX09/01/202012/31/3999No Changes
J7195 FACTOR IX (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.09/01/202012/31/3999No Changes
J7196 ANTITHROMBIN RECOMBINANT09/01/202012/31/3999No Changes
J7197 ANTITHROMBIN III INJECTION09/01/202012/31/3999No Changes
J7198 ANTI-INHIBITOR09/01/202012/31/3999No Changes
J7200 FACTOR IX RECOMBINAN RIXUBIS09/01/202012/31/3999No Changes
J7201 FACTOR IX FC FUSION RECOMB09/01/202012/31/3999No Changes
J7202 FACTOR IX IDELVION INJ09/01/202012/31/3999No Changes
J7203 FACTOR IX RECOMB GLY REBINYN09/01/202012/31/3999No Changes
J7204 INJ RECOMBIN ESPEROCT PER IU09/01/202012/31/3999No Changes
J7205 FACTOR VIII FC FUSION RECOMB09/01/202012/31/3999No Changes
J7207 FACTOR VIII PEGYLATED RECOMB09/01/202012/31/3999No Changes
J7208 INJ. JIVI 1 IU09/01/202012/31/3999No Changes
J7209 FACTOR VIII NUWIQ RECOMB 1IU09/01/202012/31/3999No Changes
J7210 INJ, AFSTYLA, 1 I.U.09/01/202012/31/3999No Changes
J7211 INJ, KOVALTRY, 1 I.U.09/01/202012/31/3999No Changes
J7212 FACTOR VIIA RECOMB SEVENFACT04/01/202112/31/3999No Changes
J7501 AZATHIOPRINE PARENTERAL09/01/202012/31/3999No Changes
J7504 LYMPHOCYTE IMMUNE GLOBULIN09/01/202012/31/3999No Changes
J7511 ANTITHYMOCYTE GLOBULN RABBIT09/01/202012/31/3999No Changes
J7516 CYCLOSPORIN PARENTERAL 250MG09/01/202012/31/3999No Changes
J7525 TACROLIMUS INJECTION09/01/202012/31/3999No Changes
J9000 DOXORUBICIN HCL INJECTION09/01/202012/31/3999No Changes
J9017 ARSENIC TRIOXIDE INJECTION09/01/202012/31/3999No Changes
J9019 ERWINAZE INJECTION09/01/202012/31/3999No Changes
J9021 INJ, ASPARA, RYLAZE, 0.1 MG01/01/202212/31/3999No Changes
J9022 INJ, ATEZOLIZUMAB,10 MG09/01/202012/31/3999No Changes
J9023 INJECTION, AVELUMAB, 10 MG09/01/202012/31/3999No Changes
J9025 AZACITIDINE INJECTION09/01/202012/31/3999No Changes
J9027 CLOFARABINE INJECTION09/01/202012/31/3999No Changes
J9030 BCG LIVE INTRAVESICAL 1MG09/01/202012/31/3999No Changes
J9032 INJECTION, BELINOSTAT, 10MG09/01/202012/31/3999No Changes
J9033 BENDAMUSTINE INJECTION09/01/202012/31/3999No Changes
J9035 BEVACIZUMAB INJECTION09/01/202012/31/3999No Changes
J9037 INJ BELANTAMAB MAFODONT BLMF04/01/202112/31/3999No Changes
J9039 INJECTION, BLINATUMOMAB09/01/202012/31/3999No Changes
J9040 BLEOMYCIN SULFATE INJECTION09/01/202012/31/3999No Changes
J9041 BORTEZOMIB INJECTION09/01/202012/31/3999No Changes
J9042 BRENTUXIMAB VEDOTIN INJ09/01/202012/31/3999No Changes
J9043 CABAZITAXEL INJECTION09/01/202012/31/3999No Changes
J9044 INJ, BORTEZOMIB, NOS, 0.1 MG09/01/202012/31/3999No Changes
J9047 INJECTION, CARFILZOMIB, 1 MG09/01/202012/31/3999No Changes
J9050 CARMUSTINE INJECTION09/01/202012/31/3999No Changes
J9055 CETUXIMAB INJECTION09/01/202012/31/3999No Changes
J9065 INJ CLADRIBINE PER 1 MG09/01/202012/31/3999No Changes
J9070 CYCLOPHOSPHAMIDE 100 MG INJ09/01/202012/31/3999No Changes
J9071 INJ CYCLOPHOSPHAMD AUROMEDIC04/01/202212/31/3999No Changes
J9100 CYTARABINE HCL 100 MG INJ09/01/202012/31/3999No Changes
J9118 INJ. CALASPARGASE PEGOL-MKNL09/01/202012/31/3999No Changes
J9120 DACTINOMYCIN INJECTION09/01/202012/31/3999No Changes
J9130 DACARBAZINE 10 MG INJ09/01/202012/31/3999No Changes
J9145 INJECTION, DARATUMUMAB 10 MG09/01/202012/31/3999No Changes
J9150 DAUNORUBICIN INJECTION09/01/202012/31/3999No Changes
J9153 INJ DAUNORUBICIN, CYTARABINE09/01/202012/31/3999No Changes
J9171 DOCETAXEL INJECTION09/01/202012/31/3999No Changes
J9173 INJ., DURVALUMAB, 10 MG09/01/202012/31/3999No Changes
J9176 INJECTION, ELOTUZUMAB, 1MG09/01/202012/31/3999No Changes
J9177 INJ ENFORT VEDO-EJFV 0.25MG09/01/202012/31/3999No Changes
J9178 INJ, EPIRUBICIN HCL, 2 MG09/01/202012/31/3999No Changes
J9179 ERIBULIN MESYLATE INJECTION09/01/202012/31/3999No Changes
J9181 ETOPOSIDE INJECTION09/01/202012/31/3999No Changes
J9185 FLUDARABINE PHOSPHATE INJ09/01/202012/31/3999No Changes
J9190 FLUOROURACIL INJECTION09/01/202012/31/3999No Changes
J9200 FLOXURIDINE INJECTION09/01/202012/31/3999No Changes
J9203 GEMTUZUMAB OZOGAMICIN 0.1 MG09/01/202012/31/3999No Changes
J9204 INJ, MOGAMULIZUMAB-KPKC, 1 MG09/01/202012/31/3999No Changes
J9205 INJ IRINOTECAN LIPOSOME 1 MG09/01/202012/31/3999No Changes
J9206 IRINOTECAN INJECTION09/01/202012/31/3999No Changes
J9207 IXABEPILONE INJECTION09/01/202012/31/3999No Changes
J9208 IFOSFAMIDE INJECTION09/01/202012/31/3999No Changes
J9210 INJ., EMAPALUMAB-LZSG, 1 MG09/01/202012/31/3999No Changes
J9211 IDARUBICIN HCL INJECTION09/01/202012/31/3999No Changes
J9216 INTERFERON GAMMA 1-B INJ09/01/202012/31/3999No Changes
J9223 INJ. LURBINECTEDIN, 0.1 MG01/01/202112/31/3999No Changes
J9227 INJ. ISATUXIMAB-IRFC 10 MG10/01/202012/31/3999No Changes
J9228 IPILIMUMAB INJECTION09/01/202012/31/3999No Changes
J9229 INJ INOTUZUMAB OZOGAM 0.1 MG09/01/202012/31/3999No Changes
J9230 MECHLORETHAMINE HCL INJ09/01/202012/31/3999No Changes
J9245 INJ MELPHALAN HYDROCHL 50 MG09/01/202012/31/3999No Changes
J9246 INJ., EVOMELA, 1 MG09/01/202012/31/3999No Changes
J9250 METHOTREXATE SODIUM INJ09/01/202012/31/3999No Changes
J9260 METHOTREXATE SODIUM INJ09/01/202012/31/3999No Changes
J9261 NELARABINE INJECTION09/01/202012/31/3999No Changes
J9262 INJ, OMACETAXINE MEP, 0.01MG09/01/202012/31/3999No Changes
J9263 OXALIPLATIN09/01/202012/31/3999No Changes
J9264 PACLITAXEL PROTEIN BOUND09/01/202012/31/3999No Changes
J9266 PEGASPARGASE INJECTION09/01/202012/31/3999No Changes
J9267 PACLITAXEL INJECTION09/01/202012/31/3999No Changes
J9268 PENTOSTATIN INJECTION09/01/202012/31/3999No Changes
J9269 INJ. TAGRAXOFUSP-ERZS 10 MCG09/01/202012/31/3999No Changes
J9271 INJ PEMBROLIZUMAB09/01/202012/31/3999No Changes
J9273 INJ TISOTU VEDOTIN-TFTV, 1MG04/01/202212/31/3999No Changes
J9274 INJ, TEBENTAFUSP-TEBN, 1 MCG10/01/202212/31/3999New
J9280 MITOMYCIN INJECTION09/01/202012/31/3999No Changes
J9285 INJ, OLARATUMAB, 10 MG09/01/202012/31/3999No Changes
J9299 INJECTION, NIVOLUMAB09/01/202012/31/3999No Changes
J9303 PANITUMUMAB INJECTION09/01/202012/31/3999No Changes
J9305 PEMETREXED INJECTION09/01/202012/31/3999No Changes
J9307 PRALATREXATE INJECTION09/01/202012/31/3999No Changes
J9308 INJECTION, RAMUCIRUMAB09/01/202012/31/3999No Changes
J9309 INJ, POLATUZUMAB VEDOTIN 1MG09/01/202012/31/3999No Changes
J9312 INJ., RITUXIMAB, 10 MG09/01/202012/31/3999No Changes
J9313 INJ., LUMOXITI, 0.01 MG09/01/202012/31/3999No Changes
J9317 SACITUZUMAB GOVITECAN-HZIY01/01/202112/31/3999No Changes
J9318 INJ ROMIDEPSIN NON-LYO 0.1MG10/01/202112/31/3999No Changes
J9319 INJ ROMIDEPSIN LYOPHIL 0.1MG10/01/202112/31/3999No Changes
J9320 STREPTOZOCIN INJECTION09/01/202012/31/3999No Changes
J9328 TEMOZOLOMIDE INJECTION09/01/202012/31/3999No Changes
J9331 INJ SIROLIMUS PROT PART 1 MG07/01/202212/31/3999No Changes
J9332 INJ EFGARTIGIMOD 2MG07/01/202212/31/3999No Changes
J9340 THIOTEPA INJECTION09/01/202012/31/3999No Changes
J9348 INJ. NAXITAMAB-GQGK, 1 MG07/01/202112/31/3999No Changes
J9349 INJ., TAFASITAMAB-CXIX04/01/202112/31/3999No Changes
J9351 TOPOTECAN INJECTION09/01/202012/31/3999No Changes
J9352 INJECTION TRABECTEDIN 0.1MG09/01/202012/31/3999No Changes
J9353 INJ. MARGETUXIMAB-CMKB, 5 MG07/01/202112/31/3999No Changes
J9354 INJ, ADO-TRASTUZUMAB EMT 1MG09/01/202012/31/3999No Changes
J9355 INJ TRASTUZUMAB EXCL BIOSIMI09/01/202012/31/3999No Changes
J9358 INJ FAM-TRASTU DERU-NXKI 1MG09/01/202012/31/3999No Changes
J9359 INJ LON TESIRIN-LPYL 0.075MG04/01/202212/31/3999No Changes
J9370 VINCRISTINE SULFATE 1 MG INJ09/01/202012/31/3999No Changes
J9371 INJ, VINCRISTINE SUL LIP 1MG09/01/202012/31/3999No Changes
J9390 VINORELBINE TARTRATE INJ09/01/202012/31/3999No Changes
J9400 INJ, ZIV-AFLIBERCEPT, 1MG09/01/202012/31/3999No Changes
Q2009 FOSPHENYTOIN INJ PE09/01/202012/31/3999No Changes
Q2017 TENIPOSIDE, 50 MG09/01/202012/31/3999No Changes
Q2050 DOXORUBICIN INJ 10MG09/01/202012/31/3999No Changes
Q4081 EPO ALFA 100 UNITS, ESRD09/01/202012/31/3999No Changes
Q5101 INJECTION ZAEXIO09/01/202012/31/3999No Changes
Q5103 INJECTION, INFLECTRA09/01/202012/31/3999No Changes
Q5104 INJECTION, RENFLEXIS09/01/202012/31/3999No Changes
Q5105 INJ RETACRIT ESRD ON DIALYSI09/01/202012/31/3999No Changes
Q5106 INJ RETACRIT NON-ESRD USE09/01/202012/31/3999No Changes
Q5107 INJ MVASI 10 MG09/01/202012/31/3999No Changes
Q5108 INJECTION, FULPHILA?09/01/202012/31/3999No Changes
Q5110 NIVESTYM09/01/202012/31/3999No Changes
Q5111 INJECTION, UDENYCA 0.5 MG09/01/202012/31/3999No Changes
Q5112 INJ ONTRUZANT 10 MG10/01/202012/31/3999No Changes
Q5113 INJ HERZUMA 10 MG09/01/202012/31/3999No Changes
Q5114 INJ  OGIVRI 10 MG09/01/202012/31/3999No Changes
Q5115 INJ TRUXIMA 10 MG09/01/202012/31/3999No Changes
Q5116 INJ., TRAZIMERA, 10 MG09/01/202012/31/3999No Changes
Q5117 INJ., KANJINTI, 10 MG09/01/202012/31/3999No Changes
Q5118 INJ., ZIRABEV, 10 MG09/01/202012/31/3999No Changes
Q5119 INJ RUXIENCE, 10 MG09/01/202012/31/3999No Changes
Q5121 INJ. AVSOLA, 10 MG01/01/202112/31/3999No Changes
Q5122 INJ, NYVEPRIA04/01/202112/31/3999No Changes
Q5123 INJ. RIABNI, 10 MG07/01/202112/31/3999No Changes
90281HUMAN IG, IM09/01/202001/15/4000Deleted
90283HUMAN IG, IV09/01/202001/15/4000Deleted
90396VARICELLA-ZOSTER IG, IM09/01/202001/15/4000Deleted
C9094INJ, SUTIMLIMAB-JOME, 10 MG07/01/202201/15/4000Deleted
C9095INJ, TEBENTAFUSP-TEBN, 1 MCG07/01/202201/15/4000Deleted
C9096INJ, RELEUKO, 1 MCG07/01/202201/15/4000Deleted
J0220ALGLUCOSIDASE ALFA INJECTION09/01/202001/15/4000Deleted
J1130INJ DICLOFENAC SODIUM 0.5MG09/01/202001/15/4000Deleted
J2941SOMATROPIN INJECTION09/01/202001/15/4000Deleted
J3365UROKINASE 250,000 IU INJ09/01/202001/15/4000Deleted

If you have any questions, please email TCHP Pharmacy at:  TCHPPharmacy@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.

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