Browse HCPCS Level II 2020 Edition

J7500 - J7599  Immunosuppressive Drugs (Includes Non-injectibles)

J7500 Azathioprine, oral, 50 mg short Azathioprine oral 50mg RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical Oral Medication; Not Payable OPH 15.0 3 Date of Service Edit: Clinical Prescribing Information DME 450.0 3 Date of Service Edit: Clinical Prescribing Information

J7501 Azathioprine, parenteral, 100 mg short Azathioprine parenteral RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 1.0 3 Date of Service Edit: Clinical Clinical: CMS Workgroup OPH 8.0 3 Date of Service Edit: Clinical Prescribing Information DME 8.0 3 Date of Service Edit: Clinical Clinical: CMS Workgroup

J7502 Cyclosporine, oral, 100 mg short Cyclosporine oral 100 mg RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical Oral Medication; Not Payable OPH 60.0 3 Date of Service Edit: Clinical Clinical: Data DME 240.0 3 Date of Service Edit: Clinical Clinical: Data

J7503 Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg short Tacrol envarsus ex rel oral RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical Oral Medication; Not Payable OPH 120.0 3 Date of Service Edit: Clinical Prescribing Information DME 3600.0 3 Date of Service Edit: Clinical Prescribing Information

J7504 Lymphocyte immune globulin, antithymocyte globulin, equine, parenteral, 250 mg short Lymphocyte immune globulin RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 15.0 3 Date of Service Edit: Clinical Prescribing Information OPH 15.0 3 Date of Service Edit: Clinical Prescribing Information DME 0.0 3 Date of Service Edit: Clinical Published Contractor Policy

J7505 Muromonab-cd3, parenteral, 5 mg short Monoclonal antibodies RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 1.0 3 Date of Service Edit: Clinical Prescribing Information OPH 1.0 3 Date of Service Edit: Clinical Prescribing Information DME 0.0 3 Date of Service Edit: Clinical Published Contractor Policy

J7506 Prednisone, oral, per 5 mg short Prednisone oral

J7507 Tacrolimus, immediate release, oral, 1 mg short Tacrolimus imme rel oral 1mg RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical Oral Medication; Not Payable OPH 40.0 3 Date of Service Edit: Clinical Prescribing Information DME 1200.0 3 Date of Service Edit: Clinical Published Contractor Policy

J7508 Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg short Tacrol astagraf ex rel oral RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 300.0 3 Date of Service Edit: Clinical Prescribing Information DME 9000.0 3 Date of Service Edit: Clinical Prescribing Information

J7509 Methylprednisolone oral, per 4 mg short Methylprednisolone oral RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical Oral Medication; Not Payable OPH 60.0 3 Date of Service Edit: Clinical Prescribing Information DME 360.0 3 Date of Service Edit: Clinical Clinical: Data

J7510 Prednisolone oral, per 5 mg short Prednisolone oral per 5 mg RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical Oral Medication; Not Payable OPH 60.0 3 Date of Service Edit: Clinical Prescribing Information DME 240.0 3 Date of Service Edit: Clinical Clinical: Data

J7511 Lymphocyte immune globulin, antithymocyte globulin, rabbit, parenteral, 25 mg short Antithymocyte globuln rabbit RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 9.0 3 Date of Service Edit: Clinical Prescribing Information OPH 9.0 3 Date of Service Edit: Clinical Prescribing Information DME 0.0 3 Date of Service Edit: Clinical Published Contractor Policy

J7512 Prednisone, immediate release or delayed release, oral, 1 mg short Prednisone ir or dr oral 1mg RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical Oral Medication; Not Payable OPH 300.0 3 Date of Service Edit: Clinical Prescribing Information DME 7000.0 3 Date of Service Edit: Clinical Prescribing Information

J7513 Daclizumab, parenteral, 25 mg short Daclizumab, parenteral RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical Drug discontinued OPH 0.0 3 Date of Service Edit: Clinical Drug discontinued DME 0.0 3 Date of Service Edit: Clinical Drug discontinued

J7515 Cyclosporine, oral, 25 mg short Cyclosporine oral 25 mg RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical Oral Medication; Not Payable OPH 90.0 3 Date of Service Edit: Clinical Clinical: Data DME 600.0 3 Date of Service Edit: Clinical Clinical: Data

J7516 Cyclosporin, parenteral, 250 mg short Cyclosporin parenteral 250mg RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 1.0 3 Date of Service Edit: Clinical Clinical: Data OPH 4.0 3 Date of Service Edit: Clinical Prescribing Information DME 0.0 3 Date of Service Edit: Clinical Published Contractor Policy

J7517 Mycophenolate mofetil, oral, 250 mg short Mycophenolate mofetil oral RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical Oral Medication; Not Payable OPH 16.0 3 Date of Service Edit: Clinical Clinical: Data DME 480.0 3 Date of Service Edit: Clinical Clinical: Data

J7518 Mycophenolic acid, oral, 180 mg short Mycophenolic acid RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 12.0 3 Date of Service Edit: Clinical Clinical: Society Comment DME 360.0 3 Date of Service Edit: Clinical Clinical: Society Comment

J7520 Sirolimus, oral, 1 mg short Sirolimus, oral RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical Oral Medication; Not Payable OPH 40.0 3 Date of Service Edit: Clinical Prescribing Information DME 600.0 3 Date of Service Edit: Clinical Clinical: Data

J7525 Tacrolimus, parenteral, 5 mg short Tacrolimus injection RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 2.0 3 Date of Service Edit: Clinical Prescribing Information OPH 2.0 3 Date of Service Edit: Clinical Prescribing Information DME 0.0 3 Date of Service Edit: Clinical Published Contractor Policy

J7527 Everolimus, oral, 0.25 mg short Oral everolimus RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 0.0 3 Date of Service Edit: Clinical CMS Policy OPH 20.0 3 Date of Service Edit: Clinical Clinical: Data DME 960.0 3 Date of Service Edit: Clinical Clinical: Data

J7599 Immunosuppressive drug, not otherwise classified short Immunosuppressive drug noc RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 1.0 3 Date of Service Edit: Clinical Clinical: CMS Workgroup OPH 1.0 3 Date of Service Edit: Clinical Clinical: CMS Workgroup