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HCPCS Generic Name Brand Name Strength SEER*Rx Category Major Drug Class (Descending) Minor Drug Class Oral (Y/N) FDA Approval Year FDA Discontinuation Year CMS Effective Date CMS Discontinuation Date Status
NA Palbociclib Ibrance 75 mg Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 Yes 2015 In Use
NA Palbociclib Ibrance 100 mg Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 Yes 2015 In Use
NA Palbociclib Ibrance 125 mg Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 Yes 2015 In Use
NA Ribociclib Kisqali 200 mg Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 Yes 2017 In Use
C9078 Trilaciclib Cosela 1mg Chemotherapy Cyclin Dependent Kinase Inhibitor CDX 4/6 No 2021 July 23, 2021 Sept. 27, 2021 No Longer Used
J1448 Trilaciclib Cosela 1mg Chemotherapy Cyclin Dependent Kinase Inhibitor CDK 4/6 No 2021 Sept. 27, 2021 In Use
J0207 Amifostine Ethyol 500 mg Ancillary Therapy Chemoprotective Detoxifying Agent No 1995 Jan. 1, 1998 In Use
J1190 Dexrazoxane Zinecard 250 mg Ancillary Therapy Chemoprotective Detoxifying Agent No 1995 Jan. 1, 2007 In Use
C9293 Glucarpidase Voraxaze 10 units Ancillary Therapy Chemoprotective Antidote No 2012 Jan. 1, 2012 In Use
NA Leucovorin Calcium Calcium leucovorin, Lederfoline, Leucosar, Leucovorin rescue, Wellcovorin 15 mg Ancillary Therapy Chemoprotective Antidote Yes 1952 Jan. 1, 1997 In Use
NA Leucovorin Calcium Calcium leucovorin, Lederfoline, Leucosar, Leucovorin rescue, Wellcovorin 10 mg Ancillary Therapy Chemoprotective Antidote Yes 1952 Jan. 1, 1997 In Use
NA Leucovorin Calcium Calcium leucovorin, Lederfoline, Leucosar, Leucovorin rescue, Wellcovorin 15 mg Ancillary Therapy Chemoprotective Antidote Yes 1952 Jan. 1, 1997 In Use
NA Leucovorin Calcium Calcium leucovorin, Lederfoline, Leucosar, Leucovorin rescue, Wellcovorin 25 mg Ancillary Therapy Chemoprotective Antidote Yes 1952 Jan. 1, 1997 In Use
J0640 Leucovorin Calcium Calcium leucovorin, Lederfoline, Leucosar, Leucovorin rescue, Wellcovorin 50 mg Ancillary Therapy Chemoprotective Antidote No 1952 Jan. 1, 1997 In Use
J0641 Levoleucovorin Fusilev, Levoleucovorin 0.5 mg Ancillary Therapy Chemoprotective Antidote No 2008 Oct. 1, 2019 In Use
NA Mesna Mesnex 400 mg Ancillary Therapy Chemoprotective Detoxifying Agent Yes 2002 In Use
J9209 Mesna Mesna rescue, Mesnex, Mesna Novaplus, Uromitexan 200 mg Ancillary Therapy Chemoprotective Detoxifying Agent No 1988 Jan. 1, 1990 In Use
C9428 Mesna Mesna rescue, Mesnex, Mesna Novaplus, Uromitexan 200 mg Ancillary Therapy Chemoprotective Detoxifying Agent No 1988 Jan. 1, 2004 Dec. 31, 2005 No Longer Used
NA Uridine Triacetate Xuriden 2 g Ancillary Therapy Chemoprotective Antidote Yes 2015 In Use
NA Uridine Triacetate Vistogard 10 g Ancillary Therapy Chemoprotective Antidote Yes 2015 In Use
J0642 Levoleucovorin Khapzory 0.5mg Ancillary Therapy Chemoprotective Antidote No 2018 Oct. 1, 2019 In Use
J9298 Nivolumab & relatlimab-rmbw Opdualag 3mg/1mg Immunotherapy Checkpoint Inhibitor, Monoclonal Antibody PD-1, LAG3 No 2022 Sept. 27, 2022 In Use
C9491 Avelumab Bavencio 10 mg Immunotherapy Checkpoint Inhibitor PD-1 No 2017 Oct. 1, 2017 In Use
C9483 Atezolizumab Tecentriq 10 mg Immunotherapy Checkpoint Inhibitor PD-1 No 2016 Oct. 1, 2016 In Use
C9492 Durvalumab Imfinzi 10 mg Immunotherapy Checkpoint Inhibitor PD-L1 No 2017 Oct. 1, 2017 In Use

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The use of NA indicates that the HCPCS code was Not Available. NA may mean that a) the HCPCS code has not yet been created (new drug), b) the drug is given as an oral drug or alternative route (only in specific instances are HCPCS assigned to these medications), or c) the HCPCS could not be found or is truly not available.