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HCPCS Generic Name Brand Name Strength SEER*Rx Category Major Drug Class Minor Drug Class (Ascending) Oral (Y/N) FDA Approval Year FDA Discontinuation Year CMS Effective Date CMS Discontinuation Date Status
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 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
S0176 Hydroxyurea Hydrea 500 mg Chemotherapy Miscellaneous Agent Antimetabolite/Organooxygen Yes 1967 Jan. 1, 2002 In Use
NA venetoclax Venclexta 10 mg Chemotherapy Enzyme Inhibitor BCL-2 Yes 2016 In Use
NA venetoclax Venclexta 50 mg Chemotherapy Enzyme Inhibitor BCL-2 Yes 2016 In Use
NA venetoclax Venclexta 100 mg Chemotherapy Enzyme Inhibitor BCL-2 Yes 2016 In Use
C9069 Belantamab mafodotin-blmf Blenrep 0.5mg Immunotherapy Drug Antibody Conjugate BCMA No 2020 Jan. 1, 2021 No Longer Used
J9037 Belantamab mafodontin-blmf Blenrep 0.5mg Immunotherapy Drug Antibody Conjugate BCMA No 2020 April 1, 2021 In Use
C9081 Idecabtagene vicleucel Abecma up to 460000000 Immunotherapy CAR-T BCMA No 2021 Sept. 27, 2021 Jan. 26, 2022 No Longer Used
Q2055 Idecabtagene vicleucel Abecma 460 million Immunotherapy CAR-T BCMA No 2021 Jan. 26, 2022 In Use
C9148 Teclistamab-cqyv Tecvayli 0.5mg Immunotherapy Monoclonal Antibody BCMA, CD3 No 2022 March 17, 2023 July 11, 2023 No Longer Used
J9380 Teclistamab cqyv Tecvayli 0.5mg Immunotherapy Monoclonal Antibody BCMA, CD3 No 2022 July 11, 2023 In Use
C9165 Elranatamab-bcmm Elrexfio 1mg Immunotherapy Monoclonal Antibody BCMA, CD3 No 2023 Dec. 7, 2023 April 17, 2024 No Longer Used
J1323 Elranatamab-bcmm Elranatamab-bcmm 1mg Immunotherapy Monoclonal Antibody BCMA, CD3 No 2023 April 17, 2024 In Use
NA Bosutinib Bosulif 100 mg Chemotherapy Tyrosine Kinase Inhibitor BCR-ABL Yes 2012 In Use
NA Bosutinib Bosulif 500 mg Chemotherapy Tyrosine Kinase Inhibitor BCR-ABL Yes 2012 In Use
NA Dasatinib Sprycel 20 mg Chemotherapy Tyrosine Kinase Inhibitor BCR-ABL Yes 2006 In Use
NA Dasatinib Sprycel 50 mg Chemotherapy Tyrosine Kinase Inhibitor BCR-ABL Yes 2006 In Use
NA Dasatinib Sprycel 70 mg Chemotherapy Tyrosine Kinase Inhibitor BCR-ABL Yes 2006 In Use
NA Dasatinib Sprycel 80 mg Chemotherapy Tyrosine Kinase Inhibitor BCR-ABL Yes 2006 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.