HCPCS Range Immunosuppressive Drugs

• 1 Azathioprine, oral, 50 mg ( J7500 )

• 2 Azathioprine, parenteral, 100 mg ( J7501 )

• 3 Cyclosporine, oral, 100 mg ( J7502 )

• 4 Lymphocyte immune globulin, antithymocyte globulin, equine, parenteral, 250 mg ( J7504 )

• 5 Muromonab-CD3, parenteral, 5 mg ( J7505 )

• 6 Tacrolimus, immediate release, oral, 1 mg ( J7507 )

• 7 Tacrolimus, extended release, (Astagraf XL), oral, 0.1 mg ( J7508 )

• 8 Methylprednisolone oral, per 4 mg ( J7509 )

• 9 Prednisolone oral, per 5 mg ( J7510 )

• 10 Lymphocyte immune globulin, antithymocyte globulin, rabbit, parenteral, 25 mg ( J7511 )

• 11 Daclizumab, parenteral, 25 mg ( J7513 )

• 12 Cyclosporine, oral, 25 mg ( J7515 )

• 13 Injection, cyclosporine, 250 mg ( J7516 )

• 14 Mycophenolate mofetil, oral, 250 mg ( J7517 )

• 15 Mycophenolic acid, oral, 180 mg ( J7518 )

• 16 Sirolimus, oral, 1 mg ( J7520 )

• 17 Tacrolimus, parenteral, 5 mg ( J7525 )

• 18 Everolimus, oral, 0.25 mg ( J7527 )

• 19 Immunosuppressive drug, not otherwise classified ( J7599 )

• 20 Prednisone, immediate release or delayed release, oral, 1 mg ( J7512 )

• 21 Tacrolimus, extended release, (Envarsus XR), oral, 0.25 mg ( J7503 )

• 22 Injection, mycophenolate mofetil, 10 mg ( J7519 )