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Rx only

1 LUPRON INJECTION (leuprolide acetate) Rx only DESCRIPTION Leuprolide acetate is a synthetic nonapeptide analog of naturally occurring gonadotropin releasing hormone (GnRH or ...

http://pitap.abbott.com/LUPRONINJECTION.PDF

Provider Administered Injectable Drug Program Quick Reference Guide

... must be authorized by ICORE before being administered in the office: Table 1 J-Code ... Intron-A Supprelin LA Lupron Depot Synagis Neumega Tysabri Nplate ...

https://specialtydrug.magellanprovider.com/MHS/Sdrug/content/PDFs/avmedQRG.pdf

2008 Table of Drugs

2008 Table of Drugs IA - Intra-arterial administration IV - Intravenous administration IM - Intramuscular administration IT - Intrathecal SC - Subcutaneous ...

http://www.cms.gov/HCPCSReleaseCodeSets/downloads/DRUG2008.pdf

Clinical Coverage Guideline

Supprelin LA (histrelin acetate) Subcutaneous Implant for the Treatment of Central Precocious Puberty (CPP)

http://www.wellcare.com/WCAssets/corporate/assets/HS020_Supprelin.pdf

C IGNA M EDICAL C OVERAGE P OLICY

Lupron Depot 3- month 22.5 mg were similar to that of the ... injections of leuprorelin 3-month depot (11.25 mg). J Clin Endocrinol Metab 2002; 87:4111-4116.

http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/pharmacy/ph_6117_coveragepositioncriteria_leuprolide.pdf

Specialty Injectable Drug Program

... Blue Shield Association 06/10/03 1 of 3 HCPCS Billing Code ... NUTROPIN AQ NUTROPIN DEPOT SAIZEN SEROSTIM AWP- 15% J3240 ... AWP- 15% J9217 LUPRON AWP- 15% J9218 LEUPROLIDE LUPRON AWP- 15% ...

http://www.bcbstx.com/provider/pdf/spec_inject_druglist.pdf

LUPRON DEPOT4 Month 30 mg

LUPRON DEPOT-4 Month 30 mg Package Insert Page 1 of 10 LUPRON DEPOT - 4 Month 30 mg ... in most (45/49) patients for as long as the patients received their injections.

http://pitap.abbott.com/lupron4month30mg.pdf

Health Choice of Arizona PRIOR AUTHORIZATION GUIDELINES

... the Pharmacy section of this guideline for injections ... with authorization: Medication description J Code ... FOR DEPOT SUSPENSION), 7.5 MG (ELIGARD/LUPRON DEPOT) J9217 ...

http://www.healthchoiceaz.com/generalproviders/Documents/ProviderManual/Chapter6-Authorizations/Exhibit%206-1%20Health%20Choice%20Arizona%20Prior%20Authorization%20Requirements.pdf

National Drug Code (NDC) Billing Reference

NDC Billing Reference for Nevada Medicaid and Nevada Check Up Claims 09/16/08 Page 1 National Drug Code (NDC) Billing Reference (for Nevada Medicaid and Nevada Check Up ...

http://www.sentryds.com/wp-content/uploads/nv_dra.pdf

Title: Health Plan Providers: Therapeutic Injections and ...

Clearance #4942 Title: Health Plan Providers: Therapeutic Injections and Prescribed Drugs (To comment, please click inside the red box) OHIO DEPARTMENT OF JOB FAMILY ...

http://jfs.ohio.gov/OLS/clearance/public/4942.pdf

Policy Name Self-Administered Drugs

... joints), intrathecal injections, limited subcutaneous injections ... 07/01/2009 Updated codes 06/01/2009 Removed Lupron Depot, added Affinitor to code list 06/01 ...

https://provider.medica.com/C14/ClaimPolicies/Document%20Library/Self_Administered_Drugs_Claims_Policy.pdf

National Drug Code (NDC) Billing Reference

... December 31 will be processed with current J Code ... 1000mcg/ml is NDC quantity 1 - Two 1.5ml injections of ... ACETATE (FOR DEPOT SUSPENSION), 7.5MG KIT LUPRON DEPOT (SRN ...

http://www.sentryds.com/wp-content/uploads/nv_dra.pdf

NDC Billing Reference

National Drug Code (NDC) Billing Reference Revised ... Two 1.5ml injections of Lidocaine 1% are NDC quantity 3 ... One Lupron depot 7.5mg kit is NDC quantity 1 Transdermal ...

http://www.medicaid.nv.gov/downloads/provider/nv_billing_ndc_reference.pdf

MORTAR MIXER

Page 2 SKU 95906 For technical questions, please call 1-800-444-3353. sPECIFICATIOns Drum Capacity 6 Cubic Feet Batch Capacity 1-1/2 to 2 Bags of cement Wheel to ...

http://www.harborfreight.com/manuals/95000-95999/95906.pdf

National Drug Code (NDC) Billing Reference

NDC Billing Reference for Nevada Medicaid and Nevada Check Up Claims Updated nl 07/14/10 pv 09/16/08 Page 1 National Drug Code (NDC) Billing Reference (for Nevada Medicaid and ...

https://nevada.fhsc.com/downloads/provider/nv_billing_ndc_reference.pdf

CIGNAs pharmacy coverage position on leuprolide (Lupron, Lupron ...

C IGNA M EDICAL C OVERAGE P OLICY The following Coverage Policy applies to all plans administered by CIGNA Companies including plans administered by Great-West ...

http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/pharmacy/ph_6117_coveragepositioncriteria_leuprolide.pdf

Medical Injection Prior Authorization List Coventry Health Care of ...

Effective 01/01/2012 Drug Name Code Code Drug Name Abraxane J9264 90283 Immune ... Koate-DVI/HP J7190 J1950 Lupron Depot Kogenate/FS J7192 J2020 Zyvok (linezolid)

http://chcmissouri.coventryhealthcare.com/web/groups/public/@cvty_regional_chcmo/documents/webcontent/c037380.pdf

HMO Blue Specialty Injectable Drug Program - J-Code Drug Name Discount

j-code drug name discount j0476 lioresal intrathecal awp ... awp- 16% j1830 betaseron awp- 15% j1950 lupron awp- 15% ... nutropin depot saizen serostim awp- 15% j3240 thyrogen ...

http://www.bcbstx.com/provider/pdf/jcode_and_awp_discount_list.pdf

Power Bike

Power Bike By Earl Seidlinqer ASOLINE-powered engines have been popular with bicycle enthusiasts ever since such engines were made small enough to fit a bicycle frame.

http://countryplans.com/vintage_farm/bigkids/PowerBike.pdf

Title: Health Plan Providers: Therapeutic Injections and ...

Clearance #4942 Title: Health Plan Providers: Therapeutic Injections and Prescribed Drugs (To comment, please click inside the red box) OHIO DEPARTMENT OF JOB FAMILY ...

http://jfs.ohio.gov/OLS/clearance/public/4942.pdf

Clearance #4942 Title: Health Plan Providers: Therapeutic ...

Title: Health Plan Providers: Therapeutic Injections and ... (v) Lupron depot. (a) Lupron depot for the treament of ... made only when billed with an injection code (J code ...

http://jfs.ohio.gov/OLS/clearance/public/4942.pdf

Rx only

1 LUPRON INJECTION (leuprolide acetate) Rx only DESCRIPTION Leuprolide acetate is a synthetic nonapeptide analog of naturally occurring gonadotropin releasing hormone (GnRH or ...

http://pitap.abbott.com/LUPRONINJECTION.PDF

2008 Table of Drugs

2008 Table of Drugs IA - Intra-arterial administration IV - Intravenous administration IM - Intramuscular administration IT - Intrathecal SC - Subcutaneous ...

http://www.cms.gov/HCPCSReleaseCodeSets/downloads/DRUG2008.pdf

HCPCS REQUIRING CORRESPONDING NDC CODES

The list of procedure codes affected by the J Code NDC Requirements is now available ... NALBUPHINE HCL PER 10 MG J2310 INJ NALOXONE HCL PER 1 MG J2315 INJ NALTREXONE DEPOT ...

http://medicaidalaska.com/Downloads/providers/AKRx_HCPCS_NDC_Code_after20080401.pdf

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