Self-Administered Drug Exclusion List - Medical Policy Article (Jurisdiction K Only)

Related CPT/HCPCS Codes:

C9399, J0129, J0139, J0270, J0364, J0593, J0599, J0630, J0801, J0802, J1324, J1438, J1559, J1562, J1595, J1628, J1675, J1744, J1748, J1811, J1812, J1814, J1815, J1817, J1826, J1830, J1941, J2170, J2212, J2267, J2354, J2440, J2502, J2760, J2940, J2941, J3030, J3031, J3110, J3355, J3357, J3490, J3590, J3357, J7999, J9212, J9213, J9216, J9218, Q0515, Q3027, Q3028, Q5137, Q5140, Q5141, Q5142, Q5143, Q5144, Q5145, Q9996, Q9998