Self-Administered Drug Exclusion List (SAD List)

April 1st, 2024

The CMS self-administered drug exclusion list contains drugs that are usually self-administered by the patient and, therefore, are not typically covered by Medicare when provided in an outpatient setting such as a hospital outpatient department. This is because Medicare Part B generally does not cover the cost of self-administered drugs that beneficiaries would typically take on their own. 

BuyandBill.com republishes the self-administered drug exclusion list in conjunction with the CMS data file. The SAD list can be found here: 

Excluded CPT/HCPCS Codes:

CodeHCPCS Code DescriptorBrand NameExclusion Effective Date
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSRebif® (Interferon Beta–1A, 1 mcg)7/16/17
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSTesamorelin (Egrifta ™)7/16/17
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSSogroya® (somapacitan-beco)11/15/21
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSPasireotide (Signifor®)11/15/21
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSRisankizumab-rzaa (Skyrizi™) subcutaneous use*1/12/20
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSofatumumab (Kesimpta®) subcutaneous use*7/24/22
C9399UNCLASSIFIED DRUGS OR BIOLOGICALStralokinumab-idrm (Adbry™)11/13/22
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSAll insulin products12/11/22
C9399UNCLASSIFIED DRUGS OR BIOLOGICALStirzepatide (Mounjaro™)12/11/22
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSAdalimumab-aacf (Idacio®), Adalimumab-afzb (Abrilada™), Adalimumab-bwwd (Hadlima), Adalimumab-fkjp (Hulio®), Adalimumab-adaz (Hyrimoz), Adalimumab-aqvh (Yusimry)6/25/23
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSsecukinumab (Cosentyx ™)*6/15/15
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSVedolizumab (Entyvio ®) subcutaneous use*1/14/24
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSadalimumab-aaty (Yuflyma ®)1/14/24
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSmirikizumab-mrkz (Omvoh™) subcutaneous use*1/14/24
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSustekinumab-auub (Wezlana™) subcutaneous use*3/16/24
J0129INJECTION, ABATACEPT, 10 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED)Orencia® subcutaneous use*4/1/21
J0135INJECTION, ADALIMUMAB, 20 MGHumira2/1/08
J0270INJECTION, ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED)Caverject, Edex2/1/08
J0364INJECTION, APOMORPHINE HYDROCHLORIDE, 1 MGApokyn®4/1/21
J0490INJECTION, BELIMUMAB, 10 MGBenlysta®, subcutaneous use*4/1/21
J0593INJECTION, LANADELUMAB-FLYO, 1 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF-ADMINISTERED)Takhzyro®12/2/19
J0599INJECTION, C-1 ESTERASE INHIBITOR (HUMAN), (HAEGARDA), 10 UNITSHaegarda®1/1/19
J0630INJECTION, CALCITONIN SALMON, UP TO 400 UNITSCalcimar, Miacalcin2/1/08
J0801INJECTION, CORTICOTROPIN (ACTHAR GEL), UP TO 40 UNITSActhar® Gel subcutaneous use*10/1/23
J0802INJECTION, CORTICOTROPIN (ANI), UP TO 40 UNITSPurified Cortrophin Gel® subcutaneous use*10/1/23
J1324INJECTION, ENFUVIRTIDE, 1 MGFuzeon2/1/08
J1438INJECTION, ETANERCEPT, 25 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED)Enbrel2/1/08
J1595INJECTION, GLATIRAMER ACETATE, 20 MGCopaxone™2/1/08
J1628INJECTION, GUSELKUMAB, 1 MGTremfya® (guselkumab)4/1/21
J1675INJECTION, HISTRELIN ACETATE, 10 MICROGRAMSSupprelin LA™2/1/08
J1744INJECTION, ICATIBANT, 1 MGFirazyr™11/15/11
J1811INSULIN (FIASP) FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITSFiasp® for insulin pump use9/3/23
J1812INSULIN (FIASP), PER 5 UNITSFiasp® injection*9/3/23
J1813INSULIN (LYUMJEV) FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITSLyumjev® for insulin pump use9/3/23
J1814INSULIN (LYUMJEV), PER 5 UNITSLyumjev® injection*9/3/23
J1815INJECTION, INSULIN, PER 5 UNITSHumalog, Humulin, Iletin, Insulin Lispro, Novo Nordisk, NPH, Pork Insulin, Regular Insulin, Ultralente, Velosulin, Humulin R, Iletin II Regular Port, Insulin Purified Pork, ReliOn, Lente Iletin I, Novolin R, Humulin R U-5002/1/08
J1815INJECTION, INSULIN, PER 5 UNITSAll insulin products12/11/22
J1817INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITSAll insulin products12/11/22
J1817INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITSHumalog, Humulin, Vesolin BR, Iletin II NPH Pork, Lantus, Lispro-PFC, Novolin, Novolog, Novolog Flexpen, Novolog Mix, ReliOn Novolin2/1/08
J1826INJECTION, INTERFERON BETA-1A, 30 MCGAvonex Pen®, Rebif®, Rebif® Rebidose®11/15/21
J1830INJECTION, INTERFERON BETA-1B, 0.25 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED)Betaseron™2/1/08
J1941INJECTION, FUROSEMIDE (FUROSCIX), 20 MGFuroscix®9/3/23
J2170INJECTION, MECASERMIN, 1 MGIplex ™ Increlex™2/1/08
J2212INJECTION, METHYLNALTREXONE, 0.1 MGRelistor ™2/15/13
J2354INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR INTRAVENOUS INJECTION, 25 MCGSandostatin™, subcutaneous use*2/1/08
J2440INJECTION, PAPAVERINE HCL, UP TO 60 MGPapaverine HCL2/1/08
J2940INJECTION, SOMATREM, 1 MGProtropin™2/1/08
J2941INJECTION, SOMATROPIN, 1 MGGenotropin™2/1/08
J3030INJECTION, SUMATRIPTAN SUCCINATE, 6 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED)Imitrex™2/1/08
J3031INJECTION, FREMANEZUMAB-VFRM, 1 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF-ADMINISTERED)Ajovy™4/1/21
J3110INJECTION, TERIPARATIDE, 10 MCGForteo™2/1/08
J3355INJECTION, UROFOLLITROPIN, 75 IUMetrodin, Bravelle, Fertinex2/1/08
J3357USTEKINUMAB, FOR SUBCUTANEOUS INJECTION, 1 MGStelara®11/15/21
J3490UNCLASSIFIED DRUGSSogroya® (somapacitan-beco)11/15/21
J3490UNCLASSIFIED DRUGSAbaloparatide (Tymlos™)7/16/18
J3490UNCLASSIFIED DRUGSAlbiglutide (Tanzeum™)6/15/16
J3490UNCLASSIFIED DRUGSAlirocumab (Praulent™)6/15/16
J3490UNCLASSIFIED DRUGSDulaglutide (Trulicity™)6/15/16
J3490UNCLASSIFIED DRUGSetanercept-szzs (Erelzi)11/15/16
J3490UNCLASSIFIED DRUGSEvolocumab (Repatha™)6/15/16
J3490UNCLASSIFIED DRUGSInsulin Glargine (Toujeo SoloStar™)6/15/16
J3490UNCLASSIFIED DRUGSInsulin Glargine (Lantus SoloStar™)6/15/16
J3490UNCLASSIFIED DRUGSSarilumab (Kevzara™)4/1/21
J3490UNCLASSIFIED DRUGSIxekizumab (Taltz™)6/15/16
J3490UNCLASSIFIED DRUGSLiraglutide (Victoza ™)10/16/11
J3490UNCLASSIFIED DRUGSLiraglutide (Saxenda™)6/15/16
J3490UNCLASSIFIED DRUGSMethotrexate (Rasuvo™)6/15/16
J3490UNCLASSIFIED DRUGSMethotrexate (Otrexup™)6/15/16
J3490UNCLASSIFIED DRUGSMetreleptin (Myalept™)6/15/16
J3490UNCLASSIFIED DRUGSMipomersen sodium (Kynamro™)9/15/13
J3490UNCLASSIFIED DRUGSParathyroid hormone (Natpara™)6/15/16
J3490UNCLASSIFIED DRUGSPasireotide (Signifor™)6/15/16
J3490UNCLASSIFIED DRUGSPeginterferon beta-1a (Plegridy™)6/15/16
J3490UNCLASSIFIED DRUGSPramlintide (Symlin™)2/1/08
J3490UNCLASSIFIED DRUGSRebif® (Interferon Beta–1A, 1 mcg)7/16/17
J3490UNCLASSIFIED DRUGSTesamorelin (Egrifta™)10/16/11
J3490UNCLASSIFIED DRUGSTriMix™10/16/11
J3490UNCLASSIFIED DRUGSQuadmix (+ Atropine)7/16/17
J3490UNCLASSIFIED DRUGSAdalimumab-atto (AMJEVITA™)2/15/17
J3490UNCLASSIFIED DRUGSGolimumab (SIMPONI)2/15/17
J3490UNCLASSIFIED DRUGSRisankizumab-rzaa (Skyrizi™) subcutaneous use*1/12/20
J3490UNCLASSIFIED DRUGSofatumumab (Kesimpta®) subcutaneous use*7/24/22
J3490UNCLASSIFIED DRUGStralokinumab-idrm (Adbry™)11/13/22
J3490UNCLASSIFIED DRUGSAll insulin products12/11/22
J3490UNCLASSIFIED DRUGStirzepatide (Mounjaro™)12/11/22
J3490UNCLASSIFIED DRUGSAdalimumab-aacf (Idacio®), Adalimumab-afzb (Abrilada™), Adalimumab-bwwd (Hadlima), Adalimumab-fkjp (Hulio®), Adalimumab-adaz (Hyrimoz), Adalimumab-aqvh (Yusimry)6/25/23
J3490UNCLASSIFIED DRUGSsecukinumab (Cosentyx ™)*6/15/15
J3490UNCLASSIFIED DRUGSVedolizumab (Entyvio ®) subcutaneous use*1/14/24
J3490UNCLASSIFIED DRUGSadalimumab-aaty (Yuflyma ®)1/14/24
J3490UNCLASSIFIED DRUGSmirikizumab-mrkz (Omvoh™) subcutaneous use*1/14/24
J3490UNCLASSIFIED DRUGSustekinumab-auub (Wezlana™) subcutaneous use*3/16/24
J3590UNCLASSIFIED BIOLOGICSustekinumab-auub (Wezlana™) subcutaneous use*3/16/24
J3590UNCLASSIFIED BIOLOGICSmirikizumab-mrkz (Omvoh™) subcutaneous use*1/14/24
J3590UNCLASSIFIED BIOLOGICSadalimumab-aaty (Yuflyma ®)1/14/24
J3590UNCLASSIFIED BIOLOGICSVedolizumab (Entyvio ®) subcutaneous use*1/14/24
J3590UNCLASSIFIED BIOLOGICSAdalimumab-aacf (Idacio®), Adalimumab-afzb (Abrilada™), Adalimumab-bwwd (Hadlima), Adalimumab-fkjp (Hulio®), Adalimumab-adaz (Hyrimoz), Adalimumab-aqvh (Yusimry)6/25/23
J3590UNCLASSIFIED BIOLOGICSAll insulin products12/11/22
J3590UNCLASSIFIED BIOLOGICStirzepatide (Mounjaro™)12/11/22
J3590UNCLASSIFIED BIOLOGICStralokinumab-idrm (Adbry™)11/13/22
J3590UNCLASSIFIED BIOLOGICSofatumumab (Kesimpta®) subcutaneous use*7/24/22
J3590UNCLASSIFIED BIOLOGICSadalimumab-adbm (Cyltezo™ )4/1/21
J3590UNCLASSIFIED BIOLOGICSAnakinra (Kineret ™)2/1/08
J3590UNCLASSIFIED BIOLOGICSAsfotase-alfa (Strensiq®)4/1/21
J3590UNCLASSIFIED BIOLOGICSBrodalumab (Siliq)7/16/17
J3590UNCLASSIFIED BIOLOGICSDupilumab (Dupixent)7/16/17
J3590UNCLASSIFIED BIOLOGICSerenumab-aooe (Aimovig™)4/1/21
J3590UNCLASSIFIED BIOLOGICSExenatide,(Byetta ™)10/16/08
J3590UNCLASSIFIED BIOLOGICSExenatide (Bydureon™)6/15/16
J3590UNCLASSIFIED BIOLOGICSGalcenezumab-gnlm (Emgality™)4/1/21
J3590UNCLASSIFIED BIOLOGICSPeginterferon alfa-2b, (Pegintron™ Sylatron™)2/1/08
J3590UNCLASSIFIED BIOLOGICSPegvisomant, (Somavert™ )2/1/08
J3590UNCLASSIFIED BIOLOGICSRebif® (Interferon Beta–1A, 1 mcg)7/16/17
J3590UNCLASSIFIED BIOLOGICSSarilumab (Kevzara®)4/1/21
J3590UNCLASSIFIED BIOLOGICSsecukinumab (Cosentyx ™)*6/15/15
J3590UNCLASSIFIED BIOLOGICSSemaglutide (Ozempic®)4/1/21
J3590UNCLASSIFIED BIOLOGICSRisankizumab-rzaa (Skyrizi™) subcutaneous use*1/12/20
J3590UNCLASSIFIED BIOLOGICSSogroya® (somapacitan-beco)11/15/21
J3590UNCLASSIFIED BIOLOGICSRopeginterferon alfa-2b-njft (BESREMI®)4/24/22
J9212INJECTION, INTERFERON ALFACON-1, RECOMBINANT, 1 MICROGRAMInfergen2/1/08
J9213INJECTION, INTERFERON, ALFA-2A, RECOMBINANT, 3 MILLION UNITSPeginterferon alfa-2a, (Pegasys ®, Pegasys ® Proclick™)2/15/13
J9216INJECTION, INTERFERON, GAMMA 1-B, 3 MILLION UNITSActimmune™2/1/08
J9218LEUPROLIDE ACETATE, PER 1 MGLupron™2/1/08
Q3027INJECTION, INTERFERON BETA-1A, 1 MCG FOR INTRAMUSCULAR USEAvonex™1/1/14
Q3028INJECTION, INTERFERON BETA-1A, 1 MCG FOR SUBCUTANEOUS USERebif™1/1/14
Q5131INJECTION, ADALIMUMAB-AACF (IDACIO), BIOSIMILAR, 20 MGIdacio®9/3/23
Q5132INJECTION, ADALIMUMAB-AFZB (ABRILADA), BIOSIMILAR, 10 MGABRILADA™6/25/23

Non-Excluded CPT/HCPCS Ended Codes:

HCPCS CodeHCPCS Code DescriptorBrand NameExclusion Effective Date
C9399UNCLASSIFIED DRUGS OR BIOLOGICALStezepelumab-ekko (Tezspire™)7/10/22
J0129INJECTION, ABATACEPT, 10 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED)Orencia11/15/13
J1559INJECTION, IMMUNE GLOBULIN (HIZENTRA), 100 MGHizentra1/15/11
J1814INSULIN (LYUMJEV), PER 5 UNITSLyumjev® 200 IU9/3/23
J3357USTEKINUMAB, FOR SUBCUTANEOUS INJECTION, 1 MGStelara™9/15/13
J3490UNCLASSIFIED DRUGStezepelumab-ekko (Tezspire™)7/10/22
J3590UNCLASSIFIED BIOLOGICStezepelumab-ekko (Tezspire™)7/10/22