Self-Administered Drug Exclusion List (SAD List)
The full list
Excluded CPT/HCPCS codes
Our full list of 233 excluded entries from First Coast Service Options, Inc.'s CMS self-administered drug exclusion list (article A52571), last refreshed October 6, 2026. Search, sort, or export the list, which may change and could contain errors.
- C9399 60 entries Unclassified drugs or biologicals
- J3490 60 entries Unclassified drugs
- J3590 60 entries Unclassified biologics
These three unclassified-drug codes account for 180 of the 233 excluded entries; the remainder are specific J-codes for individual products.
| Code | Descriptor Generic Name | Descriptor Brand Name | Exclusion Effective Date | Exclusion End Date | Reason for Exclusion |
|---|---|---|---|---|---|
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Abrilada (adalimumab-afzb) is biosimilar to Humira (adalimumab) | 6/25/23 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Adbry (tralokinumab-Idrm) | 11/14/22 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Aimovig (erenumab-aooe) | 12/2/19 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Amjevita (adalimumab-atto) | 11/16/17 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Besremi (ropeginterferon alfa-2b, injection for subcutaneous use) | 6/6/22 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Bimzelx (bimekizumab-bkzx) | 8/30/26 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Bydureon (exenatide extended release for injectable suspension) | 8/6/12 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Byetta (exenatide injection) | 1/19/06 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Cosentyx (secukinumab) | 9/28/15 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Cyltezo (adalimumab-adbm) | 12/2/19 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Dupixent (dupilumab) | 11/16/17 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Ebglyss (lebrikizumab-lbkz) | 6/1/25 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Egrifta (tesamorelin) | 6/4/11 | N/A | Presumption of Long-Term Non-Acute Administration |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Emgality (galcanezumab-gnlm) | 12/2/19 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Entyvio (vedolizumab) | 1/14/24 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Erelzi (etanercept-SZZS) | 11/16/17 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Hadlima (adalimumab-bwwd) is biosimilar to Humira (adalimumab) | 6/25/23 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Hulio (adalimumab-fkjp) is biosimilar to Humira (adalimumab) | 6/25/23 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Hyrimoz (adalimumab-adaz) is biosimilar to Humira (adalimumab) | 6/25/23 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Idacio (adalimumab-aacf) | 6/25/23 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Kesimpta* (ofatumumab, injection for subcutaneous use) | 9/19/22 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Kevzara (sarilumab) | 12/2/19 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Kineret 100 mg (anakinra) | 4/13/03 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Kynamro (mipomersen sodium) | 11/16/17 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Lantus (insulin glargine injection) | 12/2/19 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Mounjaro (tirzepatide) | 3/27/23 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Myalept 11 mg (metreleptin for injection) | 10/13/14 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Natpara (parathyroid hormone) | 1/18/16 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Nemluvio (nemolizumab-ilto) | 6/15/26 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Otrexup (methotrexate injection) | 9/28/15 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Ozempic (semaglutide) | 12/2/19 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Pegasys, Pegasys Proclick (peginterferon alfa-2a) | 3/5/06 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | PegIntron (pegylated interferon alfa-2b) | 10/31/16 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Plegridy (peginterferon beta-1a) | 9/28/15 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Praluent (alirocumab) | 1/18/16 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Quad-Mix | 11/16/17 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Rasuvo (methotrexate, injection for subcutaneous use) | 11/16/17 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Rebif 1 mcg (interferon beta-1a) | 1/1/14 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Repatha (evolocumab) | 1/18/16 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Saxenda (liraglutide) | 10/31/16 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Signifor (pasireotide) | 6/17/13 | N/A | Presumption of Long-Term Non-Acute Administration |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Siliq (brodalumab) | 11/16/17 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Simponi (golimumab) | 5/1/10 | N/A | Presumption of Long-Term Non-Acute Administration |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Skyrizi (risankizumab-rzaa, injection for subcutaneous use) | 6/6/22 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Sogroya (somapacitan-beco, injection for subcutaneous use) | 6/6/22 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Somavert (pegvisomant) | 10/31/16 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Strensiq (asfotase alfa) | 5/23/16 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Sylatron (peginterferon alfa-2b) | 5/19/12 | N/A | Presumption of Long-Term Non-Acute Administration |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Symlin (pramlintide acetate injection) | 10/31/16 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Taltz (ixekizumab) | 10/31/16 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Tanzeum 30mg (albiglutide for subcutaneous injection) | 12/1/14 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Toujeo (insulin glargine injection) | 10/31/16 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | TriMix | 10/31/16 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Trulicity (dulaglutide) | 9/28/15 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Tymlos (abaloparatide) | 12/2/19 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Victoza (liraglutide) | 5/1/10 | N/A | Acceptable Evidentiary Criteria Available |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Wegovy (semaglutide) | 6/30/24 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Yuflyma (adalimumab-aaty) | 1/14/24 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Yusimry (adalimumab-aqvh) is biosimilar to Humira (adalimumab) | 6/25/23 | N/A | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Zepbound (tirzepatide) | 6/30/24 | N/A | Apparent on its Face |
| J0129 | INJECTION, 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* | 11/16/17 | N/A | Apparent on its Face |
| J0139 | INJECTION, ADALIMUMAB, 1 MG | Humira (adalimumab) | 3/16/25 | N/A | Apparent on its Face |
| J0270 | INJECTION, 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, Prostaglandin E1 | 11/29/02 | N/A | Presumption of Long-Term Non-Acute Administration |
| J0275 | ALPROSTADIL URETHRAL SUPPOSITORY (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED) | Muse | 10/31/16 | N/A | Apparent on its Face |
| J0364 | INJECTION, APOMORPHINE HYDROCHLORIDE, 1 MG | Apokyn | 11/16/17 | N/A | Apparent on its Face |
| J0490 | INJECTION, BELIMUMAB, 10 MG | Benlysta (belimumab) subcutaneous use* | 12/2/19 | N/A | Apparent on its Face |
| J0593 | INJECTION, 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 (lanadelumab-flyo) | 12/2/19 | N/A | Apparent on its Face |
| J0599 | INJECTION, C-1 ESTERASE INHIBITOR (HUMAN), (HAEGARDA), 10 UNITS | Haegarda (injection, c-1 esterase inhibitor [human]) | 1/1/19 | N/A | Apparent on its Face |
| J0630 | INJECTION, CALCITONIN SALMON, UP TO 400 UNITS | Miacalcin, Calcimar, Calcitonin-salmon | 12/26/11 | N/A | Apparent on its Face |
| J0801 | INJECTION, CORTICOTROPIN (ACTHAR GEL), UP TO 40 UNITS | Acthar Gel, subcutaneous use* | 10/1/23 | N/A | Apparent on its Face |
| J0802 | INJECTION, CORTICOTROPIN (ANI), UP TO 40 UNITS | Purified Cortrophin Gel, subcutaneous use* | 10/1/23 | N/A | Apparent on its Face |
| J1324 | INJECTION, ENFUVIRTIDE, 1 MG | Fuzeon | 11/26/04 | N/A | Apparent on its Face |
| J1438 | INJECTION, 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) | Enbrel | 12/20/99 | N/A | Apparent on its Face |
| J1595 | INJECTION, GLATIRAMER ACETATE, 20 MG | Copaxone, Glatopa | 4/12/03 | N/A | Apparent on its Face |
| J1628 | INJECTION, GUSELKUMAB, 1 MG | Tremfya (guselkumab)* | 6/6/22 | N/A | Acceptable Evidentiary Criteria Available |
| J1744 | INJECTION, ICATIBANT, 1 MG | Firazyr (icatibant) | 5/19/12 | N/A | Apparent on its Face |
| J1748 | INJECTION, INFLIXIMAB-DYYB (ZYMFENTRA), 10 MG | Zymfentra (infliximab-dyyb) | 9/1/24 | N/A | Apparent on its Face |
| J1811 | INSULIN (FIASP) FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS | Fiasp for insulin pump | 9/3/23 | N/A | Apparent on its Face |
| J1812 | INSULIN (FIASP), PER 5 UNITS | Fiasp injection* | 9/3/23 | N/A | Apparent on its Face |
| J1813 | INSULIN (LYUMJEV) FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS | Lyumjev for insulin pump | 9/3/23 | N/A | Apparent on its Face |
| J1814 | INSULIN (LYUMJEV), PER 5 UNITS | Lyumjev injection* | 9/3/23 | N/A | Apparent on its Face |
| J1815 | INJECTION, INSULIN, PER 5 UNITS | Humalog, Humulin, Lantus, Levemir, Novolin, Novolog | 8/1/02 | N/A | Apparent on its Face |
| J1817 | INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS | Humalog, Humulin, Novolin, Novolog, Insulin Lispro, Apidra Solostar | 4/30/09 | N/A | Apparent on its Face |
| J1826 | INJECTION, INTERFERON BETA-1A, 30 MCG | Avonex | 6/6/22 | N/A | Apparent on its Face |
| J1830 | INJECTION, 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, Extavia | 4/19/99 | N/A | Apparent on its Face |
| J1941 | INJECTION, FUROSEMIDE (FUROSCIX), 20 MG | Furoscix injection | 9/3/23 | N/A | Apparent on its Face |
| J2170 | INJECTION, MECASERMIN, 1 MG | Increlex | 10/31/16 | N/A | Apparent on its Face |
| J2212 | INJECTION, METHYLNALTREXONE, 0.1 MG | Relistor (methylnatrexone bromide) | 4/20/09 | N/A | Apparent on its Face |
| J2267 | INJECTION, MIRIKIZUMAB-MRKZ, 1 MG | Omvoh (mirikizumab-mrkz)* | 7/1/24 | N/A | Apparent on its Face |
| J2354 | INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR INTRAVENOUS INJECTION, 25 MCG | Sandostatin, subcutaneous use* | 10/31/16 | N/A | Apparent on its Face |
| J2941 | INJECTION, SOMATROPIN, 1 MG | Genotropin, Humatrope, Norditropin, Nutropin, Omnitrope, Saizen, Serostim, Zomacton, Zorbtive | 12/20/99 | N/A | Apparent on its Face |
| J3030 | INJECTION, 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, Sumavel, Dosepro, Zembrace | 11/29/02 | N/A | Apparent on its Face |
| J3031 | INJECTION, 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 (fremanezumab-vfrm) | 12/2/19 | N/A | Apparent on its Face |
| J3110 | INJECTION, TERIPARATIDE, 10 MCG | Forteo | 9/1/06 | N/A | Apparent on its Face |
| J3357 | USTEKINUMAB, FOR SUBCUTANEOUS INJECTION, 1 MG | Stelara (ustekinumab) Subcutaneous | 6/6/22 | N/A | Acceptable Evidentiary Criteria Available |
| J3490 | UNCLASSIFIED DRUGS | Abrilada (adalimumab-afzb) is biosimilar to Humira (adalimumab) | 6/25/23 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Adbry (tralokinumab-idrm) | 11/14/22 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Aimovig (erenumab-aooe) | 12/2/19 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Amjevita (adalimumab-atto) | 11/16/17 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Besremi (ropeginterferon alfa-2b, injection for subcutaneous use) | 6/6/22 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Bimzelx (bimekizumab-bkzx) | 8/30/26 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Bydureon (exenatide extended release for injectable suspension) | 8/6/12 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Byetta (exenatide injection) | 1/19/06 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Cosentyx (secukinumab) | 9/28/15 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Cyltezo (adalimumab-adbm) | 12/2/19 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Dupixent (dupilumab) | 11/16/17 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Ebglyss (lebrikizumab-lbkz) | 6/1/25 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Egrifta (tesamorelin) | 6/4/11 | N/A | Presumption of Long-Term Non-Acute Administration |
| J3490 | UNCLASSIFIED DRUGS | Emgality (galcanezumab-gnlm) | 12/2/19 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Entyvio (vedolizumab) | 1/14/24 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Erelzi (etanercept-SZZS) | 11/16/17 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Hadlima (adalimumab-bwwd) is biosimilar to Humira (adalimumab) | 6/25/23 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Hulio (adalimumab-fkjp) is biosimilar to Humira (adalimumab) | 6/25/23 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Hyrimoz (adalimumab-adaz) is biosimilar to Humira (adalimumab) | 6/25/23 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Idacio (adalimumab-aacf) | 6/25/23 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Kesimpta* (ofatumumab, injection for subcutaneous use) | 9/19/22 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Kevzara (sarilumab) | 12/2/19 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Kineret 100 mg (anakinra) | 4/13/03 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Kynamro (mipomersen sodium) | 11/16/17 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Lantus (insulin glargine injection) | 12/2/19 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Mounjaro (tirzepatide) | 3/27/23 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Myalept 11 mg (metreleptin for injection) | 10/13/14 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Natpara (parathyroid hormone) | 1/18/16 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Nemluvio (nemolizumab-ilto) | 6/15/26 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Otrexup (methotrexate injection) | 9/28/15 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Ozempic (semaglutide) | 12/2/19 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Pegasys, Pegasys Proclick (peginterferon alfa-2a) | 3/5/06 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | PegIntron (pegylated interferon alfa-2b) | 10/31/16 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Plegridy (peginterferon beta-1a) | 9/28/15 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Praluent (alirocumab) | 1/18/16 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Quad-Mix | 11/16/17 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Rasuvo (methotrexate, injection for subcutaneous use) | 11/16/17 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Rebif 1 mcg (interferon beta 1a) | 1/1/14 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Repatha (evolocumab) | 1/18/16 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Saxenda (liraglutide) | 10/31/16 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Signifor (pasireotide) | 6/17/13 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Siliq (brodalumab) | 11/16/17 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Simponi (golimumab) | 5/1/10 | N/A | Presumption of Long-Term Non-Acute Administration |
| J3490 | UNCLASSIFIED DRUGS | Skyrizi (risankizumab-rzaa, injection for subcutaneous use) | 6/6/22 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Sogroya (somapacitan-beco, injection for subcutaneous use) | 6/6/22 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Somavert (pegvisomant) | 10/31/16 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Strensiq (asfotase alfa) | 5/23/16 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Sylatron (peginterferon alfa-2b) | 5/19/12 | N/A | Presumption of Long-Term Non-Acute Administration |
| J3490 | UNCLASSIFIED DRUGS | Symlin (pramlintide acetate injection) | 10/31/16 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Taltz (ixekizumab) | 10/31/16 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Tanzeum 30 mg (albiglutide for subcutaneous injection) | 12/1/14 | N/A | Presumption of Long-Term Non-Acute Administration |
| J3490 | UNCLASSIFIED DRUGS | Toujeo (insulin glargine injection) | 10/31/16 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | TriMix | 10/31/16 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Trulicity (dulaglutide) | 9/28/15 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Tymlos (abaloparatide) | 12/2/19 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Victoza (liraglutide) | 5/1/10 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Wegovy (semaglutide) | 6/30/24 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Yuflyma (adalimumab-aaty) | 1/14/24 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Yusimry (adalimumab-aqvh) is biosimilar to Humira (adalimumab) | 6/25/23 | N/A | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Zepbound (tirzepatide) | 6/30/24 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Abrilada (adalimumab-afzb) is biosimilar to Humira (adalimumab) | 6/25/23 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Adbry (tralokinumab-idrm) | 11/14/22 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Aimovig (erenumab-aooe) | 12/2/19 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Amjevita (adalimumab-atto) | 11/16/17 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Besremi (ropeginterferon alfa-2b, injection for subcutaneous use) | 6/6/22 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Bimzelx (bimekizumab-bkzx) | 8/30/26 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Bydureon (exenatide extended release for injectable suspension) | 8/6/12 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Byetta (exenatide injection) | 1/19/06 | N/A | Presumption of Long-Term Non-Acute Administration |
| J3590 | UNCLASSIFIED BIOLOGICS | Cosentyx (secukinumab) | 9/28/15 | N/A | Presumption of Long-Term Non-Acute Administration |
| J3590 | UNCLASSIFIED BIOLOGICS | Cyltezo (adalimumab-adbm) | 12/2/19 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Dupixent (dupilumab) | 11/16/17 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Ebglyss (lebrikizumab-lbkz) | 6/1/25 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Egrifta (tesamorelin) | 6/4/11 | N/A | Presumption of Long-Term Non-Acute Administration |
| J3590 | UNCLASSIFIED BIOLOGICS | Emgality (galcanezumab-gnlm) | 12/2/19 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Entyvio (vedolizumab) | 1/14/24 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Erelzi (etanercept-SZZS) | 11/16/17 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Hadlima (adalimumab-bwwd) is biosimilar to Humira (adalimumab) | 6/25/23 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Hulio (adalimumab-fkjp) is biosimilar to Humira (adalimumab) | 6/25/23 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Hyrimoz (adalimumab-adaz) is biosimilar to Humira (adalimumab) | 6/25/23 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Idacio (adalimumab-aacf) | 6/25/23 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Kesimpta* (ofatumumab, injection for subcutaneous use) | 9/19/22 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Kevzara (sarilumab) | 12/2/19 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Kineret 100 mg (anakinra) | 4/13/03 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Kynamro (mipomersen sodium) | 11/16/17 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Lantus (insulin glargine injection) | 12/2/19 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Mounjaro (tirzepatide) | 3/27/23 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Myalept 11 mg (metreleptin for injection) | 10/13/14 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Natpara (parathyroid hormone) | 1/18/16 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Nemluvio (nemolizumab-ilto) | 6/15/26 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Otrexup (methotrexate injection) | 9/28/15 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Ozempic (semaglutide) | 12/2/19 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Pegasys, Pegasys Proclick (peginterferon alfa-2a) | 3/5/06 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | PegIntron (pegylated interferon alfa-2b) | 10/31/16 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Plegridy (peginterferon beta-1a) | 9/28/15 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Praluent (alirocumab) | 1/16/16 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Quad-Mix | 11/16/17 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Rasuvo (methotrexate, injection for subcutaneous use) | 11/16/17 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Rebif 1 mcg (interferon beta 1a) | 1/1/14 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Repatha (evolocumab) | 1/18/16 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Saxenda (liraglutide) | 10/31/16 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Signifor (pasireotide) | 6/17/13 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Siliq (brodalumab) | 11/16/17 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Simponi (golimumab) | 5/10/10 | N/A | Presumption of Long-Term Non-Acute Administration |
| J3590 | UNCLASSIFIED BIOLOGICS | Skyrizi (risankizumab-rzaa, injection for subcutaneous use) | 6/6/22 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Sogroya (somapacitan-beco, injection for subcutaneous use) | 6/6/22 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Somavert (pegvisomant) | 10/31/16 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Strensiq (asfotase alfa) | 5/23/16 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Sylatron (peginterferon alfa-2b) | 5/19/12 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Symlin (pramlintide acetate injection) | 10/31/16 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Taltz (ixekizumab) | 10/31/16 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Tanzeum 30 mg (albiglutide for subcutaneous injection) | 12/1/14 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Toujeo (insulin glargine injection) | 10/31/16 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | TriMix | 10/31/16 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Trulicity (dulaglutide) | 9/28/15 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Tymlos (abaloparatide) | 12/2/19 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Victoza (liraglutide) | 5/1/10 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Wegovy (semaglutide) | 6/30/24 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Yuflyma (adalimumab-aaty) | 1/14/24 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Yusimry (adalimumab-aqvh) is biosimilar to Humira (adalimumab) | 6/25/23 | N/A | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Zepbound (tirzepatide) | 6/30/24 | N/A | Apparent on its Face |
| J9213 | INJECTION, INTERFERON, ALFA-2A, RECOMBINANT, 3 MILLION UNITS | N/A | 10/31/16 | N/A | Apparent on its Face |
| J9216 | INJECTION, INTERFERON, GAMMA 1-B, 3 MILLION UNITS | Actimmune | 10/31/16 | N/A | Apparent on its Face |
| J9218 | LEUPROLIDE ACETATE, PER 1 MG | Lupron, Eligard | 12/20/99 | N/A | Apparent on its Face |
| Q0515 | INJECTION, SERMORELIN ACETATE, 1 MICROGRAM | N/A | 10/23/16 | N/A | Apparent on its Face |
| Q5098 | INJECTION, USTEKINUMAB-SRLF (IMULDOSA), BIOSIMILAR, 1 MG | Imuldosa (ustekinumab-srlf)* | 8/31/25 | N/A | Apparent on its Face |
| Q5099 | INJECTION, USTEKINUMAB-STBA (STEQEYMA), BIOSIMILAR, 1 MG | Steqeyma (ustekinumab-stba)* | 7/1/25 | N/A | Apparent on its Face |
| Q5100 | INJECTION, USTEKINUMAB-KFCE (YESINTEK), BIOSIMILAR, 1 MG | Yesintek (ustekinumab-kfce)* | 8/31/25 | N/A | Apparent on its Face |
| Q5137 | INJECTION, USTEKINUMAB-AUUB (WEZLANA), BIOSIMILAR, SUBCUTANEOUS, 1 MG | Wezlana (ustekinumab-auub) | 7/1/24 | N/A | Apparent on its Face |
| Q5140 | INJECTION, ADALIMUMAB-FKJP, BIOSIMILAR, 1 MG | Hulio (adalimumab-fkjp) | 3/16/25 | N/A | Apparent on its Face |
| Q5141 | INJECTION, ADALIMUMAB-AATY, BIOSIMILAR, 1 MG | Yuflyma (adalimumab-aaty) | 3/16/25 | N/A | Apparent on its Face |
| Q5142 | INJECTION, ADALIMUMAB-RYVK BIOSIMILAR, 1 MG | Simlandi (adalimumab-ryvk) | 3/16/25 | N/A | Apparent on its Face |
| Q5143 | INJECTION, ADALIMUMAB-ADBM, BIOSIMILAR, 1 MG | Cyltezo (adalimumab-adbm) | 3/16/25 | N/A | Apparent on its Face |
| Q5144 | INJECTION, ADALIMUMAB-AACF (IDACIO), BIOSIMILAR, 1 MG | Idacio (adalimumab-aacf) | 3/16/25 | N/A | Apparent on its Face |
| Q5145 | INJECTION, ADALIMUMAB-AFZB (ABRILADA), BIOSIMILAR, 1 MG | Abrilada (adalimumab-afzb) | 3/16/25 | N/A | Apparent on its Face |
| Q5164 | INJECTION, USTEKINUMAB-HMNY (STARJEMZA), BIOSIMILAR, 1 MG | Starjemza (ustekinumab-hmny)* | 8/30/26 | N/A | Apparent on its Face |
| Q9996 | INJECTION, USTEKINUMAB-TTWE (PYZCHIVA), SUBCUTANEOUS, 1 MG | Pyzchiva (ustekinumab-ttwe) | 3/16/25 | N/A | Apparent on its Face |
| Q9998 | INJECTION, USTEKINUMAB-AEKN (SELARSDI), BIOSIMILAR, 1 MG | Selarsdi (ustekinumab-aekn)* | 3/16/25 | N/A | Apparent on its Face |
| Q9999 | INJECTION, USTEKINUMAB-AAUZ (OTULFI), BIOSIMILAR, 1 MG | Otulfi (ustekinumab-aauz)* | 6/1/25 | N/A | Apparent on its Face |
Exclusion ended
Non-excluded (ended) codes
25 CPT/HCPCS codes whose exclusion carries an end date. As of that date the exclusion no longer applies, so the code is no longer treated as self-administered for Part B purposes.
| Code | Descriptor Generic Name | Descriptor Brand Name | Exclusion Effective Date | Exclusion End Date | Reason for Exclusion |
|---|---|---|---|---|---|
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Daclizumab (Zinbryta™) | 10/31/16 | 1/1/21 | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Icatibant (Firazyr ®) | 5/19/12 | 12/31/12 | |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | methylnatrexone bromide (Relistor®) | 4/20/09 | 12/31/12 | |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Omvoh (mirikizumab-mrkz)* EFFECTIVE 7/1/2024 REPLACED BY CODE J2267 (SEE EXCLUDED CPT/HCPCS Codes TABLE ABOVE) | 1/14/24 | 7/1/24 | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Orencia®, subcutaneous only | 11/16/17 | 12/2/19 | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | Steqeyma (ustekinumab-stba)* | 6/1/25 | 7/1/25 | Apparent on its Face |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS | WEZLANA (ustekinumab-auub)* EFFECTIVE 7/1/2024, REPLACED BY CODE Q5137 (SEE EXCLUDED CPT/HCPCS Codes TABLE ABOVE) | 3/17/24 | 7/1/24 | Apparent on its Face |
| J1558 | INJECTION, IMMUNE GLOBULIN (XEMBIFY), 100 MG | Xembify® | 6/6/22 | 6/6/22 | Apparent on its Face |
| J1559 | INJECTION, IMMUNE GLOBULIN (HIZENTRA), 100 MG | Hizentra® | 6/18/11 | 1/1/21 | Presumption of Long-Term Non-Acute Administration |
| J2502 | INJECTION, PASIREOTIDE LONG ACTING, 1 MG | Injection Pasireotide long acting 1 mg | 10/31/16 | 4/5/21 | Apparent on its Face |
| J3262 | INJECTION, TOCILIZUMAB, 1 MG | Actemra® (tocilizumab) subcutaneous use* | 12/2/19 | 1/1/21 | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Daclizumab (Zinbryta™) | 10/31/16 | 1/1/21 | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Haegarda® (C1 Esterase Inhibitor Subcutaneous [Human]) | 4/2/18 | 12/31/18 | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Icatibant (Firazyr ®) | 5/19/12 | 12/31/12 | |
| J3490 | UNCLASSIFIED DRUGS | methylnatrexone bromide (Relistor®) | 4/20/09 | 12/31/12 | |
| J3490 | UNCLASSIFIED DRUGS | Omvoh (mirikizumab-mrkz)* EFFECTIVE 7/1/2024 REPLACED BY CODE J2267 (SEE EXCLUDED CPT/HCPCS Codes TABLE ABOVE) | 1/14/24 | 7/1/24 | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | Steqeyma (ustekinumab-stba)* | 6/1/25 | 7/1/25 | Apparent on its Face |
| J3490 | UNCLASSIFIED DRUGS | WEZLANA (ustekinumab-auub)* EFFECTIVE 7/1/2024, REPLACED BY CODE Q5137 (SEE EXCLUDED CPT/HCPCS Codes TABLE ABOVE) | 3/17/24 | 7/1/24 | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Daclizumab (Zinbryta™) | 10/31/16 | 1/1/21 | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Haegarda® (C1 Esterase Inhibitor Subcutaneous [Human]) | 4/2/18 | 12/31/18 | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Icatibant (Firazyr ®) | 5/19/12 | 12/31/12 | |
| J3590 | UNCLASSIFIED BIOLOGICS | Omvoh (mirikizumab-mrkz)* EFFECTIVE 7/1/2024 REPLACED BY CODE J2267 (SEE EXCLUDED CPT/HCPCS Codes TABLE ABOVE) | 1/14/24 | 7/1/24 | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Orencia®, subcutaneous only | 11/16/17 | 12/2/19 | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | Steqeyma (ustekinumab-stba)* | 6/1/25 | 7/1/25 | Apparent on its Face |
| J3590 | UNCLASSIFIED BIOLOGICS | WEZLANA (ustekinumab-auub)* EFFECTIVE 7/1/2024, REPLACED BY CODE Q5137 (SEE EXCLUDED CPT/HCPCS Codes TABLE ABOVE) | 3/17/24 | 7/1/24 | Apparent on its Face |
Overview
What is the SAD exclusion list?
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 Part B when administered by a physician, whether in a physician's office or 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.
Each Medicare Administrative Contractor (MAC) maintains its own exclusion list, and CMS refreshes the underlying data quarterly. BuyandBill.com republishes each MAC's self-administered drug exclusion list from the CMS Coverage API so providers can check a code before billing.
How it is decided
How CMS decides a drug is self-administered
A drug lands on the exclusion list when CMS determines it is usually administered by the patient. Four factors drive that determination.
-
Usually self-administered
CMS excludes a drug when it is self-administered more than 50% of the time across all Medicare beneficiaries who use it, a population-level determination rather than a single claim.
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Route of administration
Products a patient can reasonably give themselves, such as subcutaneous injections or oral therapies, are far more likely to be excluded than infusions that require clinical administration.
-
Apparent on its face
Some products are excluded because they are plainly intended for patient self-administration. This is the determination method recorded for the entries on this list.
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Acute vs. chronic use
CMS weighs whether a drug treats an acute condition, more often given in the office, or a chronic one the patient manages at home over an extended course of therapy.
FAQ
Frequently asked questions
What is the self-administered drug (SAD) exclusion list?
The SAD exclusion list is a CMS list of drugs that are usually self-administered by the patient and are therefore not typically covered by Medicare Part B when administered by a physician, whether in a physician's office or a hospital outpatient setting. Each Medicare Administrative Contractor (MAC) publishes its own exclusion list; BuyandBill.com republishes the list in conjunction with the CMS data file.
Why does Medicare Part B not cover these drugs?
Medicare Part B generally covers drugs that are administered by a physician or under direct supervision and that are not usually self-administered. When a drug is usually self-administered, the cost is expected to fall under Part D or the patient rather than Part B.
What does "Apparent on its Face" mean?
It is one of the methods CMS uses to determine that a drug is self-administered. The product is excluded because it is clearly intended for the patient to administer themselves.
How often is the SAD list updated?
CMS updates the self-administered drug exclusion data on a quarterly basis. BuyandBill.com refreshes the list monthly from the CMS Coverage API so it reflects the current version of each contractor’s article.
What is the difference between the excluded and the non-excluded (ended) list?
The excluded list contains codes currently treated as self-administered and not covered by Part B in the outpatient setting. The non-excluded list contains codes whose exclusion has an end date, meaning the exclusion no longer applies as of that date.
How does the SAD list affect buy and bill?
If an office-administered drug appears on the exclusion list, a Part B claim in the outpatient setting may be denied as self-administered. Checking the list before billing helps providers avoid denials and route the claim correctly.
