Self-Administered Drug Exclusion List (SAD List)

Name: Self-Administered Drug (SAD) Exclusion List — Noridian Healthcare Solutions, LLC (A53033)
Creator: BuyandBill.com
Published: 2026-10-06

Updated monthly

Contractor: Noridian (A53033)
Last updated: October 6, 2026
Excluded entries: 168
HCPCS codes: 57
Source: CMS

The full list

Excluded CPT/HCPCS codes

Our full list of 168 excluded entries from Noridian Healthcare Solutions, LLC's CMS self-administered drug exclusion list (article A53033), last refreshed October 6, 2026. Search, sort, or export the list, which may change and could contain errors.

J3590 42 entries Unclassified biologics
C9399 38 entries Unclassified drugs or biologicals
J3490 33 entries Unclassified drugs

These three unclassified-drug codes account for 113 of the 168 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	Adalimumab-aacf (Idacio®)	6/25/23	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Adalimumab-aaty (Yuflyma)	1/14/24	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Adalimumab-adaz (Hyrimoz)	6/25/23	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Adalimumab-afzb (Abrilada™)	6/25/23	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Adalimumab-aqvh (Yusimry)	6/25/23	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Adalimumab-atto (Amjevita™)	2/28/17	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Adalimumab-bwwd (Hadlima)	6/25/23	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Adalimumab-fkjp (Hulio®)	6/25/23	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Albiglutide for SQ injection (Tanzeum™)	6/4/15	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Alirocumab (Praluent®)	11/24/15	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	All insulin products	6/27/16	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Asfotase-alfa (Strensiq™)	2/28/17	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	bimekizumab-bkzx (Bimzelx®)	8/29/26	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Brodalumab (Siliq)	8/7/17	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Dulaglutide (Trulicity®)	6/27/16	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Dupilumab (Dupixent)	8/7/17	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Etanercept-SZZS (Erelzi™)	12/6/16	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Evolucumab (Repatha™)	11/24/15	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Exenatide (Byetta®)	6/27/16	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Exenatide XR (Bydureon®)	6/4/15	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Interferon beta 1a (Rebif ®)	6/4/15	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Ixekizumab (Taltz™)	2/28/17	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	lebrikizumab-lbkz (Ebglyss)	6/1/25	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Methotrexate - Solution Auto-injector Non Chemotherapeutic (Otrexup™, Rasuvo®)	6/27/16	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Metreleptin for injection (Myalept ™)	6/4/15	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Nemolizumab-ilto (Nemluvio)	6/6/26	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	ofatumumab (Kesimpta®) subcutaneous use*	7/17/22	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Parathyroid Hormone (Natpara®)	6/27/16	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Pasireotide (Signifor®)	6/4/15	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Peginterferon beta-1a (Plegridy™)	6/27/16	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Risankizumab-rzaa (Skyrizi™) subcutaneous use	5/15/22	N/A	Presumption of Long-Term Non-Acute Administration, Acceptable Evidentiary Criteria Available
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Ropeginterferon alfa-2b-njft (Besremi®)	4/24/22	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Secukinumab (Cosentyx) subcutaneous use	6/4/15	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	somapacitan-beco (Sogroya®)	4/5/21	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Tirzepatide (Mounjaro™, Zepbound)	11/19/22	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	tralokinumab-ldrm (Adbry™)	11/1/22	N/A	Presumption of Long-Term Non-Acute Administration, Acceptable Evidentiary Criteria Available
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	ustekinumab-stba (SteQeyma)*	6/1/25	N/A	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Vedolizumab (Entyvio®) subcutaneous use*	1/14/24	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*	4/5/21	N/A	Apparent on its Face
J0139	INJECTION, ADALIMUMAB, 1 MG	Adalimumab	1/1/25	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)	Alprostadil&reg, Caverject&reg, Edex&reg, Prostin VR Pediatric&reg	1/15/03	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J0364	INJECTION, APOMORPHINE HYDROCHLORIDE, 1 MG	Apokyn®	6/4/15	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J0490	INJECTION, BELIMUMAB, 10 MG	Belimumab (Benlysta)*	11/15/25	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)	lanadelumab-flyo (TAKHZYRO)	12/2/19	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J0599	INJECTION, C-1 ESTERASE INHIBITOR (HUMAN), (HAEGARDA), 10 UNITS	HAEGARDA®	9/18/19	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J0630	INJECTION, CALCITONIN SALMON, UP TO 400 UNITS	Calcimar®, Miacalcin, Osteocalcin, Salmonine, Fortical	1/15/03	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J0801	INJECTION, CORTICOTROPIN (ACTHAR GEL), UP TO 40 UNITS	H.P. Acthar® Gel subcutaneous use**	10/1/23	N/A	Apparent on its Face
J0802	INJECTION, CORTICOTROPIN (ANI), UP TO 40 UNITS	H.P. Acthar® Gel subcutaneous use**	10/1/23	N/A	Apparent on its Face
J1324	INJECTION, ENFUVIRTIDE, 1 MG	Fuzeon&reg	5/1/04	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
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&reg	1/15/03	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J1595	INJECTION, GLATIRAMER ACETATE, 20 MG	Copaxone&reg	5/1/04	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J1628	INJECTION, GUSELKUMAB, 1 MG	guselkumab (Tremfya®)*	5/15/21	N/A	Acceptable Evidentiary Criteria Available
J1675	INJECTION, HISTRELIN ACETATE, 10 MICROGRAMS	Supprelin LA&reg	7/15/06	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J1744	INJECTION, ICATIBANT, 1 MG	Icatibant (Firazyr&reg)	7/31/12	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J1748	INJECTION, INFLIXIMAB-DYYB (ZYMFENTRA), 10 MG	Injection, infliximab-dyyb (zymfentra)	8/18/24	N/A	Apparent on its Face
J1811	INSULIN (FIASP) FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS	Fiasp®	8/20/23	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J1812	INSULIN (FIASP), PER 5 UNITS	Fiasp®	8/20/23	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J1813	INSULIN (LYUMJEV) FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS	Lyumjev®	8/20/23	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J1814	INSULIN (LYUMJEV), PER 5 UNITS	Lyumjev® - 100 IU*	8/20/23	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J1814	INSULIN (LYUMJEV), PER 5 UNITS	Lyumjev® - 200 IU	8/20/23	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J1815	INJECTION, INSULIN, PER 5 UNITS	All insulin products	11/1/03	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J1817	INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS	All insulin products	1/15/03	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
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&reg	1/15/03	N/A	Presumption of Long-Term Non-Acute Administration, Acceptable Evidentiary Criteria Available
J2170	INJECTION, MECASERMIN, 1 MG	Increlex&reg, Iplex	4/15/07	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J2212	INJECTION, METHYLNALTREXONE, 0.1 MG	Relistor®	9/30/13	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J2267	INJECTION, MIRIKIZUMAB-MRKZ, 1 MG	Mirikizumab-mrkz*	7/1/24	N/A	Apparent on its Face
J2354	INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR INTRAVENOUS INJECTION, 25 MCG	Octreotide Acetate (Sandostatin)*	10/15/05	N/A	Presumption of Long-Term Non-Acute Administration
J2440	INJECTION, PAPAVERINE HCL, UP TO 60 MG	Papaverine HCL	11/1/03	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J2941	INJECTION, SOMATROPIN, 1 MG	Humatrope, Genotropin, Omnitrope, (Saizen, Zorbtive, Zomacton, Norditropin, Nutropin)	1/15/03	N/A	Presumption of Long-Term Non-Acute Administration, Acceptable Evidentiary Criteria Available
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&reg	1/15/03	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
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)	Fremanezumab-vfrm (Ajovy)	9/18/19	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3110	INJECTION, TERIPARATIDE, 10 MCG	Forteo&reg	11/1/03	N/A	Presumption of Long-Term Non-Acute Administration
J3357	USTEKINUMAB, FOR SUBCUTANEOUS INJECTION, 1 MG	Stelara® subcutaneous	10/15/21	N/A	Acceptable Evidentiary Criteria Available
J3490	UNCLASSIFIED DRUGS	Adalimumab-aacf (Idacio®)	6/25/23	N/A	Apparent on its Face
J3490	UNCLASSIFIED DRUGS	Adalimumab-aaty (Yuflyma)	1/14/24	N/A	Apparent on its Face
J3490	UNCLASSIFIED DRUGS	Adalimumab-adaz (Hyrimoz)	6/25/23	N/A	Apparent on its Face
J3490	UNCLASSIFIED DRUGS	Adalimumab-adbm (Cyltezo)	9/18/19	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3490	UNCLASSIFIED DRUGS	Adalimumab-afzb (Abrilada™)	6/25/23	N/A	Apparent on its Face
J3490	UNCLASSIFIED DRUGS	Adalimumab-aqvh (Yusimry)	6/25/23	N/A	Apparent on its Face
J3490	UNCLASSIFIED DRUGS	Adalimumab-bwwd (Hadlima)	6/25/23	N/A	Apparent on its Face
J3490	UNCLASSIFIED DRUGS	Adalimumab-fkjp (Hulio®)	6/25/23	N/A	Apparent on its Face
J3490	UNCLASSIFIED DRUGS	Albiglutide for SQ injection (Tanzeum™)	6/4/15	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3490	UNCLASSIFIED DRUGS	All insulin products	9/18/19	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3490	UNCLASSIFIED DRUGS	bimekizumab-bkzx (Bimzelx®)	8/29/26	N/A	Apparent on its Face
J3490	UNCLASSIFIED DRUGS	Exenatide (Byetta®)	4/1/06	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3490	UNCLASSIFIED DRUGS	Exenatide XR (Bydureon®)	6/4/15	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3490	UNCLASSIFIED DRUGS	Interferon beta 1a, (Rebif®)	6/4/15	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3490	UNCLASSIFIED DRUGS	lebrikizumab-lbkz (Ebglyss)	6/1/25	N/A	Apparent on its Face
J3490	UNCLASSIFIED DRUGS	Liraglutide GLP-1 (Victoza®, Saxenda®)	9/30/13	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3490	UNCLASSIFIED DRUGS	Metreleptin for injection (Myalept™)	6/4/15	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3490	UNCLASSIFIED DRUGS	mipomersen sodium (Kynamro®)	6/26/13	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3490	UNCLASSIFIED DRUGS	Nemolizumab-ilto (Nemluvio)	6/6/26	N/A	Apparent on its Face
J3490	UNCLASSIFIED DRUGS	ofatumumab (Kesimpta®) subcutaneous use*	7/17/22	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3490	UNCLASSIFIED DRUGS	Pasireotide (Signifor®)	6/4/15	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3490	UNCLASSIFIED DRUGS	Peginterferon Alfa 2-b Sylatron, Pegintron	6/26/13	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3490	UNCLASSIFIED DRUGS	Pramlintide acetate, (Symlin®, SymlinPen 60, SymlinPen 120)	4/1/06	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3490	UNCLASSIFIED DRUGS	Risankizumab-rzaa (Skyrizi™) subcutaneous use	5/15/22	N/A	Presumption of Long-Term Non-Acute Administration, Acceptable Evidentiary Criteria Available
J3490	UNCLASSIFIED DRUGS	Ropeginterferon alfa-2b-njft (Besremi®)	4/24/22	N/A	Apparent on its Face
J3490	UNCLASSIFIED DRUGS	Secukinumab (Cosentyx) subcutaneous use	6/4/15	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3490	UNCLASSIFIED DRUGS	somapacitan-beco (Sogroya®)	4/5/21	N/A	Apparent on its Face
J3490	UNCLASSIFIED DRUGS	Tesamorelin Acetate (Egrifta®)	9/30/13	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3490	UNCLASSIFIED DRUGS	Tirzepatide (Mounjaro™, Zepbound)	11/1/22	N/A	Apparent on its Face
J3490	UNCLASSIFIED DRUGS	tralokinumab-ldrm (Adbry™)	11/1/22	N/A	Presumption of Long-Term Non-Acute Administration, Acceptable Evidentiary Criteria Available
J3490	UNCLASSIFIED DRUGS	Trimix	9/30/13	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3490	UNCLASSIFIED DRUGS	ustekinumab-stba (SteQeyma)*	6/1/25	N/A	Apparent on its Face
J3490	UNCLASSIFIED DRUGS	Vedolizumab (Entyvio®) subcutaneous use*	1/14/24	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	Abaloparatide (Tymlos)	9/18/19	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3590	UNCLASSIFIED BIOLOGICS	Abatacept (Orencia®)	9/30/13	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3590	UNCLASSIFIED BIOLOGICS	Adalimumab-aacf (Idacio®)	6/25/23	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	Adalimumab-aaty (Yuflyma)	1/14/24	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	Adalimumab-adaz (Hyrimoz)	6/25/23	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	Adalimumab-afzb (Abrilada™)	6/25/23	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	Adalimumab-aqvh (Yusimry)	6/25/23	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	Adalimumab-atto (Amjevita™)	2/28/17	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	Adalimumab-bwwd (Hadlima)	6/25/23	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	Adalimumab-fkjp (Hulio®)	6/25/23	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	Alcanezumab-gnlm (Emgality)	9/18/19	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3590	UNCLASSIFIED BIOLOGICS	Alirocumab (Praluent®)	11/24/15	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	All insulin products	6/27/16	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	Anakinra (Kineret&reg)	10/15/05	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3590	UNCLASSIFIED BIOLOGICS	Asfotase-alfa (Strensiq™)	2/28/17	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	bimekizumab-bkzx (Bimzelx®)	8/29/26	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	Brodalumab (Siliq)	8/7/17	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	Dulaglutide (Trulicity®)	6/27/16	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	Dupilumab (Dupixent)	8/7/17	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	Erenumab-aoooe (Aimovig)	9/18/19	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3590	UNCLASSIFIED BIOLOGICS	Etanercept-SZZS (Erelzi™)	12/6/16	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	Evolucumab (Repatha™)	11/24/15	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	Golimumab (Simponi®)	9/30/13	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3590	UNCLASSIFIED BIOLOGICS	Ixekizumab (Taltz™)	2/28/17	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	lebrikizumab-lbkz (Ebglyss)	6/1/25	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	Methotrexate - Solution Auto-injector Non Chemotherapeutic (Otrexup™, Rasuvo®)	6/27/16	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	Nemolizumab-ilto (Nemluvio)	6/6/26	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	ofatumumab (Kesimpta®) subcutaneous use*	7/17/22	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3590	UNCLASSIFIED BIOLOGICS	Parathyroid Hormone (Natpara®)	6/27/16	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	Peginterferon Alfa-2a (Pegasys™, Roferon®-A)	5/1/05	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3590	UNCLASSIFIED BIOLOGICS	Peginterferon beta-1a (Plegridy™)	6/27/16	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	Pegvisomant (Somavert&reg, variable)	5/1/04	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3590	UNCLASSIFIED BIOLOGICS	Risankizumab-rzaa (Skyrizi™) subcutaneous use	5/15/22	N/A	Presumption of Long-Term Non-Acute Administration, Acceptable Evidentiary Criteria Available
J3590	UNCLASSIFIED BIOLOGICS	Ropeginterferon alfa-2b-njft (Besremi®)	4/24/22	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	Sarilumab (Kevzara)	9/18/19	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3590	UNCLASSIFIED BIOLOGICS	Secukinumab (Cosentyx) subcutaneous use	6/4/15	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3590	UNCLASSIFIED BIOLOGICS	Semaglutide (Ozempic, Wegovy)	9/18/19	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3590	UNCLASSIFIED BIOLOGICS	somapacitan-beco (Sogroya®)	4/5/21	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	Tirzepatide (Mounjaro™, Zepbound)	11/19/22	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	tralokinumab-ldrm (Adbry™)	11/1/22	N/A	Presumption of Long-Term Non-Acute Administration, Acceptable Evidentiary Criteria Available
J3590	UNCLASSIFIED BIOLOGICS	ustekinumab-stba (SteQeyma)*	6/1/25	N/A	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	Vedolizumab (Entyvio®) subcutaneous use*	1/14/24	N/A	Apparent on its Face
J9213	INJECTION, INTERFERON, ALFA-2A, RECOMBINANT, 3 MILLION UNITS	Roferon-A&reg	11/1/03	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J9216	INJECTION, INTERFERON, GAMMA 1-B, 3 MILLION UNITS	Actimmune&reg	1/15/03	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J9218	LEUPROLIDE ACETATE, PER 1 MG	Leuprolide Acetate, Leuprolide Acetate Inj	1/15/03	N/A	Presumption of Long-Term Non-Acute Administration, Acceptable Evidentiary Criteria Available
Q0515	INJECTION, SERMORELIN ACETATE, 1 MICROGRAM	Geref®	4/15/07	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
Q3027	INJECTION, INTERFERON BETA-1A, 1 MCG FOR INTRAMUSCULAR USE	Avonex®, Avonex Pen®	6/4/15	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
Q3028	INJECTION, INTERFERON BETA-1A, 1 MCG FOR SUBCUTANEOUS USE	Rebif®	6/4/15	N/A	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
Q5098	INJECTION, USTEKINUMAB-SRLF (IMULDOSA), BIOSIMILAR, 1 MG	ustekinumab-srlf (imuldosa)*	7/1/25	N/A	Apparent on its Face
Q5099	INJECTION, USTEKINUMAB-STBA (STEQEYMA), BIOSIMILAR, 1 MG	ustekinumab-stba (steqeyma)*	7/1/25	N/A	Apparent on its Face
Q5100	INJECTION, USTEKINUMAB-KFCE (YESINTEK), BIOSIMILAR, 1 MG	ustekinumab-kfce (yesintek)*	7/1/25	N/A	Apparent on its Face
Q5137	INJECTION, USTEKINUMAB-AUUB (WEZLANA), BIOSIMILAR, SUBCUTANEOUS, 1 MG	ustekinumab-auub (wezlana)	7/1/24	N/A	Apparent on its Face
Q5140	INJECTION, ADALIMUMAB-FKJP, BIOSIMILAR, 1 MG	adalimumab-fkjp	1/1/25	N/A	Apparent on its Face
Q5141	INJECTION, ADALIMUMAB-AATY, BIOSIMILAR, 1 MG	adalimumab-aaty	1/1/25	N/A	Apparent on its Face
Q5142	INJECTION, ADALIMUMAB-RYVK BIOSIMILAR, 1 MG	adalimumab-ryvk	1/1/25	N/A	Apparent on its Face
Q5143	INJECTION, ADALIMUMAB-ADBM, BIOSIMILAR, 1 MG	adalimumab-adbm	1/1/25	N/A	Apparent on its Face
Q5144	INJECTION, ADALIMUMAB-AACF (IDACIO), BIOSIMILAR, 1 MG	adalimumab-aacf (idacio)	1/1/25	N/A	Apparent on its Face
Q5145	INJECTION, ADALIMUMAB-AFZB (ABRILADA), BIOSIMILAR, 1 MG	adalimumab-afzb (abrilada)	1/1/25	N/A	Apparent on its Face
Q5164	INJECTION, USTEKINUMAB-HMNY (STARJEMZA), BIOSIMILAR, 1 MG	ustekinumab-hmny (starjemza)*	8/29/26	N/A	Apparent on its Face
Q9996	INJECTION, USTEKINUMAB-TTWE (PYZCHIVA), SUBCUTANEOUS, 1 MG	ustekinumab-ttwe (pyzchiva)	1/1/25	N/A	Acceptable Evidentiary Criteria Available
Q9998	INJECTION, USTEKINUMAB-AEKN (SELARSDI), BIOSIMILAR, 1 MG	ustekinumab-aekn (selarsdi)*	1/1/25	N/A	Apparent on its Face
Q9999	INJECTION, USTEKINUMAB-AAUZ (OTULFI), BIOSIMILAR, 1 MG	Ustekinumab-aauz (Otulfi)*	6/1/25	N/A	Apparent on its Face

Exclusion ended

Non-excluded (ended) codes

22 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™)	2/28/17	2/18/21	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Mirikizumab-mrkz (Omvoh™) subcutaneous use*	1/14/24	6/30/24	Apparent on its Face
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	Tezspire™ (tezepelumab-ekko)	7/17/22	7/17/22	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS	ustekinumab-auub* (Wezlana)	3/17/24	6/30/24	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 (Abatacept)	9/30/13	9/30/13
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&reg	1/15/03	7/14/17	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J1559	INJECTION, IMMUNE GLOBULIN (HIZENTRA), 100 MG	Hizentra&reg	2/15/11	12/31/20	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J1575	INJECTION, IMMUNE GLOBULIN/HYALURONIDASE, (HYQVIA), 100 MG IMMUNEGLOBULIN	Immune globulin	2/11/16	7/25/16
J1628	INJECTION, GUSELKUMAB, 1 MG	Tremfya®	5/3/20	5/3/20	Acceptable Evidentiary Criteria Available
J2502	INJECTION, PASIREOTIDE LONG ACTING, 1 MG	Pasireotide long acting	2/11/16	10/1/16	Apparent on its Face
J2760	INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG	Regitine®	9/30/13	7/14/17	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3357	USTEKINUMAB, FOR SUBCUTANEOUS INJECTION, 1 MG	Stelara® subcutaneous	5/3/20	5/3/20	Acceptable Evidentiary Criteria Available
J3490	UNCLASSIFIED DRUGS	Methylnaltrexone bromide	9/30/13	7/14/17	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3490	UNCLASSIFIED DRUGS	Mirikizumab-mrkz (Omvoh™) subcutaneous use*	1/14/24	6/30/24	Apparent on its Face
J3490	UNCLASSIFIED DRUGS	Tezspire™ (tezepelumab-ekko)	7/17/22	7/17/22	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3490	UNCLASSIFIED DRUGS	ustekinumab-auub* (Wezlana)	3/17/24	6/30/24	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	Daclizumab (Zinbryta™)	2/28/17	2/18/21	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	efalizumab (Raptiva&reg), variable	5/1/04	7/14/17	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3590	UNCLASSIFIED BIOLOGICS	Mirikizumab-mrkz (Omvoh™) subcutaneous use*	1/14/24	6/30/24	Apparent on its Face
J3590	UNCLASSIFIED BIOLOGICS	Peginterferon Alfa 2-b, Sylatron, Pegintron	11/1/03	6/6/17	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3590	UNCLASSIFIED BIOLOGICS	Tezspire™ (tezepelumab-ekko)	7/17/22	7/17/22	Apparent on its Face, Presumption of Long-Term Non-Acute Administration
J3590	UNCLASSIFIED BIOLOGICS	ustekinumab-auub* (Wezlana)	3/17/24	6/30/24	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.
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.
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.

Check whether a drug is payable under Part B →

Usually self-administered

Route of administration

Apparent on its face

Acute vs. chronic use

Frequently asked questions