Self-Administered Drug Exclusion List (SAD List)

Updated monthly
Contractor
Novitas (A53127)
Last updated
October 6, 2026
Excluded entries
236
HCPCS codes
56
Source
CMS

The full list

Excluded CPT/HCPCS codes

Our full list of 236 excluded entries from Novitas Solutions, Inc.'s CMS self-administered drug exclusion list (article A53127), last refreshed October 6, 2026. Search, sort, or export the list, which may change and could contain errors.

  • C9399 61 entries Unclassified drugs or biologicals
  • J3490 61 entries Unclassified drugs
  • J3590 61 entries Unclassified biologics

These three unclassified-drug codes account for 183 of the 236 excluded entries; the remainder are specific J-codes for individual products.

CodeDescriptor Generic NameDescriptor Brand NameExclusion Effective DateExclusion End DateReason for Exclusion
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSAbrilada (adalimumab-afzb) is biosimilar to HUMIRA Humira (adalimumab)6/25/23N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSAdbry (tralokinumab-idrm)11/14/22N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSAimovig (erenumab-aooe)12/2/19N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSAmjevita (adalimumab-atto)8/28/17N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSBesremi (ropeginterferon alfa-2b, injection for subcutaneous use)6/6/22N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSBimzelx (bimekizumab-bkzx)8/30/26N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSBydureon (exenatide extended release for injectable suspension)10/1/15N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSByetta (exenatide injection)10/1/15N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSCosentyx (secukinumab)10/24/16N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSCyltezo (adalimumab-adbm)12/2/19N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSDupixent (dupilumab)8/28/17N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSEbglyss (lebrikizumab-lbkz)6/1/25N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSEgrifta (tesamorelin)10/24/16N/APresumption of Long-Term Non-Acute Administration
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSEmgality (galcanezumab-gnlm)12/2/19N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSEntyvio (vedolizumab)1/14/24N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSErelzi (etanercept-SZZS)8/28/17N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSHadlima (adalimumab-bwwd) is biosimilar to Humira (adalimumab)6/25/23N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSHulio (adalimumab-fkjp) is biosimilar to Humira (adalimumab)6/25/23N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSHyrimoz (adalimumab-adaz) is biosimilar to Humira (adalimumab)6/25/23N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSIdacio (adalimumab-aacf)6/25/23N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSKesimpta* (ofatumumab, injection for subcutaneous use)9/19/22N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSKevzara (sarilumab)12/2/19N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSKineret 100mg (anakinra)10/24/16N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSKynamro (mipomersen sodium)8/28/17N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSLantus (insulin glargine injection)12/2/19N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSMounjaro (tirzepatide)3/27/23N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSMyalept 11mg (metreleptin for injection)10/1/15N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSNatpara (parathyroid hormone)10/24/16N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSNemluvio (nemolizumab-ilto)6/15/26N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSOrencia, subcutaneous*8/28/17N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSOtrexup (methotrexate injection)10/24/16N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSOzempic (semaglutide)12/2/19N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSPegasys, Pegasys Proclick (peginterferon alfa-2a)3/17/16N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSPegIntron (pegylated interferon alfa-2b)10/24/16N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSPlegridy (peginterferon beta-1a)10/24/16N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSPraluent (alirocumab)10/24/16N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSQuad-Mix8/28/17N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSRasuvo (methotrexate, injection for subcutaneous use)8/28/17N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSRebif 1 mcg (interferon beta-1a)10/24/16N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSRepatha (evolocumab)10/24/16N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSSaxenda (liraglutide)10/24/16N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSSignifor (pasireotide)10/1/15N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSSiliq (brodalumab)8/28/17N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSSimponi (golimumab)10/24/16N/APresumption of Long-Term Non-Acute Administration
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSSkyrizi (risankizumab-rzaa, injection for subcutaneous use)6/6/22N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSSogroya (somapacitan-beco, injection for subcutaneous use)6/6/22N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSSomavert (pegvisomant)10/24/16N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSStrensiq (asfotase alfa)10/24/16N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSSylatron (peginterferon alfa-2b)3/17/16N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSSymlin (pramlintide acetate injection)10/24/16N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSTaltz (ixekizumab)10/24/16N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSTanzeum 30mg (albiglutide for subcutaneous injection)10/1/15N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSToujeo (insulin glargine injection)10/24/16N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSTriMix3/17/16N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSTrulicity (dulaglutide)10/24/16N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSTymlos (abaloparatide)12/2/19N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSVictoza (liraglutide)10/1/15N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSWegovy (semaglutide)6/30/24N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSYuflyma (adalimumab-aaty)1/14/24N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSYusimry (adalimumab-aqvh) is biosimilar to Humira (adalimumab)6/25/23N/AApparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSZepbound (tirzepatide)6/30/24N/AApparent on its Face
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*12/2/19N/AApparent on its Face
J0139INJECTION, ADALIMUMAB, 1 MGHumira (adalimumab)3/16/25N/AApparent on its Face
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, Edex, Prostaglandin E18/13/12N/AApparent on its Face
J0275ALPROSTADIL 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)Muse8/13/12N/AApparent on its Face
J0364INJECTION, APOMORPHINE HYDROCHLORIDE, 1 MGApokyn8/28/17N/AApparent on its Face
J0490INJECTION, BELIMUMAB, 10 MGBenlysta (belimumab) subcutaneous use*12/2/19N/AApparent on its Face
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 (lanadelumab-flyo)12/2/19N/AApparent on its Face
J0599INJECTION, C-1 ESTERASE INHIBITOR (HUMAN), (HAEGARDA), 10 UNITSHaegarda (injection, c-1 esterase inhibitor [human])1/1/19N/AApparent on its Face
J0630INJECTION, CALCITONIN SALMON, UP TO 400 UNITSMiacalcin, Fortical8/13/12N/AApparent on its Face
J0801INJECTION, CORTICOTROPIN (ACTHAR GEL), UP TO 40 UNITSActhar Gel, subcutaneous*10/1/23N/AApparent on its Face
J0802INJECTION, CORTICOTROPIN (ANI), UP TO 40 UNITSPurified Cortrophin Gel, subcutaneous*10/1/23N/AApparent on its Face
J1324INJECTION, ENFUVIRTIDE, 1 MGFuzeon8/13/12N/AApparent on its Face
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)Enbrel8/13/12N/AApparent on its Face
J1595INJECTION, GLATIRAMER ACETATE, 20 MGCopaxone, Glatopa8/13/12N/AApparent on its Face
J1628INJECTION, GUSELKUMAB, 1 MGTremfya (guselkumab)*6/6/22N/AAcceptable Evidentiary Criteria Available
J1744INJECTION, ICATIBANT, 1 MGFirazyr (icatibant)10/1/15N/AApparent on its Face
J1748INJECTION, INFLIXIMAB-DYYB (ZYMFENTRA), 10 MGZymfentra (infliximab-dyyb)9/1/24N/AApparent on its Face
J1811INSULIN (FIASP) FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITSFiasp for insulin pump use9/3/23N/AApparent on its Face
J1812INSULIN (FIASP), PER 5 UNITSFiasp injection*9/3/23N/AApparent on its Face
J1813INSULIN (LYUMJEV) FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITSLyumjev for insulin pump use9/3/23N/AApparent on its Face
J1814INSULIN (LYUMJEV), PER 5 UNITSLyumjev injection*9/3/23N/AApparent on its Face
J1815INJECTION, INSULIN, PER 5 UNITSHumalog, Humulin, Lantus, Novolin, Novolog, etc.8/13/12N/AApparent on its Face
J1817INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITSLispro, Humalog, etc.8/13/12N/AApparent on its Face
J1826INJECTION, INTERFERON BETA-1A, 30 MCGAvonex6/6/22N/AApparent on its Face
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, Extavia8/13/12N/AApparent on its Face
J1941INJECTION, FUROSEMIDE (FUROSCIX), 20 MGFuroscix9/3/23N/AApparent on its Face
J2170INJECTION, MECASERMIN, 1 MGIncrelex8/13/12N/AApparent on its Face
J2212INJECTION, METHYLNALTREXONE, 0.1 MGRelistor (methylnaltrexone bromide)10/1/15N/AApparent on its Face
J2267INJECTION, MIRIKIZUMAB-MRKZ, 1 MGOmvoh (mirikizumab-mrkz)*7/1/24N/AApparent on its Face
J2354INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR INTRAVENOUS INJECTION, 25 MCGSandostatin, subcutaneous*8/13/12N/AApparent on its Face
J2941INJECTION, SOMATROPIN, 1 MGGenotropin, Humatrope, Norditropin, Nutropin, Omnitrope, Saizen, Serostim, Zomacton, Zorbtive8/13/12N/AApparent on its Face
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, Sumavel, Dosepro, Zembrace8/13/12N/AApparent on its Face
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 (fremanezumab-vfrm)12/2/19N/AApparent on its Face
J3110INJECTION, TERIPARATIDE, 10 MCGForteo8/13/12N/AApparent on its Face
J3357USTEKINUMAB, FOR SUBCUTANEOUS INJECTION, 1 MGStelara (ustekinumab) Subcutaneous6/6/22N/AAcceptable Evidentiary Criteria Available
J3490UNCLASSIFIED DRUGSAbrilada (adalimumab-afzb) is biosimilar to Humira (adalimumab)6/25/23N/AApparent on its Face
J3490UNCLASSIFIED DRUGSAdbry (tralokinumab-idrm)11/14/22N/AApparent on its Face
J3490UNCLASSIFIED DRUGSAimovig (erenumab-aooe)12/2/19N/AApparent on its Face
J3490UNCLASSIFIED DRUGSAmjevita (adalimumab-atto)8/28/17N/AApparent on its Face
J3490UNCLASSIFIED DRUGSBesremi (ropeginterferon alfa-2b, injection for subcutaneous use)6/6/22N/AApparent on its Face
J3490UNCLASSIFIED DRUGSBimzelx (bimekizumab-bkzx)8/30/26N/AApparent on its Face
J3490UNCLASSIFIED DRUGSBydureon (exenatide extended release for injectable suspension)10/1/15N/AApparent on its Face
J3490UNCLASSIFIED DRUGSByetta (exenatide injection)8/13/12N/AApparent on its Face
J3490UNCLASSIFIED DRUGSCosentyx (secukinumab)3/17/16N/AApparent on its Face
J3490UNCLASSIFIED DRUGSCyltezo (adalimumab-adbm)12/2/19N/AApparent on its Face
J3490UNCLASSIFIED DRUGSDupixent (dupilumab)8/28/17N/AApparent on its Face
J3490UNCLASSIFIED DRUGSEbglyss (lebrikizumab-lbkz)6/1/25N/AApparent on its Face
J3490UNCLASSIFIED DRUGSEgrifta (tesamorelin)10/24/16N/APresumption of Long-Term Non-Acute Administration
J3490UNCLASSIFIED DRUGSEmgality (galcanezumab-gnlm)12/2/19N/AApparent on its Face
J3490UNCLASSIFIED DRUGSEntyvio (vedolizumab)1/14/24N/AApparent on its Face
J3490UNCLASSIFIED DRUGSErelzi (etanercept-SZZS)8/28/17N/AApparent on its Face
J3490UNCLASSIFIED DRUGSHadlima (adalimumab-bwwd) is biosimilar to Humira (adalimumab)6/25/23N/AApparent on its Face
J3490UNCLASSIFIED DRUGSHulio (adalimumab-fkjp) is biosimilar to Humira (adalimumab)6/25/23N/AApparent on its Face
J3490UNCLASSIFIED DRUGSHyrimoz (adalimumab-adaz) is biosimilar to Humira (adalimumab)6/25/23N/AApparent on its Face
J3490UNCLASSIFIED DRUGSIdacio (adalimumab-aacf)6/25/23N/AApparent on its Face
J3490UNCLASSIFIED DRUGSKesimpta* (ofatumumab, injection for subcutaneous use)9/19/22N/AApparent on its Face
J3490UNCLASSIFIED DRUGSKevzara (sarilumab)12/2/19N/AApparent on its Face
J3490UNCLASSIFIED DRUGSKineret 100 mg (anakinra)8/13/12N/AApparent on its Face
J3490UNCLASSIFIED DRUGSKynamro (mipomersen sodium)8/28/17N/AApparent on its Face
J3490UNCLASSIFIED DRUGSLantus (insulin glargine)12/2/19N/AApparent on its Face
J3490UNCLASSIFIED DRUGSMounjaro (tirzepatide)3/27/23N/AApparent on its Face
J3490UNCLASSIFIED DRUGSMyalept 11 mg (metreleptin for injection)10/1/15N/AApparent on its Face
J3490UNCLASSIFIED DRUGSNatpara (parathyroid hormone)10/24/16N/AApparent on its Face
J3490UNCLASSIFIED DRUGSNemluvio (nemolizumab-ilto)6/15/26N/AApparent on its Face
J3490UNCLASSIFIED DRUGSOrencia, subcutaneous*8/28/17N/AApparent on its Face
J3490UNCLASSIFIED DRUGSOtrexup (methotrexate, injection)3/17/16N/AApparent on its Face
J3490UNCLASSIFIED DRUGSOzempic (semaglutide)12/2/19N/AApparent on its Face
J3490UNCLASSIFIED DRUGSPegasys, Pegasys Proclick (peginterferon alfa-2a)8/13/12N/AApparent on its Face
J3490UNCLASSIFIED DRUGSPegIntron (pegylated interferon alfa-2b)8/13/12N/AApparent on its Face
J3490UNCLASSIFIED DRUGSPlegridy (peginterferon beta-1a)10/24/16N/AApparent on its Face
J3490UNCLASSIFIED DRUGSPraluent (alirocumab)10/24/16N/AApparent on its Face
J3490UNCLASSIFIED DRUGSQuad-Mix8/28/17N/AApparent on its Face
J3490UNCLASSIFIED DRUGSRasuvo (methotrexate injection)8/28/17N/AApparent on its Face
J3490UNCLASSIFIED DRUGSRebif 1 mcg (interferon beta-1a)10/24/16N/AApparent on its Face
J3490UNCLASSIFIED DRUGSRepatha (evolocumab)10/24/16N/AApparent on its Face
J3490UNCLASSIFIED DRUGSSaxenda (liraglutide)10/24/16N/AApparent on its Face
J3490UNCLASSIFIED DRUGSSignifor (pasireotide)10/1/15N/AApparent on its Face
J3490UNCLASSIFIED DRUGSSiliq (brodalumab)8/28/17N/AApparent on its Face
J3490UNCLASSIFIED DRUGSSimponi (golimumab)10/24/16N/APresumption of Long-Term Non-Acute Administration
J3490UNCLASSIFIED DRUGSSkyrizi (risankizumab-rzaa, injection for subcutaneous use)6/6/22N/AApparent on its Face
J3490UNCLASSIFIED DRUGSSogroya (somapacitan-beco, injection for subcutaneous use)6/6/22N/AApparent on its Face
J3490UNCLASSIFIED DRUGSSomavert (pegvisomant)10/24/16N/AApparent on its Face
J3490UNCLASSIFIED DRUGSStrensiq (asfotase alfa)10/24/16N/AApparent on its Face
J3490UNCLASSIFIED DRUGSSylatro (peginterferon alfa-2b)3/17/16N/AApparent on its Face
J3490UNCLASSIFIED DRUGSSymlin (pramlintide acetate injection)8/13/12N/AApparent on its Face
J3490UNCLASSIFIED DRUGSTaltz (ixekizumab)10/24/16N/AApparent on its Face
J3490UNCLASSIFIED DRUGSTanzeum 30 mg (albiglutide for subcutaneous injection)10/1/15N/AApparent on its Face
J3490UNCLASSIFIED DRUGSToujeo (insulin glargine injection)10/24/16N/AApparent on its Face
J3490UNCLASSIFIED DRUGSTriMix3/17/16N/AApparent on its Face
J3490UNCLASSIFIED DRUGSTrulicity (dulaglutide)10/24/16N/AApparent on its Face
J3490UNCLASSIFIED DRUGSTymlos (abaloparatide)12/2/19N/AApparent on its Face
J3490UNCLASSIFIED DRUGSVictoza (liraglutide)10/1/15N/AApparent on its Face
J3490UNCLASSIFIED DRUGSWegovy (semaglutide)6/30/24N/AApparent on its Face
J3490UNCLASSIFIED DRUGSYuflyma (adalimumab-aaty)1/14/24N/AApparent on its Face
J3490UNCLASSIFIED DRUGSYusimry (adalimumab-aqvh) is biosimilar to Humira (adalimumab)6/25/23N/AApparent on its Face
J3490UNCLASSIFIED DRUGSZepbound (tirzepatide)6/30/24N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSAbrilada (adalimumab-afzb) is biosimilar to Humira (adalimumab)6/25/23N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSAdbry (tralokinumab-Idrm)11/14/22N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSAimovig (erenumab-aooe)12/2/19N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSAmjevita (adalimumab-atto)8/28/17N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSBesremi (ropeginterferon alfa-2b, injection for subcutaneous use)6/6/22N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSBimzelx (bimekizumab-bkzx)8/30/26N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSBydureon (exenatide extended release for injectable suspension)10/1/15N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSByetta (exenatide injection)10/1/15N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSCosentyx (secukinumab)3/17/16N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSCyltezo (adalimumab-adbm)12/2/19N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSDupixent (dupilumab)8/28/17N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSEbglyss (lebrikizumab-lbkz)6/1/25N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSEgrifta (tesamorelin)10/24/16N/APresumption of Long-Term Non-Acute Administration
J3590UNCLASSIFIED BIOLOGICSEmgality (galcanezumab-gnlm)12/2/19N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSEntyvio (vedolizumab)1/14/24N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSErelzi (etanercept-SZZS)8/28/17N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSHadlima (adalimumab-bwwd) is biosimilar to Humira (adalimumab)6/25/23N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSHulio (adalimumab-fkjp) is biosimilar to Humira (adalimumab)6/25/23N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSHyrimoz (adalimumab-adaz) is biosimilar to Humira (adalimumab)6/25/23N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSIdacio (adalimumab-aacf)6/25/23N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSKesimpta* (ofatumumab, injection for subcutaneous use)9/19/22N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSKevzara (sarilumab)12/2/19N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSKineret 100 mg (anakinra)10/24/16N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSKynamro (mipomersen sodium)8/28/17N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSLantus (insulin glargine injection)12/2/19N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSMounjaro (tirzepatide)3/27/23N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSMyalept 11 mg (metreleptin for injection)10/1/15N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSNatpara (parathyroid hormone)10/24/16N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSNemluvio (nemolizumab-ilto)6/15/26N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSOrencia, subcutaneous*8/28/17N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSOtrexup (methotrexate injection)10/24/16N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSOzempic (semaglutide)12/2/19N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSPegasys, Pegasys Proclick (peginterferon alfa-2a)3/17/16N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSPegIntron (pegylated interferon alfa-2b)10/24/16N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSPlegridy (peginterferon beta-1a)10/24/16N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSPraluent (alirocumab)10/24/16N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSQuad-Mix8/28/17N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSRasuvo (methotrexate injection)8/28/17N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSRebif 1 mcg (interferon beta-1a)10/24/16N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSRepatha (evolocumab)10/24/16N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSSaxenda (liraglutide)10/1/15N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSSignifor (pasireotide)10/1/15N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSSiliq (brodalumab)8/28/17N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSSimponi (golimumab)10/24/16N/APresumption of Long-Term Non-Acute Administration
J3590UNCLASSIFIED BIOLOGICSSkyrizi (risankizumab-rzaa, injection for subcutaneous use)6/6/22N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSSogroya (somapacitan-beco, injection for subcutaneous use)6/6/22N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSSomavert (pegvisomant)8/13/12N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSStrensiq (asfotase alfa)10/24/16N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSSylatron (peginterferon alfa-2b)3/17/16N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSSymlin (pramlintide acetate injection)10/24/16N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSTaltz (ixekizumab)10/24/16N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSTanzeum 30 mg (albiglutide for subcutaneous injection)10/1/15N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSToujeo (insulin glargine injection)3/17/16N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSTriMix10/24/16N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSTrulicity (dulaglutide)3/17/16N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSTymlos (abaloparatide)12/2/19N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSVictoza (liraglutide)10/1/15N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSWegovy (semaglutide)6/30/24N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSYuflyma (adalimumab-aaty)1/14/24N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSYusimry (adalimumab-aqvh) is biosimilar to Humira (adalimumab)6/25/23N/AApparent on its Face
J3590UNCLASSIFIED BIOLOGICSZepbound (tirzepatide)6/30/24N/AApparent on its Face
J9213INJECTION, INTERFERON, ALFA-2A, RECOMBINANT, 3 MILLION UNITSN/A8/13/12N/AApparent on its Face
J9216INJECTION, INTERFERON, GAMMA 1-B, 3 MILLION UNITSActimmune8/13/12N/AApparent on its Face
J9218LEUPROLIDE ACETATE, PER 1 MGLupron, Eligard8/13/12N/APresumption of Long-Term Non-Acute Administration
Q0515INJECTION, SERMORELIN ACETATE, 1 MICROGRAMN/A8/13/12N/AApparent on its Face
Q5098INJECTION, USTEKINUMAB-SRLF (IMULDOSA), BIOSIMILAR, 1 MGImuldosa (ustekinumab-srlf)*8/31/25N/AApparent on its Face
Q5099INJECTION, USTEKINUMAB-STBA (STEQEYMA), BIOSIMILAR, 1 MGSteqeyma (ustekinumab-stba)*7/1/25N/AApparent on its Face
Q5100INJECTION, USTEKINUMAB-KFCE (YESINTEK), BIOSIMILAR, 1 MGYesintek (ustekinumab-kfce)*8/31/25N/AApparent on its Face
Q5137INJECTION, USTEKINUMAB-AUUB (WEZLANA), BIOSIMILAR, SUBCUTANEOUS, 1 MGWezlana (ustekinumab-auub)7/1/24N/AApparent on its Face
Q5140INJECTION, ADALIMUMAB-FKJP, BIOSIMILAR, 1 MGHulio (adalimumab-fkjp)3/16/25N/AApparent on its Face
Q5141INJECTION, ADALIMUMAB-AATY, BIOSIMILAR, 1 MGYuflyma (adalimumab-aaty)3/16/25N/AApparent on its Face
Q5142INJECTION, ADALIMUMAB-RYVK BIOSIMILAR, 1 MGSimlandi (adalimumab-ryvk)3/16/25N/AApparent on its Face
Q5143INJECTION, ADALIMUMAB-ADBM, BIOSIMILAR, 1 MGCyltezo (adalimumab-adbm)3/16/25N/AApparent on its Face
Q5144INJECTION, ADALIMUMAB-AACF (IDACIO), BIOSIMILAR, 1 MGIdacio (adalimumab-aacf)3/16/25N/AApparent on its Face
Q5145INJECTION, ADALIMUMAB-AFZB (ABRILADA), BIOSIMILAR, 1 MGAbrilada (adalimumab-afzb)3/16/25N/AApparent on its Face
Q5164INJECTION, USTEKINUMAB-HMNY (STARJEMZA), BIOSIMILAR, 1 MGStarjemza (ustekinumab-hmny)*8/30/26N/AApparent on its Face
Q9996INJECTION, USTEKINUMAB-TTWE (PYZCHIVA), SUBCUTANEOUS, 1 MGPyzchiva (ustekinumab-ttwe)3/16/25N/AApparent on its Face
Q9998INJECTION, USTEKINUMAB-AEKN (SELARSDI), BIOSIMILAR, 1 MGSelarsdi (ustekinumab-aekn)*3/16/25N/AApparent on its Face
Q9999INJECTION, USTEKINUMAB-AAUZ (OTULFI), BIOSIMILAR, 1 MGOtulfi (ustekinumab-aauz)*6/1/25N/AApparent on its Face

Exclusion ended

Non-excluded (ended) codes

21 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.

CodeDescriptor Generic NameDescriptor Brand NameExclusion Effective DateExclusion End DateReason for Exclusion
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSOmvoh (mirikizumab-mrkz)* EFFECTIVE 7/1/2024 REPLACED BY CODE J2267 (SEE EXCLUDED CPT/HCPCS Codes TABLE ABOVE)1/14/247/1/24Apparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSSteqeyma (ustekinumab-stba)*6/1/257/1/25Apparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSWEZLANA (ustekinumab-auub)* EFFECTIVE 7/1/2024, REPLACED BY CODE Q5137 (SEE EXCLUDED CPT/HCPCS Codes TABLE ABOVE)3/17/247/1/24Apparent on its Face
C9399UNCLASSIFIED DRUGS OR BIOLOGICALSZinbryta™ (Daclizumab)10/24/161/1/21Apparent on its Face
J1558INJECTION, IMMUNE GLOBULIN (XEMBIFY), 100 MGXembify®6/6/226/6/22Apparent on its Face
J1559INJECTION, IMMUNE GLOBULIN (HIZENTRA), 100 MGHizentra®10/24/161/1/21Presumption of Long-Term Non-Acute Administration
J3262INJECTION, TOCILIZUMAB, 1 MGActemra®, subcutaneous*12/2/191/1/21Apparent on its Face
J3490UNCLASSIFIED DRUGSHaegarda (injection, c-1 esterase inhibitor [human])3/15/181/1/19Apparent on its Face
J3490UNCLASSIFIED DRUGSOmvoh (mirikizumab-mrkz)* EFFECTIVE 7/1/2024 REPLACED BY CODE J2267 (SEE EXCLUDED CPT/HCPCS Codes TABLE ABOVE)1/14/247/1/24Apparent on its Face
J3490UNCLASSIFIED DRUGSSteqeyma (ustekinumab-stba)*6/1/257/1/25Apparent on its Face
J3490UNCLASSIFIED DRUGSWEZLANA (ustekinumab-auub)* EFFECTIVE 7/1/2024, REPLACED BY CODE Q5137 (SEE EXCLUDED CPT/HCPCS Codes TABLE ABOVE)3/17/247/1/24Apparent on its Face
J3490UNCLASSIFIED DRUGSZinbryta™ (Daclizumab)10/24/161/1/21Apparent on its Face
J3590UNCLASSIFIED BIOLOGICSHaegarda (injection, c-1 esterase inhibitor [human])3/15/181/1/19Apparent on its Face
J3590UNCLASSIFIED BIOLOGICSOmvoh (mirikizumab-mrkz)* EFFECTIVE 7/1/2024 REPLACED BY CODE J2267 (SEE EXCLUDED CPT/HCPCS Codes TABLE ABOVE)1/14/247/1/24Apparent on its Face
J3590UNCLASSIFIED BIOLOGICSRaptiva (Efalizumab) *discontinued drug8/13/1210/1/15
J3590UNCLASSIFIED BIOLOGICSSimponi (Injection, golimumab)8/13/128/13/12
J3590UNCLASSIFIED BIOLOGICSSteqeyma (ustekinumab-stba)*6/1/257/1/25Apparent on its Face
J3590UNCLASSIFIED BIOLOGICSWEZLANA (ustekinumab-auub)* EFFECTIVE 7/1/2024, REPLACED BY CODE Q5137 (SEE EXCLUDED CPT/HCPCS Codes TABLE ABOVE)3/17/247/1/24Apparent on its Face
J3590UNCLASSIFIED BIOLOGICSZinbryta™ (Daclizumab)10/24/161/1/21Apparent on its Face
XX000Not ApplicableN/A8/13/128/13/12
XX000Not ApplicableNot Applicable8/13/128/13/12

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 →