| Corrections to the January 2005 Payment Allowance Limits For Medicare Part B Drugs | ||||
| Effective January 1, 2005 | ||||
| HCPCS | Short Description | HCPCS Code Dosage | 1st Quarter 05 Payment Limit | 1st Quarter Independent ESRD Limit |
| 90747 | ENGERIX-B | 40 MCG | $113.91 | $113.91 |
| J0835 | Inj cosyntropin per 0.25 MG | 0.25 MG | $64.60 | $64.60 |
| J1563 | IV immune globulin | 1 GRAM | $56.72 | $56.72 |
| J1564 | Immune globuline 10 mg | 10 MG | $0.57 | $0.57 |
| J1655 | Tinzaparin sodium injection | 1000 IU | $2.60 | $2.60 |
| J2324 | Nesiritide | 0.25 MG (revised) | $73.33 | $73.33 |
| J3315 | Triptorelin pamoate | 3.75 MG | $180.93 | $180.93 |
| J3470 | Inj hyaluronidase | up to 150 units | $20.00 | $20.00 |
| J7030 | Sodium Chloride | 1000 CC | $0.10 | $0.10 |
| J7350 | Injectable human tissue | 10 MG | $4.53 | $4.53 |
| J7611 | Albuterol concentrated form | 1 MG | $0.07 | $0.07 |
| J8501 | Oral aprepitant | 5 MG | $4.62 | $4.62 |
| J9185 | Fludarabine phosphate inj | 50 MG | $272.09 | $272.09 |
| J9214 | Intron-A | 1 UNIT | $13.12 | $13.12 |
| Q0179 | Zofran | 8 MG | $30.86 | $30.86 |
| Q2014 | Geref | 0.5 MG | $8.77 | $8.77 |
| 1/20/2005 | ||||
| Reference: CR 3695 | ||||