Macugen

• Official CMSCMSNDC–HCPCS Crosswalks (ASP, OPPS, AWP, PrEP, NOC)Q4 2026·Effective Oct 1, 2026 – Dec 31, 2026·Published 09/17/2026 - Final file·Imported Oct 15, 2026 05:54 UTCSource file (opens CMS website)
• Official CMSCMSHCPCS Level II Quarterly Update (Alpha-Numeric HCPCS File)Q4 2026·Effective Oct 1, 2026 – Dec 31, 2026·Published Updated 09/23/2026·Imported Oct 15, 2026 05:52 UTCSource file (opens CMS website)
• Derived calculationDrug-to-code links are aggregated from NDC-level CMS crosswalk rows.

Home infusion per diem (S-codes)

When a home infusion pharmacy dispenses this drug, the drug is billed with the code above and each day of pharmacy services, supplies, and equipment with a per diem S-code. CMS publishes no drug-to-per-diem crosswalk, so CodeRx picks the therapy category from the FDA pharmacologic class and route. S-codes are not payable by Medicare; confirm the code against the payer contract.

• Not otherwise classified

  Derived calculationVerification needed

  No category matched · FDA class: No FDA pharmacologic class (EPC) listed

  • S9379Infusion therapy with no specific per diem codeCMS: Home infusion therapy, infusion therapy, not otherwise classified
  • S9542Injectable therapy with no specific per diem codeCMS: Home injectable therapy, not otherwise classified

  No specific category was found in this drug’s FDA pharmacologic class. Use a specific code instead when the therapy is one CodeRx cannot detect: hydration (S9373–S9377), tocolytic (S9349), anti-spasmodic (S9363), blood products (S9538), or irrigation (S9590).

Home infusion per diem (S-codes)

Medicare

Not payable by Medicare — CMS coverage code I (all 2 codes)

Part B pricing indicator

00 — Not separately priced by Part B (all 2 codes)

National payment amount

None. No per diem code here is in the CMS Part B payment limit file for Q4 2026; CMS sets no national per diem rate.

Washington Apple Health (Medicaid)

Not on HCA’s Home Infusion Therapy/Parenteral Nutrition Program fee schedule (effective Jul 1, 2026), so these per diems are not separately paid. Home infusion is paid with the supply, pump, and nutrition codes in that schedule instead (below).

Billing unit

1 unit = 1 day on service (the CMS descriptor ends “per diem”)

Who sets the rate

Each commercial plan’s contract or state Medicaid fee schedule. Some payers reduce a second per diem billed for the same day.

Billed separately

The drug, with its own HCPCS code and units, and nursing visits — the CMS descriptor says “drugs and nursing visits coded separately”.

Verification neededCodeRx links to coverage documents instead of copying them: CMS distributes their code lists under AMA, ADA, and AHA license terms that limit reuse. Medicare Advantage, Medicaid, and commercial plans set their own coverage and prior-authorization rules.

Every import with its checksum is listed on the data sources page.