Table 4 – New Coverage for Hospital Drugs Previously Not Paid in 2003 (List is not all-inclusive)
J1626	Granisetron HCl injection	17.18	J9093	Cyclophosphamide lyophilized	2.36
J2353	Octreotide injection, depot	73.62	J9098	Cytarabine liposome	344.08
J2354	Octreotide inj, non-depot	3.94	J9100	Cytarabine hcl 100 MG inj	1.55
J2505	Pegfilgrastim, per 6 mg single dose vial Chg code from Q4053	2,596.00	J9130	Dacarbazine 100 mg inj	5.31
J2790	Rho d immune globulin inj	92.93	J9178	Inj, epirubicin hcl, 2 mg	25.60
J2820	Sargramostim injection	26.92	J9181	Etoposide 10 MG inj	0.83
J3315	Triptorelin pamoate, per 375 mg	59.58	J9213	Interferon alfa-2a inj	32.31
J3486	Ziprasidone mesylate, per 10 mg	3.11	J9214	Interferon alfa-2b inj	13.78
J7310	Ganciclovir long act implant	86.54	J9215	Interferon alfa-n3 inj	8.17
J7317	Sodium hyaluronate injection	67.16	J9270	Plicamycin (mithramycin) inj	86.89
J7525	Tacrolimus injection	110.04	J9320	Streptozocin injection	131.05
J8510	Oral busulfan	1.93	J9340	Thiotepa injection	45.31
J9000	Doxorubic hcl 10 MG vl chemo	4.69	J9395	Injection, Fulvestrant, per 25 mg	13.09
J9020	Asparaginase injection	58.00	Q0137	Darbepoetin alfa, non esrd	3.88
J9031	Bcg live intravesical vac	77.54	Q0166	Granisetron HCl 1 mg oral	171.78
J9070	Cyclophosphamide 100 MG inj	2.77	Q0180	Dolasetron mesylate oral	152.38
Drugs Previously Paid in 2003, but Not Covered in 2004
J9050	Carmus bischl nitro inj	.00	J9266	Pegaspargase/singl dose vial	.00
J9165	Diethylstilbestrol injection	.00

Note: Hospital Medicare drug fees are not subject to wage index or geographic adjustments. The same amount is paid to all hospitals, nationwide.