Appendix Z

List of Outpatient Hospital Specialty Drugs

For the Outpatient Hospital Specialty Drugs which are carved out from Enhanced Ambulatory Patient Group (EAPG) payment and their corresponding codes for use in billing, please refer to the Outpatient Hospital Specialty Drugs List.

This is a resource list of the medication names of the current outpatient hospital specialty drugs which are carved out from Enhanced Ambulatory Patient Group (EAPG) payment with an approved, member-specific prior authorization (PA).

For the corresponding Healthcare Common Procedure Coding System (HCPCS) codes and National Drug Code (NDC) numbers for use in billing, please refer to Appendix X: The HCPCS/NDC Crosswalk for billing Physician Administered Drugs (PADs).

Appendix Z Revision Log