MAC Implementation File 8 - FY 2021 New Technology Add-on Payment (NTAP) - Technologies Continuing to Receive NTAP 			
Technology	Maximum Add-on Payment	ICD-10-CM/PCS Coding Used to Identify Cases Eligible for NTAP	Alternative Pathways Status
AndexXa 	"$18,281.25"	XW03372 or XW04372	
Azedra 	"$98,150.00"	XW033S5 or XW043S5	
Balversa (erdafitinib) 	"$3,563.23"	XW0DXL5	
CABLIVI (caplacizumab) 	"$33,215.00"	"XW013W5, XW033W5, or XW043W5"	
Elzonris 	"$125,448.05"	XW033Q5 or XW043Q5	
Jakafi (ruxolitinib) 	"$4,096.21"	XW0DXT5	
Spravato (esketamine)	"$1,014.79"	XW097M5	
T2 Bacteria Test Panel 	$97.50	XXE5XM5	
Xospata 	"$7,312.50"	XW0DXV5	
ZEMDRI (Plazomicin)	"$4,083.75"	XW033G4 or XW043G4	QIDP
