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NDC	HCPCS	HCPCS Description	NDC Label	Route of Administration
67457-0323-25	J2281	INJECTION, MOXIFLOXACIN (FRESENIUS KABI) NOT THERAPEUTICALLY EQUIVALENT TO J2280, 100 MG	MOXIFLOXACIN HCL (FLEXIBAG,LATEX-FREE) 400 MG/250 ML	IV
67457-0348-10	J0295	INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER 1.5 GM	AMPICILLIN-SULBACTAM 1 GM-0.5 GM	IJ
67457-0348-15	J0295	INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER 1.5 GM	AMPICILLIN-SULBACTAM 1 GM-0.5 GM	IJ
67457-0349-03	J0295	INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER 1.5 GM	AMPICILLIN-SULBACTAM 2 GM-1 GM	IJ
67457-0349-10	J0295	INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER 1.5 GM	AMPICILLIN-SULBACTAM 2 GM-1 GM	IJ
67457-0350-10	J0290	INJECTION, AMPICILLIN SODIUM, 500 MG	AMPICILLIN (USP,CRYSTALLINE) 500 MG	IJ
67457-0351-10	J0290	INJECTION, AMPICILLIN SODIUM, 500 MG	AMPICILLIN (USP,CRYSTALLINE) 1 GM	IJ
67457-0352-10	J0290	INJECTION, AMPICILLIN SODIUM, 500 MG	AMPICILLIN (USP,CRYSTALLINE) 2 GM	IJ
67457-0353-10	J0290	INJECTION, AMPICILLIN SODIUM, 500 MG	AMPICILLIN (USP,CRYSTALLINE) 250 MG	IJ
67457-0359-59	J2680	INJECTION, FLUPHENAZINE DECANOATE, UP TO 25 MG	FLUPHENAZINE DECANOATE 25 MG/1 ML	IJ
67457-0372-99	J1644	INJECTION, HEPARIN SODIUM, PER 1000 UNITS	HEPARIN SODIUM (MDV,25X1ML) 1000 U/1 ML	IJ
67457-0373-99	J1644	INJECTION, HEPARIN SODIUM, PER 1000 UNITS	HEPARIN SODIUM (MDV,25X1ML,LATEX-FREE) 20000 U/1 ML	IJ

HCPCS Code	Description	Billing Unit	SA Type
L2192	Addition to lower extremity fracture orthosis, hip joint, pelvic band, thigh flange, and pelvic belt	Each	Y
L2200	Addition to lower extremity, limited ankle motion, each joint	Each	Y
L2210	Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint	Each	Y
L2220	Addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint	Each	Y
L2230	Addition to lower extremity, split flat caliper stirrups and plate attachment	Each	Y
L2232	Addition to lower extremity orthosis, rocker bottom for total contact ankle foot orthosis, for custom fabricated orthosis only	Each	Y
L2240	Addition to lower extremity, round caliper and plate attachment	Each	Y
L2250	Addition to lower extremity, foot plate, molded to patient model, stirrup attachment	Each	Y
L2260	Addition to lower extremity, reinforced solid stirrup (Scott-Craig type)	Each	Y
L2265	Addition to lower extremity, long tongue stirrup	Each	Y
L1300	Other scoliosis procedure, body jacket molded to patient model	Each	Y
L1310	Other scoliosis procedure, postoperative body jacket	Each	Y