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NDC	HCPCS	HCPCS Description	NDC Label	Route of Administration
70594-0083-01	J0295	INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER 1.5 GM	AMPICILLIN-SULBACTAM (PHARMACY BULK, USP,PF) 10 GM-5 GM	IV
70594-0084-02	J0290	INJECTION, AMPICILLIN SODIUM, 500 MG	AMPICILLIN (USP,PF,LATEX-FREE) 250 MG	IJ
70594-0085-02	J0290	INJECTION, AMPICILLIN SODIUM, 500 MG	AMPICILLIN (USP,PF,LATEX-FREE) 500 MG	IJ
70594-0086-02	J0290	INJECTION, AMPICILLIN SODIUM, 500 MG	AMPICILLIN (USP,PF,LATEX-FREE) 1 GM	IJ
70594-0087-02	J0290	INJECTION, AMPICILLIN SODIUM, 500 MG	AMPICILLIN (PF,LATEX-FREE) 2 GM	IJ
70594-0088-01	J0290	INJECTION, AMPICILLIN SODIUM, 500 MG	AMPICILLIN (PHARMACY BULK;USP,PF) 10 GM	IV
70594-0089-02	J0692	INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG	CEFEPIME (SDV,PF,LATEX-FREE) 1 GM	IJ
70594-0090-02	J0692	INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG	CEFEPIME (SDV,PF,LATEX-FREE) 2 GM	IJ
70644-0899-99	J7682	TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, UNIT DOSE FORM, ADMINISTERED THROUGH DME, PER 300 MILLIGRAMS	TOBRAMYCIN INHALATION SOLUTION PAK (PF) 300 MG/5 ML	IH
70644-0899-99	J7682	TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, UNIT DOSE FORM, ADMINISTERED THROUGH DME, PER 300 MILLIGRAMS	TOBRAMYCIN INHALATION SOLUTION PAK (PF) 300 MG/5 ML	IH
70655-0002-06	J1450	INJECTION FLUCONAZOLE, 200 MG	FLUCONAZOLE (PF,LATEX-FREE) 200 MG/100 ML	IV
70655-0002-10	J1450	INJECTION FLUCONAZOLE, 200 MG	FLUCONAZOLE (PF,LATEX-FREE) 200 MG/100 ML	IV

HCPCS Code	Description	Billing Unit	SA Type
L1690	Combination, bilateral, lumbo-sacral, hip, femur orthosis providing adduction and internal rotation control, prefabricated, includes fitting and adjustment	Each	Y
L1700	Legg Perthes orthosis, (Toronto type), custom fabricated	Each	Y
L1710	Legg Perthes orthosis, (Newington type), custom fabricated	Each	Y
L1720	Legg Perthes orthosis, trilateral, (Tachdijan type), custom fabricated	Each	Y
L1730	Legg Perthes orthosis, (Scottish Rite type), custom fabricated	Each	Y
L1755	Legg Perthes orthosis, (Patten bottom type), custom fabricated	Each	Y
L1810	Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise	Each	Y
L1812	Knee orthosis, elastic with joints, prefabricated, off-the-shelf	Each	Y
L1820	KO, elastic with condylar pads and joints, with or without patellar control, prefabricated, includes fitting and adjustment	Each	Y
L1830	Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf	Each	Y
L1831	KO, locking knee joints(s), positional orthosis, prefabricated, includes fitting and adjustment	Each	Y
L1832	Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise	Each	Y