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NDC	HCPCS	HCPCS Description	NDC Label	Route of Administration
69918-0899-11	J2597	INJECTION, DESMOPRESSIN ACETATE, PER 1 MCG	DESMOPRESSIN ACETATE NOVAPLUS (PF) 4 MCG/1 ML	IJ
69918-0901-11	J2597	INJECTION, DESMOPRESSIN ACETATE, PER 1 MCG	DESMOPRESSIN ACETATE NOVAPLUS 4 MCG/1 ML	IJ
69918-0901-12	J2597	INJECTION, DESMOPRESSIN ACETATE, PER 1 MCG	PREMIERPRO RX DESMOPRESSIN ACETATE 4 MCG/1 ML	IJ
70020-1910-01	J9207	INJECTION, IXABEPILONE, 1 MG	IXEMPRA (W/DILUENT) 15 MG	IV
70020-1911-01	J9207	INJECTION, IXABEPILONE, 1 MG	IXEMPRA (W/DILUENT) 45 MG	IV
70069-0005-10	J3420	INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG	CYANOCOBALAMIN (M.D.V.,25X1ML) 1000 MCG/1 ML	IJ
70069-0021-25	J1100	INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG	DEXAMETHASONE SODIUM PHOSPHATE (PF,LATEX-FREE) 10 MG/1 ML	IJ
66795-0225-41	J2700	INJECTION, OXACILLIN SODIUM, UP TO 250 MG	OXACILLIN (BUFFERED) 1 GM	IJ
66887-0004-20	J3490	UNCLASSIFIED DRUGS	TESTOPEL PELLETS	SC
66993-0021-27	J7614	LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG	LEVALBUTEROL HCL (24X3ML,PF) 0.31 MG/3 ML	IH
66993-0021-27	J7614	LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG	LEVALBUTEROL HCL (24X3ML,PF) 0.31 MG/3 ML	IH
66993-0022-27	J7614	LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG	LEVALBUTEROL HCL (24X3ML,PF) 0.63 MG/3 ML	IH

HCPCS Code	Description	Billing Unit	SA Type
L1852	Knee orthosis (KO), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the shelf	Each	Y
L1860	KO, modification of supracondylar prosthetic socket, custom fabricated (SK)	Each	Y
L1900	AFO, spring wire, dorsiflexion assist calf band, custom fabricated	Each	Y
L1902	Ankle foot orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf	Each	Y
L1904	Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated	Each	Y
L1906	Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf	Each	Y
L1907	Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated	Each	Y
L1910	AFO, posterior, single bar, clasp attachment to shoe counter, prefabricated, includes fitting and adjustment	Each	Y
L1920	AFO, single upright with static or adjustable stop (Phelps or Perlstein type), custom fabricated	Each	Y
L1930	AFO, plastic or other material, prefabricated, includes fitting and adjustment	Each	Y
L1932	AFO, rigid anterior tibial section, total carbon fiber or equal material, prefabricated, includes fitting and adjustment	Each	Y
L1940	AFO, plastic or other material, custom fabricated	Each	Y