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NDC | HCPCS | HCPCS Description | NDC Label | Route of Administration |
|---|---|---|---|---|
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 |
66993-0023-27 | J7614 | LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG | LEVALBUTEROL HCL (24X3ML,PF) 1.25 MG/3 ML | IH |
66993-0023-27 | J7614 | LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG | LEVALBUTEROL HCL (24X3ML,PF) 1.25 MG/3 ML | IH |
66993-0038-83 | J1729 | INJECTION, HYDROXYPROGESTERONE CAPROATE, NOT OTHERWISE SPECIFIED, 10 MG | HYDROXYPROGESTERONE CAPROATE (PF) 250 MG/1 ML | IM |
66993-0039-01 | J1729 | INJECTION, HYDROXYPROGESTERONE CAPROATE, NOT OTHERWISE SPECIFIED, 10 MG | HYDROXYPROGESTERONE CAPROATE (MDV) 250 MG/1 ML | IM |
66993-0083-79 | J3030 | INJECTION, SUMATRIPTAN SUCCINATE, 6 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED) | SUMATRIPTAN SUCCINATE (2X0.5ML) 4 MG/0.5 ML | SC |
66993-0083-98 | J3030 | INJECTION, SUMATRIPTAN SUCCINATE, 6 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED) | SUMATRIPTAN SUCCINATE (W/AUTO-INJ PEN&CASE) 4 MG/0.5 ML | SC |
66993-0084-79 | J3030 | INJECTION, SUMATRIPTAN SUCCINATE, 6 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED) | SUMATRIPTAN SUCCINATE (2X0.5ML) 6 MG/0.5 ML | SC |
66993-0084-98 | J3030 | INJECTION, SUMATRIPTAN SUCCINATE, 6 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED) | SUMATRIPTAN SUCCINATE (W/AUTO-INJ PEN&CASE) 6 MG/0.5 ML | SC |
66993-0195-94 | J7682 | TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, UNIT DOSE FORM, ADMINISTERED THROUGH DME, PER 300 MILLIGRAMS | TOBRAMYCIN (SINGLE-USE,PF) 300 MG/4 ML | IH |
66993-0195-94 | J7682 | TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, UNIT DOSE FORM, ADMINISTERED THROUGH DME, PER 300 MILLIGRAMS | TOBRAMYCIN (SINGLE-USE,PF) 300 MG/4 ML | IH |
66993-0370-25 | J1050 | INJECTION, MEDROXYPROGESTERONE ACETATE, 1 MG | MEDROXYPROGESTERONE ACETATE (SDV,LATEX-FREE) 150 MG/1 ML | IM |
HCPCS Code | Description | Billing Unit | SA Type |
|---|---|---|---|
L0641 | Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf | Each | Y |
L0642 | Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf | Each | Y |
L0643 | Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf | Each | Y |
L0648 | Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf | Each | Y |
L0649 | Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf | Each | Y |
L0650 | Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf | Each | Y |
L0651 | Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, prefabricated, off-the-shelf | Each | Y |
L0700 | CTLSO, anterior-posterior-lateral control, molded to patient model (Minerva type) | Each | Y |
L0710 | CTLSO, anterior-posterior-lateral control, molded to patient model, with interface material (Minerva type) | Each | Y |
L0810 | Halo procedure, cervical halo incorporated into jacket vest | Each | Y |
L0820 | Halo procedure, cervical halo incorporated into plaster body jacket | Each | Y |
L0830 | Halo procedure, cervical halo incorporated into Milwaukee type orthosis | Each | Y |
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