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NDC | HCPCS | HCPCS Description | NDC Label | Route of Administration |
|---|---|---|---|---|
66993-0371-79 | J1050 | INJECTION, MEDROXYPROGESTERONE ACETATE, 1 MG | MEDROXYPROGESTERONE ACETATE (PF,LATEX-FREE) 150 MG/1 ML | IM |
66993-0489-83 | J9120 | INJECTION, DACTINOMYCIN, 0.5 MG | DACTINOMYCIN (SDV,PF,LYOPHILIZED) 0.5 MG | IV |
66993-0730-02 | J8540 | DEXAMETHASONE, ORAL, 0.25 MG | DEXAMETHASONE (USP) 4 MG | PO |
66993-0730-80 | J8540 | DEXAMETHASONE, ORAL, 0.25 MG | DEXAMETHASONE (10X10) 4 MG | PO |
67253-0101-10 | J8499 | PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS | ACYCLOVIR 400 MG | PO |
67253-0101-11 | J8499 | PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS | ACYCLOVIR 400 MG | PO |
67253-0102-10 | J8499 | PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS | ACYCLOVIR 800 MG | PO |
67253-0102-50 | J8499 | PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS | ACYCLOVIR 800 MG | PO |
67253-0320-10 | None | METHOTREXATE, 2.5 MG, ORAL | METHOTREXATE (USP) 2.5 MG | PO |
67253-0320-36 | None | METHOTREXATE, 2.5 MG, ORAL | METHOTREXATE 2.5 MG | PO |
67457-0124-10 | J1200 | INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG | DIPHENHYDRAMINE HYDROCHLORIDE (MDV,USP) 50 MG/ML | IJ |
67457-0153-03 | J0282 | INJECTION, AMIODARONE HYDROCHLORIDE, 30 MG | AMIODARONE HCL 50 MG/ML | IV |
HCPCS Code | Description | Billing Unit | SA Type |
|---|---|---|---|
L0859 | Addition to halo procedure, magnetic resonance image compatible system, rings and pins, any material | Each | Y |
L0861 | Addition to halo procedure, replacement liner/interface material | Each | Y |
L0970 | TLSO, corset front | Each | Y |
L0972 | LSO, corset front | Each | Y |
L0974 | TLSO, full corset | Each | Y |
L0976 | LSO, full corset | Each | Y |
L0978 | Axillary crutch extension | Each | Y |
L0980 | Peroneal straps, prefabricated, off-the-shelf, pair | Pair | Y |
L0982 | Stocking supporter grips, prefabricated, off-the-shelf, set of four (4) | Set of 4 | Y |
L0984 | Protective body sock, prefabricated, off-the-shelf, each | Each | Y |
L0999 | Addition to spinal orthosis, NOS (Providers need to determine if an alternative HCPCS code better describes the service being reported or that is not already included in the main code. This code should only be used if a more specific code is unavailable) | Each | Y |
L1000 | CTLSO (Milwaukee), inclusive of furnishing initial orthosis, including model | Each | Y |
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