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NDC | HCPCS | HCPCS Description | NDC Label | Route of Administration |
|---|---|---|---|---|
69452-0171-73 | Q0144 | AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM | AZITHROMYCIN (3X6, USP,FILM-COATED) 250 MG | PO |
69452-0172-13 | Q0144 | AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM | AZITHROMYCIN (USP,FILM-COATED) 500 MG | PO |
69452-0172-72 | Q0144 | AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM | AZITHROMYCIN (3X3, USP,FILM-COATED) 500 MG | PO |
69452-0172-74 | Q0144 | AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM | AZITHROMYCIN (1X3, USP,FILM-COATED) 500 MG | PO |
69452-0173-13 | Q0144 | AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM | AZITHROMYCIN (USP,FILM-COATED) 600 MG | PO |
69452-0208-20 | J8499 | PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS | CALCITRIOL 0.5 MCG | PO |
69452-0290-20 | J8499 | PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS | ACYCLOVIR (USP) 400 MG | PO |
69452-0290-30 | J8499 | PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS | ACYCLOVIR (USP) 400 MG | PO |
69452-0291-20 | J8499 | PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS | ACYCLOVIR (USP) 800 MG | PO |
69452-0291-30 | J8499 | PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS | ACYCLOVIR (USP) 800 MG | PO |
69452-0350-01 | Q0166 | GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 24 HOUR DOSAGE REGIMEN | GRANISETRON HYDROCHLORIDE (FILM-COATED) 1 MG | PO |
69452-0350-11 | Q0166 | GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 24 HOUR DOSAGE REGIMEN | GRANISETRON HYDROCHLORIDE (FILM-COATED) 1 MG | PO |
HCPCS Code | Description | Billing Unit | SA Type |
|---|---|---|---|
L1090 | Addition to CTLSO or scoliosis orthosis, lumbar sling | Each | Y |
L1100 | Addition to CTLSO or scoliosis orthosis, ring flange, plastic or leather | Each | Y |
L1110 | Addition to CTLSO or scoliosis orthosis, ring flange, plastic or leather, molded to patient model | Each | Y |
L1120 | Addition to CTLSO or scoliosis orthosis, cover for upright, each | Each | Y |
L1200 | TLSO, inclusive of furnishing initial orthosis only | Each | Y |
L1210 | Addition to TLSO, (low profile), lateral thoracic extension | Each | Y |
L1220 | Addition to TLSO, (low profile), anterior thoracic extension | Each | Y |
L1230 | Addition to TLSO, (low profile), Milwaukee type superstructure | Each | Y |
L1240 | Addition to TLSO, (low profile), lumbar derotation pad | Each | Y |
L1250 | Addition to TLSO, (low profile), anterior asis pad | Each | Y |
L1260 | Addition to TLSO, (low profile), anterior thoracic derotation pad | Each | Y |
L1270 | Addition to TLSO, (low profile), abdominal pad | Each | Y |
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