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NDC | HCPCS | HCPCS Description | NDC Label | Route of Administration |
|---|---|---|---|---|
69452-0350-92 | 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 |
69543-0371-10 | J2469 | INJECTION, PALONOSETRON HCL, 25 MCG | PALONOSETRON HCL 0.05 MG/1 ML | IV |
69543-0386-25 | J1885 | INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG | KETOROLAC TROMETHAMINE 30 MG/1 ML | IJ |
69639-0101-01 | J8655 | NETUPITANT 300 MG AND PALONOSETRON 0.5 MG, ORAL | AKYNZEO (HARD GELATIN) 300 MG-0.5 MG | PO |
69639-0102-01 | J1454 | INJECTION, FOSNETUPITANT 235 MG AND PALONOSETRON 0.25 MG | AKYNZEO (SDV,PF,LYOPHILIZED) 235 MG-0.25 MG | IV |
69639-0102-01 | J3490 | UNCLASSIFIED DRUGS | AKYNZEO (SDV,PF,LYOPHILIZED) 235 MG-0.25 MG | IV |
69639-0103-01 | J2469 | INJECTION, PALONOSETRON HCL, 25 MCG | ALOXI (PF,LATEX-FREE) 0.05 MG/1 ML | IV |
69639-0105-01 | J1454 | INJECTION, FOSNETUPITANT 235 MG AND PALONOSETRON 0.25 MG | AKYNZEO (SDV) 235MG-0.25MG/20ML | IV |
69656-0101-02 | J8670 | ROLAPITANT, ORAL, 1 MG | VARUBI (FILM COATED) 90 MG | PO |
69656-0101-02 | Q9981 | ROLAPITANT, ORAL, 1 MG | VARUBI (FILM COATED) 90 MG | PO |
69656-0102-10 | J3490 | UNCLASSIFIED DRUGS | VARUBI (SDV) 1.8 MG/1 ML | IV |
69680-0112-10 | J3420 | INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG | CYANOCOBALAMIN 1000 MCG/1 ML | IJ |
HCPCS Code | Description | Billing Unit | SA Type |
|---|---|---|---|
L1280 | Addition to TLSO, (low profile), rib gusset (elastic), each | Each | Y |
L1290 | Addition to TLSO, (low profile), lateral trochanteric pad | Each | Y |
L0172 | Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf | Each | Y |
L0174 | Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension | Each | Y |
L0180 | Cervical, multiple post collar, occipital/mandibular supports, adjustable | Each | Y |
L0190 | Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars (SOMI, Guilford, Taylor types) | Each | Y |
L0200 | Cervical, mulitple post collar, occipital/mandibular supports, adjustable cervical bars, and thoracic extension | Each | Y |
L0220 | Thoracic, rib belt, custom fabricated | Each | Y |
L0450 | TLSO, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf | Each | Y |
L0452 | TLSO, flexable, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panels, includes shoulder straps and closures, custom fabricated | Each | Y |
L0454 | TLSO flexible, provides trunk support, extends from sacrococcygeal junction to above t-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | Each | Y |
L0455 | TLSO, flexible, provides trunk support, extends from sacrococcygeal junction to above t-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf | Each | Y |
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