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NDC
HCPCS
HCPCS Description
NDC Label
Route of Administration
69680-0112-25
J3420
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
CYANOCOBALAMIN (MDV) 1000 MCG/1 ML
IJ
69680-0113-99
J3420
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
CYANOCOBALAMIN (MDV) 1000 MCG/1 ML
IJ
69680-0121-05
J3420
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
CYANOCOBALAMIN 1000 MCG/1 ML
IJ
69680-0121-10
J3420
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
CYANOCOBALAMIN 1000 MCG/1 ML
IJ
69680-0121-30
J3420
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
CYANOCOBALAMIN 1000 MCG/1 ML
IJ
69784-0002-06
J1450
INJECTION FLUCONAZOLE, 200 MG
FLUCONAZOLE IN SODIUM CHLORIDE (6X100;USP,PF) 200 MG/100 ML
IV
69784-0003-06
J1450
INJECTION FLUCONAZOLE, 200 MG
FLUCONAZOLE IN SODIUM CHLORIDE (6X200ML;USP,PF) 400 MG/200 ML
IV
69784-0205-60
J7631
CROMOLYN SODIUM, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER 10 MILLIGRAMS
CROMOLYN SODIUM 10 MG/1 ML
IH
69784-0205-60
J7631
CROMOLYN SODIUM, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER 10 MILLIGRAMS
CROMOLYN SODIUM 10 MG/1 ML
IH
69784-0620-25
None
BUSULFAN, 2 MG, ORAL
MYLERAN (FILM-COATED) 2 MG
PO
69794-0001-01
J3397
INJECTION, VESTRONIDASE ALFA-VJBK, 1 MG
MEPSEVII (PF) 2 MG/1 ML
IV
69794-0001-01
J3490
UNCLASSIFIED DRUGS
MEPSEVII (PF) 2 MG/1 ML
IV
HCPCS Code
Description
Billing Unit
SA Type
L0456
Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes 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
L0457
TLSO, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated, off-the-shelf
Each
Y
L0458
TLSO, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal juntion and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal, coronal and transverse planes, lateral strngth is provided by over lapping plastic and stablizing closures, includes straps and closures, prefabricated, includes fitting and adjustment
Each
Y
L0460
TLSO, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes 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
L0462
TLSO, triplanar control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the sysmphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plase and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment.
Each
Y
L0464
TLSO, triplanar control, modular segmented spinal system, four rigid plastic shells, prosterior extends from sacroccygeal junction and terminates just inferior ro scapular spine, anterior extends from symphysis pubis to the sternal notch, soft liner, restricts gross motor in sagittal, coronal, and tranverse planes, latral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefacticated, includes fitting and adjustment
Each
Y
L0466
TLSO, sagittal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, restricts gross trunk motion in sagittal plane, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
Each
Y
L0467
TLSO, sagittal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, restricts gross trunk motion in sagittal plane, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated, off-the-shelf
Each
Y
L0468
TLSO, sagittal-coronal control, rigid posterial frame and flexivle soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic and lateral frame pieces, restricts gross trunk motion in sagittal and coronal, produces intracavitary pressure to reduce load on intervertebral disks, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment
Each
Y
L0469
TLSO, sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal and coronal planes, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated, off-the-shelf
Each
Y
L0470
TLSO, triplanar control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction to scapula, lateral strngth provided by pelvic, thoracic, and lateral frame pieces, rotational strength provided by subclavicular extensions, restricts gross trunk motion in sagittal, coronal and transverse, produces intracavitary pressure to reduce load on the intervertebral disks, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment
Each
Y
L0472
TLSO, triplanar control, hyperextension, rigid anterior and lateral frame extends from symphysis pubis to sternal notch with two anterior components (one pubic and one sternal), posterior and lateral pads with straps and closures, limits spinal flexion, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment
Each
Y
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