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NDC | HCPCS | HCPCS Description | NDC Label | Route of Administration |
|---|---|---|---|---|
69794-0102-01 | J0584 | INJECTION, BUROSUMAB-TWZA 1 MG | CRYSVITA (PF) 10 MG/1 ML | SC |
69794-0102-01 | J3490 | UNCLASSIFIED DRUGS | CRYSVITA (PF) 10 MG/1 ML | SC |
69794-0203-01 | J0584 | INJECTION, BUROSUMAB-TWZA 1 MG | CRYSVITA (PF) 20 MG/1 ML | SC |
69794-0203-01 | J3490 | UNCLASSIFIED DRUGS | CRYSVITA (PF) 20 MG/1 ML | SC |
69794-0304-01 | J0584 | INJECTION, BUROSUMAB-TWZA 1 MG | CRYSVITA (PF) 30 MG/1 ML | SC |
69794-0304-01 | J3490 | UNCLASSIFIED DRUGS | CRYSVITA (PF) 30 MG/1 ML | SC |
68001-0417-37 | J0640 | INJECTION, LEUCOVORIN CALCIUM, PER 50 MG | LEUCOVORIN CALCIUM (PF,LYOPHILIZED) 200 MG | IJ |
68001-0418-38 | J0640 | INJECTION, LEUCOVORIN CALCIUM, PER 50 MG | LEUCOVORIN CALCIUM (PF,LYOPHILIZED) 350 MG | IJ |
68001-0421-22 | J1453 | INJECTION, FOSAPREPITANT, 1 MG | FOSAPREPITANT DIMEGLUMINE (SDV,LATEX-FREE) 150 MG | IV |
68462-0684-01 | J7520 | SIROLIMUS, ORAL, 1 MG | SIROLIMUS (FILM-COATED) 2 MG | PO |
68462-0685-01 | J7507 | TACROLIMUS, IMMEDIATE RELEASE, ORAL, 1 MG | TACROLIMUS (USP,HARD GELATIN) 0.5 MG | PO |
68462-0686-01 | J7507 | TACROLIMUS, IMMEDIATE RELEASE, ORAL, 1 MG | TACROLIMUS (USP,HARD GELATIN) 1 MG | PO |
HCPCS Code | Description | Billing Unit | SA Type |
|---|---|---|---|
L0480 | TLSO, triplanar control, one piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross tunk motion in sagittal, coronal, and transverse plances, includes a carved plaster or CAD-CAM model, custom fabricated | Each | Y |
L0482 | TLSO, triplanar control, one piece rigid plastic shell with interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes a carved plaster or CAD-CAM model, custom fabricated | Each | Y |
L0484 | TLSO, triplanar control, two piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strngth is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and tranverse planes, includes a carved plaster or CAD-CAM model custom fabricated | Each | Y |
L0486 | TLSO, Triplanar control, two piece rigid plastic shell with interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is endhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal and transverse planes, includes a carved plaster or CAD-CAM model, custom fabricated | Each | Y |
L0488 | TLSO, triplanar control, one piece rigid plastic shell with interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal and coronal planes, prefabricated, includes fitting and adjustment | Each | Y |
L0490 | TLSO, sagittal-coronal control, one piece rigid plasitc shell, with overlapping reinforced anterior, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates at or before the T-9 vertebra, anterior extends from symphysis pubis to xiphoid, anterior opening, restricts gross trunk motion in sagittal and coronal planes, prefabricated, includes fitting and adjustment | Each | Y |
L0491 | TLSO, sagittal-coronal control, modular segmented spinal system, two rigid plastic shells, posterior extends from sacrococcygeal junction 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 and coronal planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includings fitting and adjustment | Each | Y |
L0492 | TLSO, sagittal-coronal control, modular segmented spinal system, three rigid plastic shells, posterior extends from sacrococcygeal junction 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 and coronal planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment | Each | Y |
L0621 | Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf | Each | Y |
L0622 | Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated | Each | Y |
L0623 | Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf | Each | Y |
L0624 | Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels placed over sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated | Each | Y |
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