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NDC | HCPCS | HCPCS Description | NDC Label | Route of Administration |
|---|---|---|---|---|
63629-1335-03 | Q0164 | PROCHLORPERAZINE MALEATE, 5 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 48 HOUR DOSAGE REGIMEN | PROCHLORPERAZINE MALEATE 10 MG | PO |
63629-1343-01 | Q0163 | DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT TIME OF CHEMOTHERAPY TREATMENT NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN | DIPHENHYDRAMINE 25 MG | PO |
63629-1343-02 | Q0163 | DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT TIME OF CHEMOTHERAPY TREATMENT NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN | DIPHENHYDRAMINE 25 MG | PO |
63629-1343-03 | Q0163 | DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT TIME OF CHEMOTHERAPY TREATMENT NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN | DIPHENHYDRAMINE 25 MG | PO |
63629-1343-04 | Q0163 | DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT TIME OF CHEMOTHERAPY TREATMENT NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN | DIPHENHYDRAMINE 25 MG | PO |
63629-1349-01 | Q0163 | DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT TIME OF CHEMOTHERAPY TREATMENT NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN | DIPHENHYDRAMINE 50 MG | PO |
67877-0718-31 | J7527 | EVEROLIMUS, ORAL, 0. 25 MG | EVEROLIMUS (6X10) 0.25 MG | PO |
67877-0719-31 | J7527 | EVEROLIMUS, ORAL, 0. 25 MG | EVEROLIMUS (6X10) 0.5 MG | PO |
67877-0720-31 | J7527 | EVEROLIMUS, ORAL, 0. 25 MG | EVEROLIMUS (6X10) 0.75 MG | PO |
67877-0721-31 | J7527 | EVEROLIMUS, ORAL, 0. 25 MG | EVEROLIMUS (6X10) 1 MG | PO |
67877-0746-01 | J7520 | SIROLIMUS, ORAL, 1 MG | SIROLIMUS (FILM-COATED) 0.5 MG | PO |
67877-0747-01 | J7520 | SIROLIMUS, ORAL, 1 MG | SIROLIMUS (FILM-COATED) 1 MG | PO |
HCPCS Code | Description | Billing Unit | SA Type |
|---|---|---|---|
B4160 | Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or grater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber | Per can | N |
B4161 | Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, include fats, carbohydrates, vitamins and minerals, may include fiber | Per can | N |
B4162 | Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber | Per can | N |
B9998 | NOC for enteral supplies | I.C. | Y |
E1399 | DME Drug Therapy, Recipient Owned Pump | Day | Y |
E1399 | DME TPN Management Therapy, Patient Owned IV Pump | Day | Y |
S9325 | Home infusion therapy, pain management infusion, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment, (drugs and nursing visits coded separately), per diem, (do not use this code with S9326, S9327, or S9328) DME Providers can not bill for drugs or nursing visits. These services must be billed by the appropriate provider. | Day | N |
S9326 | Home infusion therapy, continuous (twenty-four hours or more) pain management infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem DME Providers can not bill for drugs or nursing visits. These services must be billed by the appropriate provider. | Day | N |
S9327 | Home infusion therapy; intermittent (less than twenty-four hours) pain management infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem DME Providers can not bill for drugs or nursing visits. These services must be billed by the appropriate provider. | Day | N |
S9328 | Home Infusion therapy, implanted pump pain management infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem DME Providers can not bill for drugs or nursing visits. These services must be billed by the appropriate provider. | Day | N |
S9329 | Home infusion therapy, chemotherapy infusion, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem, (do not use this code with S9330 or S9331 DME Providers can not bill for drugs or nursing visits. These services must be billed by the appropriate provider. | Day | N |
S9330 | Home infusion therapy, continuous (twenty-four hours or more) chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem DME Providers can not bill for drugs or nursing visits. These services must be billed by the appropriate provider. | Day | N |
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