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NDC | HCPCS | HCPCS Description | NDC Label | Route of Administration |
|---|---|---|---|---|
65219-0010-01 | J3480 | INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ | POTASSIUM CHLORIDE (FREEFLEX,PF,LATEX-FREE) 40 MEQ/100 ML | IV |
65219-0012-01 | J3480 | INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ | POTASSIUM CHLORIDE (FREEFLEX,PF,LATEX-FREE) 10 MEQ/100 ML | IV |
65219-0014-10 | J0290 | INJECTION, AMPICILLIN SODIUM, 500 MG | AMPICILLIN SODIUM (LATEX-FREE) 250 MG | IJ |
65219-0016-10 | J0290 | INJECTION, AMPICILLIN SODIUM, 500 MG | AMPICILLIN SODIUM (USP,LATEX-FREE) 500 MG | IJ |
65219-0018-10 | J0290 | INJECTION, AMPICILLIN SODIUM, 500 MG | AMPICILLIN (VIAL,LATEX-FREE) 1 GM | IJ |
65219-0020-23 | J0290 | INJECTION, AMPICILLIN SODIUM, 500 MG | AMPICILLIN SODIUM (LATEX-FREE) 2 GM | IJ |
65219-0028-05 | J3490 | UNCLASSIFIED DRUGS | GANIRELIX ACETATE (SD,PF,LATEX-FREE) 250 MCG/0.5 ML | SC |
65219-0029-20 | J9340 | INJECTION, THIOTEPA, 15 MG | THIOTEPA (SDV,LYOPHILIZED) 100 MG | IJ |
65219-0039-01 | J2598 | INJECTION, VASOPRESSIN, 1 UNIT | VASOPRESSIN (SDV;RFID,PF,LATEX-FREE) 20 U/1 ML | IV |
65219-0160-10 | J0594 | INJECTION, BUSULFAN, 1 MG | BUSULFAN (8X10ML,SDV) 6 MG/1 ML | IV |
65219-0187-10 | A4217 | STERILE WATER/SALINE, 500 ML | STERILE WATER FOR INJECTION (25X100ML,SDV,PF) | IJ |
65219-0190-30 | J3465 | INJECTION, VORICONAZOLE, 10 MG | VORICONAZOLE (SDV,PF,LATEX-FREE) 200 MG | IV |
HCPCS Code | Description | Billing Unit | SA Type |
|---|---|---|---|
A9278 RR | Receiver (monitor); external, for use with interstitial continuous glucose monitoring system (Pregnant individuals with Type 1 or Type 2) | Each | Y |
A4233 | Replacement battery, alkaline (other than J cell), for use with medically necessary home blood glucose monitor owned by patient, each | Each | N |
A4234 | Replacement battery, alkaline, J cell, for use with medically necessary home blood glucose monitor owned by patient, each | Each | N |
A4235 | Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each | Each | N |
A4236 | Replacement battery, silver oxide, for use with medically necessary home blood glucose monitor owned by patient, each | Each | N |
A4772 | Blood glucose test strips, for dialysis, per 50 | Btl. (of 50) | Y |
A4913 | Miscellaneous Dialysis Supplies, Not Identified Elsewhere | Each | Y |
E1399 | Continuous Ambulatory Peritoneal Dialysis Supply Kit | Month | Y |
E1399 | Continuous Cycling Peritoneal, Dialysis CCPD Supply Kit | Month | Y |
E1399 | Intermittent Peritoneal Dialysis (IPD) Supply Kit | Month | Y |
E1510 | Kidney, dialysate delivery system kidney machine, pump recirculating, air removal system, flowrat meter, power off, heater and temp control with alarm, IV poles, pressure gauge, concentrate container | Month | N |
E1699 | Dialysis equipment, not otherwise specificed | Each | Y |
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