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NDC | HCPCS | HCPCS Description | NDC Label | Route of Administration |
|---|---|---|---|---|
66267-0006-25 | J8499 | PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS | ACYCLOVIR 200 MG | PO |
66267-0006-40 | J8499 | PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS | ACYCLOVIR 200 MG | PO |
66267-0006-50 | J8499 | PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS | ACYCLOVIR 200 MG | PO |
66267-0007-15 | J8499 | PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS | ACYCLOVIR 400 MG | PO |
66267-0007-21 | J8499 | PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS | ACYCLOVIR 400 MG | PO |
66267-0007-25 | J8499 | PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS | ACYCLOVIR 400 MG | PO |
66267-0007-30 | J8499 | PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS | ACYCLOVIR 400 MG | PO |
66267-0066-12 | J8540 | DEXAMETHASONE, ORAL, 0.25 MG | DEXAMETHASONE 0.75 MG | PO |
66267-0080-15 | 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 HCL 25 MG | PO |
66267-0080-20 | 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 HCL 25 MG | PO |
66267-0080-30 | 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 HCL 25 MG | PO |
66267-0080-60 | 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 HCL 25 MG | PO |
HCPCS Code | Description | Billing Unit | SA Type |
|---|---|---|---|
T4530 | Pediatric sized disposable incontinence product, brief/diaper, large or extra large, extra absorbent | Each | N |
T4535 | Panty liners, extra absorbent | Each | N |
A4554 | Disposable underpads, All sizes (e.g. chux), 150 per case | Each case | N |
T4531 | Pediatric size dispoable incontinence product, protective underwear/pull-on, small/medium size, each | Each | N |
T4532 | Pediatric size dispoable incontinence product, protective underwear/pull-on, large size, each | Each | N |
T4533 | Youth sized disposable incontinence product, brief/diaper | Each | N |
T4534 | Youth sized disposable incontinence product, protective underwear/pull-on | Each | N |
T4535 | Disposable liner/shield/guard/pad/undergarment, for incontinence, each | Each | N |
T4536 | Incontinence product, protective underwear/pull-on, resuable, any size | Each | N |
T4537 | Incontinence product, protective underpad, resuable, bed size | Each | N |
T4539 | Incontinence product, diaper brief, resuable any size | Each | N |
T4540 | Incontinence product, protective Under pad, reusable, chair size | Each | N |
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