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NDC	HCPCS	HCPCS Description	NDC Label	Route of Administration
67457-0822-99	J3371	INJECTION, VANCOMYCIN HCL (MYLAN) NOT THERAPEUTICALLY EQUIVALENT TO J3370, 500 MG	VANCOMYCIN HCL (LYOPHILIZED) 250 MG	IV
67457-0831-50	J0637	INJECTION, CASPOFUNGIN ACETATE, 5 MG	CASPOFUNGIN ACETATE (SDV,PF,LYOPHILIZED) 50 MG	IV
67457-0832-70	J0637	INJECTION, CASPOFUNGIN ACETATE, 5 MG	CASPOFUNGIN ACETATE (PF,LYOPHILIZED) 70 MG	IV
67457-0833-06	Q5108	INJECTION, PEGFILGRASTIM-JMDB, BIOSIMILAR, (FULPHILA), 0.5 MG	FULPHILA (PF) 6 MG/0.6 ML	SC
67457-0843-30	J2020	INJECTION, LINEZOLID, 200 MG	LINEZOLID (10X300ML BAGS,PF) 600 MG/300 ML	IV
67457-0845-50	Q5114	INJECTION, TRASTUZUMAB-DKST, BIOSIMILAR, (OGIVRI), 10 MG	OGIVRI (KIT COMPONENT,PF) 420 MG	IV
67457-0847-44	Q5114	INJECTION, TRASTUZUMAB-DKST, BIOSIMILAR, (OGIVRI), 10 MG	OGIVRI (PF,LYOPHILIZED) 420 MG	IV
67457-0853-50	J1120	INJECTION, ACETAZOLAMIDE SODIUM, UP TO 500 MG	ACETAZOLAMIDE (USP,PF,LATEX-FREE) 500 MG	IV
67457-0854-04	J0153	INJECTION, ADENOSINE, 1 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE COMPOUNDS)	ADENOSINE (10X4ML,SDV,PF) 3 MG/1 ML	IV
67457-0855-02	J0153	INJECTION, ADENOSINE, 1 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE COMPOUNDS)	ADENOSINE (10X2ML,SDV,PF) 3 MG/1 ML	IV
67457-0856-20	J0153	INJECTION, ADENOSINE, 1 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE COMPOUNDS)	ADENOSINE (1X20ML,USP,SDV,PF) 3 MG/1 ML	IV
67457-0857-30	J0153	INJECTION, ADENOSINE, 1 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE COMPOUNDS)	ADENOSINE (1X30ML,USP,SDV,PF) 3 MG/1 ML	IV

HCPCS Code	Description	Billing Unit	SA Type
A6022	Collagen dressing, sterile, pad size more than 16 sq. in but less than or equal to 48 sq. in., each	Each	Y
A6023	Collagen dressing, sterile, pad size more than 48 sq. in., each	Each	Y
A6024	Collagen dressing wound filler, per 6 in	Each	N
A6025	Gel sheet, for dermal or epidermal applications, (e.g. silicone, hydrogel, other), each	Each	Y
A6154	Wound pouch, each	Each	N
A6196	Alginate or other fiber gelling dressing, wound cover, pad size 16 sq. in. or less, each dressing	Each	N
A6197	Alginate or other fiber gelling dressing, wound cover, pad size more than 16 sq. in. but less than 48 sq. in., each dressing	Each	N
A6198	Alginate or other fiber gelling dressing, wound cover, pad size more than 48 sq. in. each dressing	Each	Y
A6199	Alginate or other fiber gelling dressing, wound filler, per 6 inches	Each	N
A6203	Composite dressing, pad size 16 sq. in. or less, with any size adhesive border, each dressing	Each	N
A6204	Composite dressing, pad size more than 16 sq. in. but less than or equal to 48 sq. in., any size with adhesive border, each dressing	Each	N
A6205	Composite dressing, pad size more than 48 sq. in., with any size adhesive border, each dressing	Each	Y