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NDC | HCPCS | HCPCS Description | NDC Label | Route of Administration |
|---|---|---|---|---|
67457-0858-20 | J0153 | INJECTION, ADENOSINE, 1 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE COMPOUNDS) | ADENOSINE NOVAPLUS (USP;SDV,PF,LATEX-FREE) 3 MG/1 ML | IV |
67457-0859-30 | J0153 | INJECTION, ADENOSINE, 1 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE COMPOUNDS) | ADENOSINE NOVAPLUS (USP,SDV,PF,LATEX-FREE) 3 MG/1 ML | IV |
67457-0860-50 | J0456 | INJECTION, AZITHROMYCIN, 500 MG | AZITHROMYCIN (PF,LATEX-FREE) 500 MG | IV |
67457-0863-01 | J1626 | INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG | GRANISETRON HYDROCHLORIDE (1X1ML,SDV,PF,LATEX-FREE) 1 MG/1 ML | IV |
67457-0864-04 | J1626 | INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG | GRANISETRON HYDROCHLORIDE (1X4ML,MDV,LATEX-FREE) 1 MG/1 ML | IV |
67457-0876-30 | J2795 | INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG | ROPIVACAINE HCL (SDV,PF,LATEX-FREE) 5 MG/1 ML | IJ |
67457-0877-20 | J2795 | INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG | ROPIVACAINE HCL (SDV,PF,LATEX-FREE) 10 MG/1 ML | IJ |
67457-0879-05 | J3030 | INJECTION, SUMATRIPTAN SUCCINATE, 6 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED) | SUMATRIPTAN SUCCINATE (PREFILLED,PF,LATEX-FREE) 6 MG/0.5 ML | SC |
67457-0880-05 | J3030 | INJECTION, SUMATRIPTAN SUCCINATE, 6 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED) | SUMATRIPTAN SUCCINATE (5X0.5ML,SDV,PF) 6 MG/0.5 ML | SC |
67457-0886-05 | J1729 | INJECTION, HYDROXYPROGESTERONE CAPROATE, NOT OTHERWISE SPECIFIED, 10 MG | HYDROXYPROGESTERONE CAPROATE 250 MG/1 ML | IM |
64679-0761-03 | J2550 | INJECTION, PROMETHAZINE HCL, UP TO 50 MG | PROMETHAZINE HCL 50 MG/1 ML | IJ |
64679-0761-04 | J2550 | INJECTION, PROMETHAZINE HCL, UP TO 50 MG | PROMETHAZINE HCL 50 MG/1 ML | IJ |
HCPCS Code | Description | Billing Unit | SA Type |
|---|---|---|---|
A6206 | Contact layer, 16 sq. in. or less, each dressing | Each | Y |
A6207 | Contact layer, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing | Each | N |
A6208 | Contact layer, more than 48 sq. in., each dressing | Each | Y |
A6209 | Foam dressing, wound cover, pad size 16 sq. in. or less, without adhesive border, each dressing | Each | N |
A6210 | Foam dressing, wound cover, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing | Each | N |
A6211 | Foam dressing, wound cover pad size more than 48 sq. in., without adhesive border, each dressing | Each | N |
A6212 | Foam dressing, wound cover, pad size 16 sq. in. or less, with any size adhesive border, each dressing | Each | N |
A6213 | Foam dressing, wound cover, pad size more than 16 sq. In. but less than 48 sq. in, with any size adhesive border, each dressing | Each | Y |
A6214 | Foam dressing, wound cover pad size more than 48 sq. in., with any size adhesive border, each dressing | Each | N |
A6215 | Foam dressing, wound filler, per gram | Gram | Y |
A6216 | Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | Each | N |
A6217 | Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing | Each | Y |
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