top of page
NDC | HCPCS | HCPCS Description | NDC Label | Route of Administration |
|---|---|---|---|---|
65757-0500-03 | J1943 | INJECTION, ARIPIPRAZOLE LAUROXIL, (ARISTADA INITIO), 1 MG | ARISTADA INITIO (LATEX-FREE) 675 MG/2.4 ML | IM |
65847-0205-25 | J2325 | INJECTION, NESIRITIDE, 0.1 MG | NATRECOR (S.D.V.) 1.5 MG | IV |
65862-0187-30 | Q0162 | ONDANSETRON 1 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 | ONDANSETRON HYDROCHLORIDE (FILM-COATED) 4 MG | PO |
65862-0188-30 | Q0162 | ONDANSETRON 1 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 | ONDANSETRON HYDROCHLORIDE (FILM-COATED) 8 MG | PO |
65862-0390-10 | Q0162 | ONDANSETRON 1 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 | ONDANSETRON (USP,3X10) 4 MG | PO |
65862-0391-10 | Q0162 | ONDANSETRON 1 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 | ONDANSETRON (USP,3X10) 8 MG | PO |
65862-0641-30 | Q0144 | AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM | AZITHROMYCIN (USP,FILM-COATED) 250 MG | PO |
65862-0641-63 | Q0144 | AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM | AZITHROMYCIN (3X6, USP,FILM-COATED) 250 MG | PO |
65862-0641-69 | Q0144 | AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM | AZITHROMYCIN (1X6, USP,FILM-COATED) 250 MG | PO |
65862-0642-30 | Q0144 | AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM | AZITHROMYCIN (FILM-COATED) 500 MG | PO |
65862-0642-64 | Q0144 | AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM | AZITHROMYCIN (FILM-COATED) 500 MG | PO |
65862-0642-90 | Q0144 | AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM | AZITHROMYCIN (3X3,FILM-COATED) 500 MG | PO |
HCPCS Code | Description | Billing Unit | SA Type |
|---|---|---|---|
S8189 | Permanent Pulse Oximeter Sensor, Any Style Or Size | Each | Y |
S8189 | Pulse Oximeter Battery Pack Rechargeable, Nicad. | Each | Y |
S8189 | Pulse Oximeter Printer Paper | 12/Case | Y |
S8189 | Reservoir For Transfer Chambers | Each | Y |
S8189 | Service Maintenance Agreement For A Patient -Owned Ventilator | 1 unit per month | Y |
S8189 | Service Maintenance Agreement For A Patient Owned Ventilator, Covered Under An Extended Warranty Plan | 1 unit per month | Y |
S8189 | Temperature Probe-Ventilator | Each | Y |
S8189 | Trach Blow- By System, Trach T | Each | Y |
S8189 | Transfer Chambers | Each | Y |
S8189 | Ventilator Repair | Each | Y |
S8189 | Oxygen Accumulator For Ventilator | Day | Y |
L8501 | Tracheostomy Speaking Valve | Each | N |
bottom of page