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NDC	HCPCS	HCPCS Description	NDC Label	Route of Administration
75987-0111-01	J9216	INJECTION, INTERFERON, GAMMA 1-B, 3 MILLION UNITS	ACTIMMUNE 2 MILLION IU/0.5 ML	SC
75987-0111-10	J9216	INJECTION, INTERFERON, GAMMA 1-B, 3 MILLION UNITS	ACTIMMUNE 2 Million IU/0.5 ML	SC
75987-0111-11	J9216	INJECTION, INTERFERON, GAMMA 1-B, 3 MILLION UNITS	ACTIMMUNE 2 MILLION IU/0.5 ML	SC
76045-0001-20	J2250	INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG	MIDAZOLAM (PREFILLED, USP,PF) 1 MG/ML	IJ
76045-0002-10	J2250	INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG	MIDAZOLAM (PF) 5 MG/ML	IJ
76045-0003-20	J2250	INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG	MIDAZOLAM (PF) 5 MG/ML	IJ
76045-0004-10	J2274	INJECTION, MORPHINE SULFATE, PRESERVATIVE-FREE FOR EPIDURAL OR INTRATHECAL USE, 10MG	MORPHINE SULFATE (SINGLE USE,PF) 2 MG/ML	IJ
76045-0004-11	J2274	INJECTION, MORPHINE SULFATE, PRESERVATIVE-FREE FOR EPIDURAL OR INTRATHECAL USE, 10MG	SIMPLIST MORPHINE SULFATE MICROVAULT (PF) 2 MG/1 ML	IJ
76045-0005-11	J2274	INJECTION, MORPHINE SULFATE, PRESERVATIVE-FREE FOR EPIDURAL OR INTRATHECAL USE, 10 MG	SIMPLIST MORPHINE SULFATE MICROVAULT (PF) 4 MG/1 ML	IJ
76045-0009-11	J1170	INJECTION, HYDROMORPHONE, UP TO 4 MG	SIMPLIST DILAUDID (MICROVAULT,PF) 1 MG/1 ML	IJ
76045-0010-11	J1170	INJECTION, HYDROMORPHONE, UP TO 4 MG	SIMPLIST DILAUDID (MICROVAULT,PF) 2 MG/1 ML	IJ
76045-0023-30	J7643	GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM	SIMPLIST GLYCOPYRROLATE (PF,LATEX-FREE) 0.2 MG/1 ML	IJ

HCPCS Code	Description	Billing Unit	SA Type
K0800	Power Operated Vehicle, Group 1 Standard, Patient Weight Capacity Up To And Including 300 Pounds	Each	Y
K0800 RR	Power Operated Vehicle, Group 1 Standard, Patient Weight Capacity Up To And Including 300 Pounds	Day	Y
K0801	Power Operated Vehicle, Group 1 Heavy Duty, Patient Weight Capacity, 301 To 450 Pounds	Each	Y
K0801 RR	Power Operated Vehicle, Group 1 Heavy Duty, Patient Weight Capacity, 301 To 450 Pounds	Day	Y
K0802	Power Operated Vehicle, Group 1 Very Heavy Duty, Patient Weight Capacity 451 To 600 Pound	Each	Y
K0802 RR	Power Operated Vehicle, Group 1 Very Heavy Duty, Patient Weight Capacity 451 To 600 Pound	Day	Y
E1083 RR	Hemi Wheelchair, Fixed Full Length Arms, Swing Away Detachable Elevating Leg Rests	Day	N
E1084	Hemi-Wheelchair, Detachable Arms, Desk Or Full Length Arms, Swing Away, Detachable ,Elevating Leg Rest	Each	N
E1084 RR	Hemi Wheelchair, Detachable Arms, Desk Or Full Length Arms, Swing Away, Detachable, Elevating Leg Rest	Day	N
E1085	Hemi Wheelchair, Fixed Full Length Arms, Swing Away, Detachable Footrests	Each	N
E1085 RR	Hemi Wheelchair, Fixed Full Length Arms, Swing Away, Detachable Footrests	Day	N
E1086	Hemi Wheelchair, Detachable Arms, Desk Or Full Length, Swing Away, Detachable Footrests	Each	N