top of page
NDC | HCPCS | HCPCS Description | NDC Label | Route of Administration |
|---|---|---|---|---|
63323-0411-12 | J2250 | INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG | MIDAZOLAM HCL (M.D.V.) 1 MG/ML | IJ |
63323-0411-25 | J2250 | INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG | MIDAZOLAM HCL (M.D.V.) 1 MG/ML | IJ |
63323-0412-02 | J2250 | INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG | MIDAZOLAM HCL (M.D.V.) 5 MG/ML | IJ |
63323-0412-05 | J2250 | INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG | MIDAZOLAM HCL (M.D.V.) 5 MG/ML | IJ |
63323-0617-10 | J2260 | INJECTION, MILRINONE LACTATE, 5 MG | MILRINONE LACTATE (S.D.V.) 1 MG/ML | IV |
63323-0617-20 | J2260 | INJECTION, MILRINONE LACTATE, 5 MG | MILRINONE LACTATE (S.D.V.) 1 MG/ML | IV |
63323-0617-50 | J2260 | INJECTION, MILRINONE LACTATE, 5 MG | MILRINONE LACTATE (S.D.V.) 1 MG/ML | IV |
63323-0624-50 | J7060 | 5% DEXTROSE/WATER (500 ML = 1 UNIT) | DEXTROSE (FREEFLEX BAG,LATEX-FREE) 5% | IV |
63323-0626-00 | J7799 | NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH DME | SODIUM CHLORIDE (FREEFLEX BAG,LATEX-FREE) 0.45% | IV |
63323-0626-10 | J7799 | NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH DME | SODIUM CHLORIDE (FREEFLEX BAG,LATEX-FREE) 0.45% | IV |
63323-0626-25 | J7799 | NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH DME | SODIUM CHLORIDE (FREEFLEX BAG,LATEX-FREE) 0.45% | IV |
63323-0626-50 | J7799 | NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH DME | SODIUM CHLORIDE (FREEFLEX BAG,LATEX-FREE) 0.45% | IV |
HCPCS Code | Description | Billing Unit | SA Type |
|---|---|---|---|
E0433 RR | Portable liquid liquid oxygen system, rental; home liquefier used to fill portable liquid oxygn containers, includes portable containers, regulator, flowmeter, humidifer, cannula or mask and tubing, with or without supply reservior and gauge | Day | Y |
E0433 RR U1 | Portable liquid liquid oxygen system, rental; home liquefier used to fill portable liquid oxygn containers, includes portable containers, regulator, flowmeter, humidifer, cannula or mask and tubing, with or without supply reservior and gauge High Intensity Code must have O2 rate above 4 Lpm | Day | Y |
A4772 | Blood glucose test strips, for dialysis, per 50 | Btl. (of 50) | Y |
A4913 | Miscellaneous Dialysis Supplies, Not Identified Elsewhere | Each | Y |
E1399 | Continuous Ambulatory Peritoneal Dialysis Supply Kit | Month | Y |
E1399 | Continuous Cycling Peritoneal, Dialysis CCPD Supply Kit | Month | Y |
E1399 | Intermittent Peritoneal Dialysis (IPD) Supply Kit | Month | Y |
E1510 | Kidney, dialysate delivery system kidney machine, pump recirculating, air removal system, flowrat meter, power off, heater and temp control with alarm, IV poles, pressure gauge, concentrate container | Month | N |
E1699 | Dialysis equipment, not otherwise specificed | Each | Y |
A4556 | Electrodes (e.g. Apnea monitor) | Pair | N |
A4557 | Apnea Monitor Lead wires | Pair | N |
E0618 | Apnea Monitor without recording feature | Each | Y |
bottom of page