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NDC
HCPCS
HCPCS Description
NDC Label
Route of Administration
63323-0626-55
J7799
NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH DME
SODIUM CHLORIDE (FREEFLEX BAG,LATEX-FREE) 0.45%
IV
63323-0637-10
J9017
INJECTION, ARSENIC TRIOXIDE, 1 MG
ARSENIC TRIOXIDE (10X10 SDV,PF,LATEX-FREE) 1 MG/1 ML
IV
63323-0642-20
J3475
INJECTION, MAGNESIUM SULFATE, PER 500 MG
MAGNESIUM SULFATE (S.D.V.,PF) 500 MG/1 ML
IJ
63323-0642-50
J3475
INJECTION, MAGNESIUM SULFATE, PER 500 MG
MAGNESIUM SULFATE (S.D.V.,PF) 500 MG/1 ML
IJ
63323-0651-02
J0153
INJECTION, ADENOSINE, 1 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE COMPOUNDS)
ADENOSINE (PF) 3 MG/ML
IV
63323-0651-04
J0153
INJECTION, ADENOSINE, 1 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE COMPOUNDS)
ADENOSINE (PF) 3 MG/ML
IV
63323-0651-20
J0153
INJECTION, ADENOSINE, 1 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE COMPOUNDS)
ADENOSINE (SDV,PF,LATEX-FREE) 3 MG/1 ML
IV
63323-0651-30
J0153
INJECTION, ADENOSINE, 1 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE COMPOUNDS)
ADENOSINE (SDV,PF,LATEX-FREE) 3 MG/1 ML
IV
63323-0651-89
J0153
INJECTION, ADENOSINE, 1 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE COMPOUNDS)
SIMPLIST ADENOSINE (PF,LATEX-FREE) 3 MG/1 ML
IV
63323-0651-90
J0153
INJECTION, ADENOSINE, 1 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE COMPOUNDS)
SIMPLIST ADENOSINE (PF,LATEX-FREE) 3 MG/1 ML
IV
63323-0652-10
J1805
INJECTION, ESMOLOL HYDROCHLORIDE, 10 MG
ESMOLOL HCL (25X10ML,PF) 10 MG/1 ML
IV
63323-0655-99
J1650
INJECTION, ENOXAPARIN SODIUM, 10 MG
ENOXAPARIN SODIUM (PURPLE LABEL,PF) 120 MG/0.8 ML
IJ
HCPCS Code
Description
Billing Unit
SA Type
E0618 RR
Apnea Monitor without recording feature, rental
Day
N
E0619
Apnea Monitor with recording feature
Each
Y
E0619 RR
Apnea Monitor w/recording feature; rental
Day
N
S8189
2-Channel Pneumogram/Download With Interpretation.
Each
Y
S8189
2-Channel Pneumogram/Download Without Interpretation
Each
Y
S8189
Multi-Channel Sleep Study Or Polysomnagram With Or Without Interpretation.
Channel/Signal
Y
S8189
Rib Belt
Each
Y
S8189
Service Maintenance Agreement For Patient Owned Apnea Monitor.
Each
Y
S8189
Servicing, Shipping And Handling For Apnea Monitors.
Each
Y
A4481
Tacheostoma filter, any type, any size, each
Each
N
A4483
Moisture exchanger, disposable, for use with invasive mechanical ventilation
Each
N
A4604
Tubing with integrated heating element for use with positive airway pressure device
Each
Y
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