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NDC | HCPCS | HCPCS Description | NDC Label | Route of Administration |
|---|---|---|---|---|
71288-0164-50 | J0640 | INJECTION, LEUCOVORIN CALCIUM, PER 50 MG | LEUCOVORIN CALCIUM (SDV,PF,LATEX-FREE) 500 MG | IJ |
71288-0165-53 | J9261 | INJECTION, NELARABINE, 50 MG | NELARABINE (SDV,PF,LATEX-FREE) 5 MG/1 ML | IV |
71288-0166-10 | J9305 | INJECTION, PEMETREXED, NOT OTHERWISE SPECIFIED, 10 MG | PEMETREXED (SDV,PF,LATEX-FREE) 100 MG | IV |
71288-0166-92 | J9305 | INJECTION, PEMETREXED, NOT OTHERWISE SPECIFIED, 10 MG | PREMIERPRO RX PEMETREXED (SDV,PF,LATEX-FREE) 100 MG | IV |
71288-0167-50 | J9305 | INJECTION, PEMETREXED, NOT OTHERWISE SPECIFIED, 10 MG | PEMETREXED (SDV,PF,LATEX-FREE) 500 MG | IV |
71288-0167-96 | J9305 | INJECTION, PEMETREXED, NOT OTHERWISE SPECIFIED, 10 MG | PREMIERPRO RX PEMETREXED (SDV,PF,LATEX-FREE) 500 MG | IV |
71288-0200-11 | J2260 | INJECTION, MILRINONE LACTATE, 5 MG | MILRINONE LACTATE (PF,LATEX-FREE) 1 MG/1 ML | IV |
71288-0200-21 | J2260 | INJECTION, MILRINONE LACTATE, 5 MG | MILRINONE LACTATE (PF,LATEX-FREE) 1 MG/1 ML | IV |
71288-0200-50 | J2260 | INJECTION, MILRINONE LACTATE, 5 MG | MILRINONE LACTATE (PF,LATEX-FREE) 1 MG/1 ML | IV |
71288-0203-03 | J1940 | INJECTION, FUROSEMIDE, UP TO 20 MG | FUROSEMIDE (SDV,PF,LATEX-FREE) 10 MG/1 ML | IJ |
71288-0203-05 | J1940 | INJECTION, FUROSEMIDE, UP TO 20 MG | FUROSEMIDE (SDV,PF,LATEX-FREE) 10 MG/1 ML | IJ |
71288-0203-11 | J1940 | INJECTION, FUROSEMIDE, UP TO 20 MG | FUROSEMIDE (25X10ML,SDV,PF) 10 MG/1 ML | IJ |
HCPCS Code | Description | Billing Unit | SA Type |
|---|---|---|---|
E2370 U1 | Power Wheelchair Component, integrated drive wheel motor and gear box combination,replacement only (For use only with Group 3 and above) | Each | Y |
E2371 | Power Wheelchair Accessory, Group 27 Sealed Lead Acid Battery, (E.G. Gel Cell, Absorbed Glassmat), Each | Each | N |
E2371 RR | Power Wheelchair Accessory, Group 27 Sealed Lead Acid Battery, (E.G. Gel Cell, Absorbed Glassmat), Each | Day | N |
E2372 | Power Wheelchair Accessory, Group 27 Non-Sealed Lead Acid Battery, Each | Each | Y |
E2372 RR | Power Wheelchair Accessory, Group 27 Non-Sealed Lead Acid Battery, Each | Day | Y |
E2397 | Power Wheelchair accessory, lithium-based battery, each | Each | Y |
E2397 RR | Power Wheelchair accessory, lithium-based battery, each | Day | Y |
E2398 | Wheelchair Accessory, dynamic positioning hardware for back | Each | Y |
E2378 | Power Wheelchair Component, actuator, replacement only | each | Y |
K0733 | Power Wheelchair Accessory, 12 To 24 Amp Hour Sealed Lead Acid Battery, Each (E.G. Gel Cell, Absorbed Glassmat) | Each | N |
K0733 RR | Power Wheelchair Accessory, 12 To 24 Amp Hour Sealed Lead Acid Battery, Each (E.G. Gel Cell, Absorbed Glassmat) | Day | N |
E1050 | Fully-Reclining Wheelchair, Fixed Full Length Arms, Swing Away, Detachable, Elevating Leg Rests | Each | N |
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