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NDC	HCPCS	HCPCS Description	NDC Label	Route of Administration
62991-1004-02	J0133	INJECTION, ACYCLOVIR, 5 MG	ACYCLOVIR (U.S.P.)	NA
62991-1013-01	J0475	INJECTION, BACLOFEN, 10 MG	BACLOFEN (U.S.P.)	NA
62991-1013-02	J0475	INJECTION, BACLOFEN, 10 MG	BACLOFEN (U.S.P.)	NA
62991-1013-03	J0475	INJECTION, BACLOFEN, 10 MG	BACLOFEN	NA
62991-1013-04	J0475	INJECTION, BACLOFEN, 10 MG	BACLOFEN (U.S.P.)	NA
62991-1021-02	J3490	UNCLASSIFIED DRUGS	BENZOCAINE (U.S.P./N.F.)	NA
62991-1021-04	J3490	UNCLASSIFIED DRUGS	BENZOCAINE (U.S.P.)	NA
62991-1023-02	J7624	BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM	BETAMETHASONE DIPROPIONATE (U.S.P.,MICRONIZED)	NA
62991-1023-02	J7624	BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM	BETAMETHASONE DIPROPIONATE (U.S.P.,MICRONIZED)	NA
62991-1023-03	J7624	BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM	BETAMETHASONE DIPROPIONATE (U.S.P.,MICRONIZED)	NA
62991-1023-03	J7624	BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM	BETAMETHASONE DIPROPIONATE (U.S.P.,MICRONIZED)	NA
62991-1024-01	J7624	BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM	BETAMETHASONE SODIUM PHOSPHATE (U.S.P.)	NA

HCPCS Code	Description	Billing Unit	SA Type
A7005	Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable	Each	N
A7006	Administration set, with small volume filter pneumatic nebulizer	Each	N
A7007	Large voume nebulizer, disposable, unfilled, used with aerosol compressor	Each	N
A7008	Large volume nebulizer, disposable, Prefilled, used with aerosol compressor	Each	N