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NDC	HCPCS	HCPCS Description	NDC Label	Route of Administration
81952-0111-06	J1644	INJECTION, HEPARIN SODIUM, PER 1000 UNITS	HEPARIN SODIUM (MDV,25X1ML,LATEX-FREE) 5000 U/1 ML	IJ
81952-0112-06	J1644	INJECTION, HEPARIN SODIUM, PER 1000 UNITS	HEPARIN SODIUM (MDV,25X1ML,LATEX-FREE) 1000 U/1 ML	IJ
70257-0350-51	J2792	INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN, SOLVENT DETERGENT, 100 IU	WINRHO SDF (1X2.2ML,SDV,PF) 2500 IU/2.2 ML	IJ
70257-0560-01	J0475	INJECTION, BACLOFEN, 10 MG	LIORESAL INTRATHECAL REFILL KIT 0.5 MG/1 ML	IN
70257-0560-02	J0475	INJECTION, BACLOFEN, 10 MG	LIORESAL INTRATHECAL REFILL KIT 0.5 MG/1 ML	IN
70257-0561-02	J0475	INJECTION, BACLOFEN, 10 MG	LIORESAL INTRATHECAL REFILL KIT 2 MG/1 ML	IN
70257-0562-55	J0476	INJECTION, BACLOFEN, 50 MCG FOR INTRATHECAL TRIAL	LIORESAL INTRATHECAL (SCREENING #8563,PF) 0.05 MG/1 ML	IN
70257-0563-01	J0475	INJECTION, BACLOFEN, 10 MG	LIORESAL INTRATHECAL REFILL KIT (PF) 2 MG/1 ML	IN
70257-0563-02	J0475	INJECTION, BACLOFEN, 10 MG	LIORESAL INTRATHECAL REFILL KIT (PF) 2 MG/1 ML	IN
71288-0024-21	J3370	INJECTION, VANCOMYCIN HCL, 500 MG	VANCOMYCIN HCL (PF,LATEX-FREE) 750 MG	IV
71288-0026-75	J3370	INJECTION, VANCOMYCIN HCL, 500 MG	VANCOMYCIN HCL (PHARMACY BULK,PF) 10 GM	IV
71288-0027-30	J3465	INJECTION, VORICONAZOLE, 10 MG	VORICONAZOLE (SDV,PF,LATEX-FREE) 200 MG	IV

HCPCS Code	Description	Billing Unit	SA Type
E1012 RR	Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each	Day	Y
E1012 U1	Wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each	Each	Y
E1020	Residual Limb Support System For Wheelchair,any type	Each	N
E1020 RR	Residual Limb Support System For Wheelchair	Day	N
E1020 U1	Residual Limb Support System For Wheelchair,any type Only use for Group 3 and above)	Each	Y
E2205	Manual Wheelchair Accessory, Handrim Without Projections (Includes ergonomic or controured), Any Type, Replacement Only, Each	Each	N
E2205 RR	Manual Wheelchair Accessory, Handrim Without Projections, Any Type, Replacement Only, Each	Day	N
E2207	Wheelchair Accessory, Crutch And Cane Holder, Each	Each	N
E2207 RR	Wheelchair Accessory, Crutch And Cane Holder, Each	Day	N
E2207 U1	Wheelchair Accessory, Crutch And Cane Holder, Each (For use with only Group 3 and above)	Each	Y
E2208	Wheelchair Accessory, Cylinder Tank Carrier, Each	Each	N
E2208 RR	Wheelchair Accessory, Cylinder Tank Carrier, Each	Day	N