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NDC | HCPCS | HCPCS Description | NDC Label | Route of Administration |
|---|---|---|---|---|
71288-0126-90 | J9050 | INJECTION, CARMUSTINE, 100 MG | CARMUSTINE (W/DILUENT,LYOPHILIZED) 100 MG | IV |
71288-0128-20 | J9027 | INJECTION, CLOFARABINE, 1 MG | CLOFARABINE (SDV,PF,LATEX-FREE) 1 MG/1 ML | IV |
71288-0129-02 | J9120 | INJECTION, DACTINOMYCIN, 0.5 MG | DACTINOMYCIN (SDV;USP,PF,LATEX-FREE) 0.5 MG | IV |
71288-0132-90 | J9245 | INJECTION, MELPHALAN HYDROCHLORIDE, NOT OTHERWISE SPECIFIED, 50 MG | MELPHALAN HYDROCHLORIDE (W/10ML DILUENT,PF) 50 MG | IV |
71288-0137-20 | J9280 | INJECTION, MITOMYCIN, 5 MG | MITOMYCIN (PF,LATEX-FREE) 5 MG | IV |
71288-0138-50 | J9280 | INJECTION, MITOMYCIN, 5 MG | MITOMYCIN (PF,LATEX-FREE) 20 MG | IV |
71288-0139-51 | J9280 | INJECTION, MITOMYCIN, 5 MG | MITOMYCIN (PF,LATEX-FREE) 40 MG | IV |
71288-0144-08 | J9171 | INJECTION, DOCETAXEL, 1 MG | DOCETAXEL (MDV,PF,LATEX-FREE) 10 MG/1 ML | IV |
71288-0144-16 | J9171 | INJECTION, DOCETAXEL, 1 MG | DOCETAXEL (MDV,PF,LATEX-FREE) 10 MG/1 ML | IV |
71288-0149-95 | J9263 | INJECTION, OXALIPLATIN, 0.5 MG | PREMIERPRO RX OXALIPLATIN (SDV, USP,PF,LATEX-FREE) 5 MG/1 ML | IV |
71288-0149-96 | J9263 | INJECTION, OXALIPLATIN, 0.5 MG | PREMIERPRO RX OXALIPLATIN (SDV, USP,PF,LATEX-FREE) 5 MG/1 ML | IV |
71288-0153-95 | J9025 | INJECTION, AZACITIDINE, 1 MG | AZACITIDINE NOVAPLUS (SDV,PF,LATEX-FREE) 100 MG | IJ |
HCPCS Code | Description | Billing Unit | SA Type |
|---|---|---|---|
E2387 U1 | Power Wheelchair Accessory, Foam Filled Caster Tire, Any Size, Replacement Only, Each (For use with only Group 3 and above) | Each | Y |
E2388 | Power Wheelchair Accessory, Foam Drive Wheel Tire, Any Size, Replacement Only, Each | Each | Y |
E2388 U1 | Power Wheelchair Accessory, Foam Drive Wheel Tire, Any Size, Replacement Only, Each (For use with only Group 3 and above) | Each | Y |
E2389 | Power Wheelchair Accessory, Foam Caster Tire, Any Size, Replacement Only, Each | Each | Y |
E2389 U1 | Power Wheelchair Accessory, Foam Caster Tire, Any Size, Replacement Only, Each (For use with only Group 3 and above) | Each | Y |
E2390 | Power Wheelchair Accessory, Solid (Rubber/Plastic) Drive Wheel Tire, Any Size, Replacement Only, Each | Each | Y |
E2390 U1 | Power Wheelchair Accessory, Solid (Rubber/Plastic) Drive Wheel Tire, Any Size, Replacement Only, Each (For use with Group 3 and above | Each | Y |
E2391 | Power Wheelchair Accessory, Solid (Rubber/Plastic) Caster Tire (Removable), Any Size, Replacement Only, Each | Each | Y |
E2391 U1 | Power Wheelchair Accessory, Solid (Rubber/Plastic) Caster Tire (Removable), Any Size, Replacement Only, Each (For use with Group 3 and above) | Each | Y |
E2392 | Power Wheelchair Accessory, Solid (Rubber/Plastic) Caster Tire With Integrated Wheel, Any Size, Replacement Only, Each | Each | Y |
E2392 U1 | Power Wheelchair Accessory, Solid (Rubber/Plastic) Caster Tire With Integrated Wheel, Any Size, Replacement Only, Each (For use with Group 3 and above) | Each | Y |
E2394 | Power Wheelchair Accessory, Drive Wheel Excludes Tire, Any Size, Replacement Only, Each | Each | Y |
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