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NDC	HCPCS	HCPCS Description	NDC Label	Route of Administration
58463-0017-01	J8540	DEXAMETHASONE, ORAL, 0.25 MG	DECADRON 6 MG	PO
58468-0030-02	J3240	INJECTION, THYROTROPIN ALPHA, 0.9 MG, PROVIDED IN 1.1 MG VIAL	THYROGEN (LYOPHILIZED) 1.1 MG	IM
58468-0040-01	J0180	INJECTION, AGALSIDASE BETA, 1 MG	FABRAZYME (PF) 35 MG	IV
58468-0041-01	J0180	INJECTION, AGALSIDASE BETA, 1 MG	FABRAZYME (PF) 5 MG	IV
58468-0050-01	J0218	INJECTION, OLIPUDASE ALFA-RPCP, 1 MG	XENPOZYME (SDV,PF,LATEX-FREE) 20 MG	IV
58468-0070-01	J1931	INJECTION, LARONIDASE, 0.1 MG	ALDURAZYME (PF) 0.58 MG/ML	IV
58468-0080-01	J7511	LYMPHOCYTE IMMUNE GLOBULIN, ANTITHYMOCYTE GLOBULIN, RABBIT, PARENTERAL, 25MG	THYMOGLOBULIN (VIAL,DILUENT) 25 MG	IV
58468-0127-01	J1270	INJECTION, DOXERCALCIFEROL, 1 MCG	HECTOROL (50X2ML,MDV) 2 MCG/ML	IV
58468-0218-02	J8540	DEXAMETHASONE, ORAL, 0.25 MG	DEXAMETHASONE 4 MG	PO
58864-0162-30	Q0163	DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT TIME OF CHEMOTHERAPY TREATMENT NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN	DIPHENHYDRAMINE HCL (REDI-SCRIPT) 25 MG	PO
58864-0162-56	Q0163	DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT TIME OF CHEMOTHERAPY TREATMENT NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN	DIPHENHYDRAMINE HCL (REDI-SCRIPT) 25 MG	PO
58864-0191-25	J8499	PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS	ACYCLOVIR (REDI-SCRIPT) 800 MG	PO

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