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NDC	HCPCS	HCPCS Description	NDC Label	Route of Administration
70121-2503-01	J0475	INJECTION, BACLOFEN, 10 MG	LIORESAL REFILL KIT (8564,PF,LATEX-FREE) 2 MG/1 ML	IN
70121-2504-02	J0475	INJECTION, BACLOFEN, 10 MG	LIORESAL REFILL KIT (8565,PF,LATEX-FREE) 0.5 MG/1 ML	IN
70121-2505-02	J0475	INJECTION, BACLOFEN, 10 MG	LIORESAL REFILL KIT (8566,PF,LATEX-FREE) 2 MG/1 ML	IN
70257-0300-51	J2792	INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN, SOLVENT DETERGENT, 100 IU	WINRHO SDF (SDV,PF) 15000 IU/13 ML	IJ
70257-0310-51	J2792	INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN, SOLVENT DETERGENT, 100 IU	WINRHO SDF (1X4.4ML,SDV,PF) 5000 IU/4.4 ML	IJ
70257-0330-51	J2792	INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN, SOLVENT DETERGENT, 100 IU	WINRHO SDF (PF) 1500 IU/1.3 ML	IJ
72603-0326-01	J9070	CYCLOPHOSPHAMIDE, 100 MG	CYCLOPHOSPHAMIDE (SDV,USP,PF) 1 GM	IV
72603-0401-01	J3301	INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG	TRIAMCINOLONE ACETONIDE (LATEX-FREE) 40 MG/1 ML	IJ
72603-0474-25	J1940	INJECTION, FUROSEMIDE, UP TO 20 MG	FUROSEMIDE (25X10ML,SDV,LATEX-FREE) 10 MG/1 ML	IJ
72606-0554-01	None	CAPECITABINE, 150 MG, ORAL	CAPECITABINE (USP,FILM COATED) 150 MG	PO
72606-0555-01	None	CAPECITABINE, 500 MG, ORAL	CAPECITABINE (USP,FILM COATED) 500 MG	PO
72606-0557-01	J8999	PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS	IMATINIB MESYLATE (FILM COATED) 400 MG	PO

HCPCS Code	Description	Billing Unit	SA Type
E 1228 RR	Special Back Height for Wheelchair	Day	N
E2211	Manual Wheelchair Accessory, Pneumatic Propulsion Tire, Any Size, Each	Each	N
E2211 RR	Manual Wheelchair Accessory, Pneumatic Propulsion Tire, Any Size, Each	Day	N
E2212	Manual Wheelchair Accessory, Tube For Pneumatic Propulsion Tire, Any Size, Each	Each	N
E2212 RR	Manual Wheelchair Accessory, Tube For Pneumatic Propulsion Tire, Any Size, Each	Day	N
E2213	Manual Wheelchair Accessory, Insert For Pneumatic Propulsion Tire (Removable), Any Type, Any Size, Each	Each	N
E2213 RR	Manual Wheelchair Accessory, Insert For Pneumatic Propulsion Tire (Removable), Any Type, Any Size, Each	Day	N
E2214	Manual Wheelchair Accessory, Pneumatic Caster Tire, Any Size, Each	Each	N
E2214 RR	Manual Wheelchair Accessory, Pneumatic Caster Tire, Any Size, Each	Day	N
E2215	Manual Wheelchair Accessory, Tube For Pneumatic Caster Tire, Any Size, Each	Each	N
E2215 RR	Manual Wheelchair Accessory, Tube For Pneumatic Caster Tire, Any Size, Each	Day	N
E2216	Manual Wheelchair Accessory, Foam Filled Propulsion Tire, Any Size, Each	Each	Y