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NDC	HCPCS	HCPCS Description	NDC Label	Route of Administration
72572-0100-01	J0878	INJECTION, DAPTOMYCIN, 1 MG	DAPTOMYCIN (PF,LYOPHILIZED) 350 MG	IV
72572-0102-01	J0878	INJECTION, DAPTOMYCIN, 1 MG	DAPTOMYCIN (PF,LYOPHILIZED) 500 MG	IV
72572-0120-25	J1100	INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG	DEXAMETHASONE SODIUM PHOSPHATE (USP) 4 MG/1 ML	IJ
72572-0122-25	J1100	INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG	DEXAMETHASONE SODIUM PHOSPHATE 10 MG/1 ML	IJ
72572-0140-02	J3360	INJECTION, DIAZEPAM, UP TO 5 MG	DIAZEPAM (10X2ML) 5 MG/1 ML	IJ
72572-0170-25	J3010	INJECTION, FENTANYL CITRATE, 0.1 MG	FENTANYL CITRATE (25X2ML,USP,SDV,PF) 0.05 MG/1 ML	IJ
72572-0171-25	J3010	INJECTION, FENTANYL CITRATE, 0.1 MG	FENTANYL CITRATE (25X5ML,USP,SDV,PF) 0.05 MG/1 ML	IJ
72572-0172-01	J3010	INJECTION, FENTANYL CITRATE, 0.1 MG	FENTANYL CITRATE (SDV;USP,PF) 50 MCG/1 ML	IV
72572-0190-25	J1940	INJECTION, FUROSEMIDE, UP TO 20 MG	FUROSEMIDE (SDV) 10 MG/1 ML	IJ
72572-0225-25	J7643	GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM	GLYCOPYRROLATE 0.2 MG/1 ML	IJ
72572-0225-25	J7643	GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM	GLYCOPYRROLATE 0.2 MG/1 ML	IJ
72572-0226-25	J7643	GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM	GLYCOPYRROLATE (25X1ML;USP;SDV) 0.2 MG/1 ML	IJ

HCPCS Code	Description	Billing Unit	SA Type
E2377 U1	Power Wheelchair Accessory, Expandable Controller, Including All Related Electronics And Mounting Hardware, Upgrade Provided At Initial Issue	Each	Y
E2377 RR	Power Wheelchair Accessory, Expandable Controller, Including All Related Electronics And Mounting Hardware, Upgrade Provided At Initial Issue	Day	Y
E1002	Wheelchair Accessory, Power Seating System, Tilt Only	Each	Y
E1002 RR	Wheelchair Accessory, Power Seating System, Tilt Only	Day	Y
E1002 U1	Wheelchair Accessory, Power Seating System, Tilt Only	Each	Y
E1003	Wheelchair Accessory, Power Seating System, Recline Only, Without Shear Reduction	Each	Y
E1297	Special Wheelchair Seat Depth, By Upholstery	Each	N
E1297 RR	Special Wheelchair Seat Depth, By Upholstery	Day	N
E1298	Special Wheelchair Seat Depth And/Or Width, By Construction	Each	N
E1298 RR	Special Wheelchair Seat Depth And/Or Width, By Construction	Day	N
E2201	Manual Wheelchair Accessory, Nonstandard Seat Frame, Width Greater Than Or Equal To 20 Inches And Less Than 24 Inches	Each	N
E2201 RR	Manual Wheelchair Accessory, Nonstandard Seat Frame, Width Greater Than Or Equal To 20 Inches And Less Than 24 Inches	Day	N