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NDC	HCPCS	HCPCS Description	NDC Label	Route of Administration
70860-0776-02	J2405	INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG	ONDANSETRON HCL (SDV,PF) 2 MG/1 ML	IJ
70860-0777-20	J2405	INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG	ONDANSETRON (MDV) 2 MG/1 ML	IJ
70860-0777-21	J2405	INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG	ONDANSETRON (10X20ML;MDV,LATEX-FREE) 2 MG/1 ML	IJ
70860-0778-02	J0780	INJECTION, PROCHLORPERAZINE, UP TO 10 MG	PROCHLORPERAZINE EDISYLATE (LATEX-FREE) 5 MG/1 ML	IJ
70860-0778-10	J0780	INJECTION, PROCHLORPERAZINE, UP TO 10 MG	PROCHLORPERAZINE EDISYLATE (MDV,LATEX-FREE) 5 MG/1 ML	IJ
70860-0780-10	J1453	INJECTION, FOSAPREPITANT, 1 MG	FOSAPREPITANT DIMEGLUMINE (LYOPHILIZED,PF) 150 MG	IV
70860-0782-10	J1453	INJECTION, FOSAPREPITANT, 1 MG	FOSAPREPITANT DIMEGLUMINE (SDV,PF,LATEX-FREE) 150 MG	IV
70860-0801-01	J3105	INJECTION, TERBUTALINE SULFATE, UP TO 1 MG	TERBUTALINE SULFATE (PF,LATEX-FREE) 1 MG/1 ML	SC
70860-0802-82	J3489	INJECTION, ZOLEDRONIC ACID, 1 MG	ZOLEDRONIC ACID (PF,LATEX-FREE) 5 MG/100 ML	IV
70868-0920-21	J8540	DEXAMETHASONE, ORAL, 0.25 MG	DEXAMETHASONE 1.5 MG	PO
70954-0056-10	J7512	PREDNISONE, IMMEDIATE RELEASE OR DELAYED RELEASE, ORAL, 1 MG	PREDNISONE (USP) 1 MG	PO
70954-0056-20	J7512	PREDNISONE, IMMEDIATE RELEASE OR DELAYED RELEASE, ORAL, 1 MG	PREDNISONE (USP) 1 MG	PO

HCPCS Code	Description	Billing Unit	SA Type
K0195	Elevating Leg Rest, Pair	Pair	N
K0195 RR	Elevating Leg Rest, Pair	Day	N
E0982	Wheelchair Accessory, Back Upholstery, Replacement Only, Each	Each	N
E0982 U1	Wheelchair Accessory, Back Upholstery, Replacement Only, Each (For use with only Group 3 and above)	Each	Y
E2291	Back, Planar, For Pediatric Size Wheelchair Including Fixed Attaching Hardware	Each	Y
E2291 RR	Back, Planar, For Pediatric Size Wheelchair Including Fixed Attaching Hardware	Day	Y
E2293	Back, Contoured, For Pediatric Size Wheelchair Including Fixed Attaching Hardware	Each	Y
E2293 RR	Back, Contoured, For Pediatric Size Wheelchair Including Fixed Attaching Hardware	Day	Y
E2611	General Use Wheelchair Back Cushion, Width Less Than 22 Inches, Any Height, Including Any Type Mounting Hardware	Each	Y
E2611 U1	General Use Wheelchair Back Cushion, Width Less Than 22 Inches, Any Height, Including Any Type Mounting Hardware (For use only with Group 3 and above)	Each	y
E2612	General Use Wheelchair Back Cushion, Width 22 Inches Or Greater, Any Height, Including Any Type Mounting Hardware	Each	Y
E2612 U1	General Use Wheelchair Back Cushion, Width 22 Inches Or Greater, Any Height, Including Any Type Mounting Hardware (For use only with Group 3 and above)	Each	Y