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NDC	HCPCS	HCPCS Description	NDC Label	Route of Administration
70954-0061-10	J7512	PREDNISONE, IMMEDIATE RELEASE OR DELAYED RELEASE, ORAL, 1 MG	PREDNISONE (USP) 50 MG	PO
70954-0089-02	J0692	INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG	CEFEPIME (SDV,PF,LATEX-FREE) 1 GM	IJ
70954-0090-02	J0692	INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG	CEFEPIME (SDV,PF,LATEX-FREE) 2 GM	IJ
70954-0188-10	J8499	PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS	ACYCLOVIR (1X473ML;USP,BANANA) 200 MG/5 ML	PO
70954-0401-10	J8540	DEXAMETHASONE, ORAL, 0.25 MG	DEXAMETHASONE 1.5 MG	PO
70954-0402-10	J8540	DEXAMETHASONE, ORAL, 0.25 MG	DEXAMETHASONE 2 MG	PO
70954-0403-10	J8540	DEXAMETHASONE, ORAL, 0.25 MG	DEXAMETHASONE 4 MG	PO
70954-0404-10	J8540	DEXAMETHASONE, ORAL, 0.25 MG	DEXAMETHASONE 6 MG	PO
70954-0688-10	Q0164	PROCHLORPERAZINE MALEATE, 5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN	PROCHLORPERAZINE MALEATE (USP,FILM-COATED) 5 MG	PO
70954-0689-10	Q0164	PROCHLORPERAZINE MALEATE, 5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF CHEMOTHERAPY TREATMENT, NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN	PROCHLORPERAZINE MALEATE (USP,FILM-COATED) 10 MG	PO
71045-0010-02	J0291	INJECTION, PLAZOMICIN, 5 MG	ZEMDRI (SDV,PF) 50 MG/1 ML	IV
71127-1200-01	A4216	STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML	STERILE WATER (SEVENFACT DILUENT)	IJ

HCPCS Code	Description	Billing Unit	SA Type
E2631	Wheelchair Accessory, Addition to Mobile Arm Support, Elevating Proximal Arm	Each	N
E2631 RR	Wheelchair Accessory, Addition to Mobile Arm Support, Elevating Proximal Arm	Day	N
E2632	Wheelchair Accessory, Addition to Mobile Arm Support, Offset or Lateral Rocker	Each	N
E2632 RR	Wheelchair Accessory, Addition to Mobile Arm Support, Offset or Lateral Rocker	Day	N
E2633	Wheelchair Accessory, Addition to Mobile Arm Support, Supinator	Each	N
E2633 RR	Wheelchair Accessory, Addition to Mobile Arm Support, Supinator	Day	N
K0015	Detachable, Nonadjustable Height Armrest, Each	Each	N
K0015 RR	Detachable, Nonadjustable Height Armrest, Each	Day	N
K0015 U1	Detachable, Nonadjustable Height Armrest, Each (For use only with Group 3 and above)	Each	Y
K0017	Detachable, Adjustable Height Armrest, Base, Replacement only, Each	Each	N
K0017 RR	Detachable, Adjustable Height Armrest, Base, Replacement only, Each	Day	N
K0017 U1	Detachable, Adjustable Height Armrest, Base, Replacement only, Each (For use only with Group 3 and above)	Each	Y