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NDC	HCPCS	HCPCS Description	NDC Label	Route of Administration
72572-0875-01	J3465	INJECTION, VORICONAZOLE, 10 MG	VORICONAZOLE (SDV,LYOPHILIZED) 200 MG	IV
72578-0002-01	J8499	PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS	ACYCLOVIR (USP,HARD-GELATIN) 200 MG	PO
72578-0002-05	J8499	PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS	ACYCLOVIR (USP,HARD-GELATIN) 200 MG	PO
72603-0101-01	J9263	INJECTION, OXALIPLATIN, 0.5 MG	OXALIPLATIN (PF,LATEX-FREE) 5 MG/1 ML	IV
72603-0103-01	Q2050	INJECTION, DOXORUBICIN HYDROCHLORIDE, LIPOSOMAL, NOT OTHERWISE SPECIFIED, 10 MG	DOXORUBICIN HCL LIPOSOME 2 MG/1 ML	IV
72603-0104-01	J9070	CYCLOPHOSPHAMIDE, 100 MG	CYCLOPHOSPHAMIDE (SDV,USP,PF) 500 MG	IV
72603-0106-01	J1453	INJECTION, FOSAPREPITANT, 1 MG	FOSAPREPITANT DIMEGLUMINE (SDV,PF,LATEX-FREE) 150 MG	IV
72603-0107-01	J0894	INJECTION, DECITABINE, 1 MG	DECITABINE (LATEX-FREE,LYOPHILIZED) 50 MG	IV
72266-0101-01	J1190	INJECTION, DEXRAZOXANE HYDROCHLORIDE, PER 250 MG	DEXRAZOXANE (LATEX-FREE,LYOPHILIZED) 500 MG	IV
72266-0102-01	J1920	INJECTION, LABETALOL HYDROCHLORIDE, 5 MG	LABETALOL HCL (USP,MDV,LATEX-FREE) 5 MG/1 ML	IV
72266-0103-01	J1920	INJECTION, LABETALOL HYDROCHLORIDE, 5 MG	LABETALOL HCL (USP,MDV,LATEX-FREE) 5 MG/1 ML	IV
72266-0106-01	J0637	INJECTION, CASPOFUNGIN ACETATE, 5 MG	CASPOFUNGIN ACETATE (SDV,PF,LATEX-FREE) 50 MG	IV

HCPCS Code	Description	Billing Unit	SA Type
A5063	Ostomy Pouch, Drainable, For Use On Barrier W/Flange, 2 Piece System	Each	N
A5071	Ostomy Pouch Urinary W/Barrier Attached 1 Piece	Each	N
A5072	Ostomy Pouch Urinary Without Barrier Attached, 1 Piece	Each	N
A5073	Ostomy Pouch Urinary For Use On Barrier With Flange, 2 Pieces	Each	N
A4362	Ostomy Skin Barrier; Solid, 4x4 Or Equivalent	Each	N
A4364	Adhesive liquid or equal, any type	Ounce	N
A4369	Ostomy skin barrier, liquid (spray, brush, etc.), per oz.	Ounce	N
A4371	Ostomy skin barrier powder, per oz.	Ounce	N
A4372	Ostomy skin barrier, solid 4x4 or equivalent, with built-in convexity, each	Each	N
A4373	Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each	Each	N
A4384	Ostomy faceplate equivalent, silicone ring, each	Each	N
A4385	Ostomy skin barrier, solid 4X4 or equivalent, extended wear, without built-in convexity, each	Each	N