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NDC | HCPCS | HCPCS Description | NDC Label | Route of Administration |
|---|---|---|---|---|
72485-0104-01 | J0706 | INJECTION, CAFFEINE CITRATE, 5MG | CAFFEINE CITRATE (USP,SDV,PF) 20 MG/1 ML | IV |
72485-0104-10 | J0706 | INJECTION, CAFFEINE CITRATE, 5MG | CAFFEINE CITRATE (3X10,SDV, USP,PF) 20 MG/1 ML | IV |
72485-0106-10 | J1953 | INJECTION, LEVETIRACETAM, 10 MG | LEVETIRACETAM (10X5ML;USP;SDV) 100 MG/1 ML | IV |
72485-0106-25 | J1953 | INJECTION, LEVETIRACETAM, 10 MG | LEVETIRACETAM (25X5ML;USP;SDV) 100 MG/1 ML | IV |
72485-0114-01 | J2010 | INJECTION, LINCOMYCIN HCL, UP TO 300 MG | LINCOMYCIN HCL (MDV,GLUTEN-FREE) 300 MG/1 ML | IJ |
72485-0115-10 | J2010 | INJECTION, LINCOMYCIN HCL, UP TO 300 MG | LINCOMYCIN HCL (MDV,GLUTEN-FREE) 300 MG/1 ML | IJ |
72485-0201-01 | J9025 | INJECTION, AZACITIDINE, 1 MG | AZACITIDINE (SDV) 100 MG | IJ |
72485-0203-30 | J8999 | PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS | IMATINIB MESYLATE (FILM COATED) 400 MG | PO |
72485-0204-60 | None | CAPECITABINE, 150 MG, ORAL | CAPECITABINE (USP,FILM COATED) 150 MG | PO |
72485-0205-12 | None | CAPECITABINE, 500 MG, ORAL | CAPECITABINE (USP,FILM COATED) 500 MG | PO |
72485-0210-08 | J0594 | INJECTION, BUSULFAN, 1 MG | BUSULFAN (8X10ML,SDV) 6 MG/1 ML | IV |
72485-0211-02 | J9206 | INJECTION, IRINOTECAN, 20 MG | IRINOTECAN HYDROCHLORIDE (SDV) 20 MG/1 ML | IV |
HCPCS Code | Description | Billing Unit | SA Type |
|---|---|---|---|
A4404 | Ostomy Rings All Sizes | Each | N |
A4421 | Ostomy supply miscellaneous (Any Misc Ostomy/Colostomy supplies without a HCPCS code should use A4421 instead of E1399) | Each | Y |
A4421 | Stoma Cone Replacement Unit (Using ostomy supply misc.) | Each | Y |
A4422 | Ostomy absorbent material (sheet/pad/crystal packet), for use on Ostomy pouch to thicken liquid stoma output, each | Each | N |
A4436 | Irrigation supply; Sleeve, reusable, per month | 1 unit = 1 month supply | N |
A4437 | Irrigation supply; sleeve, disposible, per month | 1 unit = 1 month supply | Y |
A4456 | Adhesive Remover, Wipes, any type, each | Each | N |
A4455 | Adhesive Remover Or Solvent (for tape, cement or other adhesive), | Ounce | N |
A5055 | Stoma Caps | Each | N |
A5056 | Ostomy Pouch, Drainable, with extended wear barrier attached, with filter (1 piece) each | Each | N |
A5057 | Ostomy Pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece) each | Each | N |
A5081 | Continent device; plug for continent stoma | Each | N |
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