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NDC | HCPCS | HCPCS Description | NDC Label | Route of Administration |
|---|---|---|---|---|
70748-0175-60 | J7605 | ARFORMOTEROL, INHALATION SOLUTION, FDA APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, 15 MICROGRAMS | ARFORMOTEROL TARTRATE (60X2ML) 15 MCG/2 ML | IH |
70748-0175-60 | J7605 | ARFORMOTEROL, INHALATION SOLUTION, FDA APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, 15 MICROGRAMS | ARFORMOTEROL TARTRATE (60X2ML) 15 MCG/2 ML | IH |
70748-0186-01 | J7517 | MYCOPHENOLATE MOFETIL, ORAL, 250 MG | MYCOPHENOLATE MOFETIL (HARD GELATIN) 250 MG | PO |
72078-0046-18 | J0282 | INJECTION, AMIODARONE HYDROCHLORIDE, 30 MG | AMIODARONE HCL NOVAPLUS (SDV,LATEX-FREE) 50 MG/1 ML | IV |
72171-0501-01 | J9210 | INJECTION, EMAPALUMAB-LZSG, 1 MG | GAMIFANT (PF) 5 MG/1 ML | IV |
72171-0505-01 | J9210 | INJECTION, EMAPALUMAB-LZSG, 1 MG | GAMIFANT (PF) 5 MG/1 ML | IV |
72187-0401-01 | J9269 | INJECTION, TAGRAXOFUSP-ERZS, 10 MICROGRAMS | ELZONRIS (PF) 1000 MCG/1 ML | IV |
72205-0006-60 | None | CAPECITABINE, 150 MG, ORAL | CAPECITABINE (FILM COATED) 150 MG | PO |
72205-0007-92 | None | CAPECITABINE, 500 MG, ORAL | CAPECITABINE (FILM COATED) 500 MG | PO |
72205-0026-01 | J1453 | INJECTION, FOSAPREPITANT, 1 MG | FOSAPREPITANT DIMEGLUMINE (LYOPHILIZED) 150 MG | IV |
72205-0031-01 | J0894 | INJECTION, DECITABINE, 1 MG | DECITABINE (SDV,LYOPHILIZED) 50 MG | IV |
72205-0036-01 | J0894 | INJECTION, DECITABINE, 1 MG | DECITABINE NOVAPLUS (SDV,LYOPHILIZED) 50 MG | IV |
HCPCS Code | Description | Billing Unit | SA Type |
|---|---|---|---|
L3976 | Shoulder elbow wrist hand finger orthosis, abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment | Each | Y |
L3977 | Shoulder elbow wrist hand finger orthosis, shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment | Each | Y |
L3978 | Shoulder elbow wrist hand finger orthosis, abduction positioning (airplane design), thoracic component and support bar, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment | Each | Y |
L3980 | Upper extremity fracture orthosis, humeral, prefabricated, includes fitting and adjustment | Each | Y |
L3981 | Upper extremity fracture orthosis, humeral, prefabricated, includes shoulder cap design, with or without joints, forearm section, may include soft interface, straps, includes fitting and adjustment | Each | Y |
L3982 | Upper extremity fracture orthosis, radius/ulnar, prefabricated, includes fitting and adjustment | Each | Y |
L3984 | Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment | Each | Y |
L3995 | Addition to upper extremity orthosis, sock, fracture or equal, each | Each | Y |
L3999 | Upper limb orthosis, NOS | Each | Y |
L4000 | Replace girdle for spinal orthosis (CTLSO or SO) | Each | Y |
L4002 | Replace strap, any orthosis, includes all components, any length, any type | Each | Y |
L4010 | Replace trilateral socket brim | Each | Y |
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