WELCOME

NDC	HCPCS	HCPCS Description	NDC Label	Route of Administration
72205-0045-01	J9340	INJECTION, THIOTEPA, 15 MG	THIOTEPA (SDV,LYOPHILIZED) 15 MG	IJ
72205-0046-01	J9340	INJECTION, THIOTEPA, 15 MG	THIOTEPA (SDV,LYOPHILIZED) 100 MG	IJ
72205-0054-01	J1453	INJECTION, FOSAPREPITANT, 1 MG	FOSAPREPITANT DIMEGLUMINE (SDV,LYOPHILIZED) 150 MG	IV
72205-0061-01	J9267	INJECTION, PACLITAXEL, 1 MG	PACLITAXEL (MDV,PF,LATEX-FREE) 6 MG/1 ML	IV
72205-0062-01	J9267	INJECTION, PACLITAXEL, 1 MG	PACLITAXEL (MDV,PF,LATEX-FREE) 6 MG/1 ML	IV
72205-0063-01	J9267	INJECTION, PACLITAXEL, 1 MG	PACLITAXEL (MDV,PF,LATEX-FREE) 6 MG/1 ML	IV
72205-0083-01	J1453	INJECTION, FOSAPREPITANT, 1 MG	PREMIERPRO RX FOSAPREPITANT DIMEGLUMINE (SDV,LYOPHILIZED) 150 MG	IV
72205-0099-78	J7520	SIROLIMUS, ORAL, 1 MG	SIROLIMUS 1 MG/1 ML	PO
72205-0101-07	J3490	UNCLASSIFIED DRUGS	BUMETANIDE (SDV,LATEX-FREE) 0.25 MG/1 ML	IJ
72205-0102-07	J3490	UNCLASSIFIED DRUGS	BUMETANIDE (MDV,LATEX-FREE) 0.25 MG/1 ML	IJ
72205-0104-91	Q0161	CHLORPROMAZINE HYDROCHLORIDE, 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	CHLORPROMAZINE HCL (SUGAR COATED) 25 MG	PO
72205-0205-07	J3486	INJECTION, ZIPRASIDONE MESYLATE, 10 MG	ZIPRASIDONE MESYLATE (SDV,PF,LATEX-FREE) 20 MG	IM

HCPCS Code	Description	Billing Unit	SA Type
L4020	Replace quadrilateral socket brim, molded to patient model	Each	Y
L4030	Replace quadrilateral socket brim, custom fabricated	Each	Y
L4040	Replace molded thigh lacer, for custom fabricated orthosis only	Each	Y
L4045	Replace nonmolded thigh lacer, for custom fabricated orthosis only	Each	Y
L4050	Replace molded calf lacer, for custom fabricated orthosis only	Each	Y
L4055	Replace nonmolded calf lacer, for custom fabricated orthosis only	Each	Y
L4060	Replace high roll cuff	Each	Y
L4070	Replace proximal and distal upright for KAFO	Each	Y
L4080	Replace metal bands KAFO, proximal thigh	Each	Y
L4090	Replace metal bands KAFO-AFO, calf or distal thigh	Each	Y
L4100	Replace leather cuff KAFO, proximal thigh	Each	Y
L4110	Replace leather cuff KAFO-AFO, calf or distal thigh	Each	Y