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NDC | HCPCS | HCPCS Description | NDC Label | Route of Administration |
|---|---|---|---|---|
70860-0302-04 | J1940 | INJECTION, FUROSEMIDE, UP TO 20 MG | FUROSEMIDE (USP,PF,LATEX-FREE) 10 MG/1 ML | IJ |
70860-0302-10 | J1940 | INJECTION, FUROSEMIDE, UP TO 20 MG | FUROSEMIDE (USP,PF,LATEX-FREE) 10 MG/1 ML | IJ |
70860-0402-10 | J0583 | INJECTION, BIVALIRUDIN, 1 MG | BIVALIRUDIN (PF,LATEX-FREE) 250 MG | IV |
70860-0405-04 | J3490 | UNCLASSIFIED DRUGS | BUMETANIDE (SDV,LATEX-FREE) 0.25 MG/1 ML | IJ |
70860-0406-10 | J3490 | UNCLASSIFIED DRUGS | BUMETANIDE (SDV,LATEX-FREE) 0.25 MG/1 ML | IJ |
70860-0454-01 | J2597 | INJECTION, DESMOPRESSIN ACETATE, PER 1 MCG | DESMOPRESSIN ACETATE (10X1ML;USP;SDV) 4 MCG/1 ML | IJ |
70860-0454-10 | J2597 | INJECTION, DESMOPRESSIN ACETATE, PER 1 MCG | DESMOPRESSIN ACETATE (1X10ML;MDV,LATEX-FREE) 4 MCG/1 ML | IJ |
70860-0600-02 | J2250 | INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG | MIDAZOLAM (SDV) 1 MG/1 ML | IJ |
70860-0601-05 | J2250 | INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG | MIDAZOLAM (MDV) 5 MG/1 ML | IJ |
70860-0601-10 | J2250 | INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG | MIDAZOLAM (MDV) 5 MG/1 ML | IJ |
70860-0602-82 | J1953 | INJECTION, LEVETIRACETAM, 10 MG | LEVETIRACETAM-SODIUM CHLORIDE (PF,LATEX-FREE) 500 MG/100 ML-0.82% | IV |
70860-0603-82 | J1953 | INJECTION, LEVETIRACETAM, 10 MG | LEVETIRACETAM-SODIUM CHLORIDE (PF,LATEX-FREE) 1000 MG/100 ML-0.75% | IV |
HCPCS Code | Description | Billing Unit | SA Type |
|---|---|---|---|
L4130 | Replace pretibial shell | Each | Y |
L4205 | Repair of orthotic device, labor component, per 15 minutes | Per 15 min | Y |
L4210 | Repair of orthotic device, repair or replace minor parts | Each | Y |
L4350 | Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf | Each | Y |
L4360 | Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | Each | Y |
L4361 | Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf | Each | Y |
L4370 | Pneumatic full leg splint, prefabricated, off-the-shelf | Each | Y |
L4386 | Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | Each | Y |
L4387 | Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf | Each | Y |
L4392 | Replacement soft interface material, static AFO | Each | Y |
L4394 | Replace soft interface material, foot drop splint | Each | Y |
L4396 | Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | Each | Y |
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