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NDC | HCPCS | HCPCS Description | NDC Label | Route of Administration |
|---|---|---|---|---|
70860-0604-82 | J1953 | INJECTION, LEVETIRACETAM, 10 MG | LEVETIRACETAM-SODIUM CHLORIDE (PF,LATEX-FREE) 1500 MG/100 ML-0.54% | IV |
70860-0653-10 | J2800 | INJECTION, METHOCARBAMOL, UP TO 10 ML | METHOCARBAMOL (PF,LATEX-FREE) 100 MG/1 ML | IJ |
70860-0700-01 | J1885 | INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG | KETOROLAC TROMETHAMINE (PF,LATEX-FREE) 15 MG/1 ML | IJ |
70860-0700-02 | J1885 | INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG | KETOROLAC TROMETHAMINE (PF,LATEX-FREE) 15 MG/1 ML | IJ |
70860-0701-01 | J1885 | INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG | KETOROLAC TROMETHAMINE (PF,LATEX-FREE) 30 MG/1 ML | IJ |
70860-0701-02 | J1885 | INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG | KETOROLAC TROMETHAMINE (PF,LATEX-FREE) 30 MG/1 ML | IM |
70860-0701-03 | J1885 | INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG | KETOROLAC TROMETHAMINE (PF,LATEX-FREE) 30 MG/1 ML | IM |
70860-0701-04 | J1885 | INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG | KETOROLAC TROMETHAMINE (PF,LATEX-FREE) 30 MG/1 ML | IM |
70860-0751-02 | J3490 | UNCLASSIFIED DRUGS | FAMOTIDINE (SDV,PF,LATEX-FREE) 10 MG/1 ML | IV |
70710-1457-01 | Q0144 | AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM | AZITHROMYCIN (CHERRY BANANA) 100 MG/5 ML | PO |
70710-1458-02 | Q0144 | AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM | AZITHROMYCIN (CHERRY BANANA) 200 MG/5 ML | PO |
70710-1459-02 | Q0144 | AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM | AZITHROMYCIN (CHERRY BANANA) 200 MG/5 ML | PO |
HCPCS Code | Description | Billing Unit | SA Type |
|---|---|---|---|
L4397 | Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, off-the-shelf | Each | Y |
L4398 | Foot drop splint, recumbent positioning device, prefabricated, off-the-shelf | Each | Y |
L4631 | Ankle foot orthosis, walking boot type, varus/valgus correction, rocker bottom, anterior tibial shell, soft interface, custom arch supprot, plastic or other material, includes straps and closures, custom fabricated. | Each | Y |
A4216 | Sterile water, saline and /or dextrose, diluent/flush, 10 ml | Each | N |
A4217 | Sterile water/saline 500 ml | Each | N |
A4361 | Ostomy Face Plate | Each | N |
A4363 | Ostomy clamp, any type, replacement only, each | Each | N |
A4366 | Ostomy vent, any type, each | Each | N |
A4367 | Ostomy Belt | Each | N |
A4368 | Ostomy filter, any type, each | Each | N |
L3891 | Addition to upper extremity joint, wrist, or elbow, concentric adjustable torsion style mechanism for custom frabricated orthotics only, each | Each | Y |
L3806 | WHFO, includes one or more nontorsion joint(s), elastic bands/springs, turnbuckles, may include soft interface material, straps, custom fabricated, includes fitting and adjustment | Each | Y |
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