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NDC | HCPCS | HCPCS Description | NDC Label | Route of Administration |
|---|---|---|---|---|
67457-0455-52 | J9100 | INJECTION, CYTARABINE, 100 MG | CYTARABINE (SDV,PF,LATEX-FREE) 20 MG/1 ML | IJ |
67457-0471-52 | J9267 | INJECTION, PACLITAXEL, 1 MG | PACLITAXEL (MDV) 6 MG/ML | IV |
67457-0474-04 | J9351 | INJECTION, TOPOTECAN, 0.1 MG | TOPOTECAN HYDROCHLORIDE (SINGLE-DOSE,LYOPHILIZED) 4 MG | IV |
67457-0476-10 | J9263 | INJECTION, OXALIPLATIN, 0.5 MG | OXALIPLATIN (PF,LYOPHILIZED) 100 MG | IV |
67457-0483-10 | J1100 | INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG | DEXAMETHASONE SODIUM PHOSPHATE NOVAPLUS (10X10ML;USP) 10 MG/1 ML | IJ |
67457-0484-30 | J1100 | INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG | DEXAMETHASONE SODIUM PHOSPHATE NOVAPLUS (25X30ML;USP;MDV) 4 MG/1 ML | IJ |
70860-0209-10 | J9209 | INJECTION, MESNA, 200 MG | MESNA 100 MG/1 ML | IV |
70860-0210-51 | J3489 | INJECTION, ZOLEDRONIC ACID, 1 MG | ZOLEDRONIC ACID (PF,LATEX-FREE) 4 MG/100 ML | IV |
70860-0214-61 | J9245 | INJECTION, MELPHALAN HYDROCHLORIDE, NOT OTHERWISE SPECIFIED, 50 MG | MELPHALAN HYDROCHLORIDE (W/10ML DILUENT,PF) 50 MG | IV |
70860-0215-68 | J9267 | INJECTION, PACLITAXEL, 1 MG | PACLITAXEL NOVAPLUS (PF,LATEX-FREE) 6 MG/1 ML | IV |
70860-0216-10 | J0594 | INJECTION, BUSULFAN, 1 MG | BUSULFAN (PF,LATEX-FREE) 6 MG/1 ML | IV |
70860-0217-10 | J9017 | INJECTION, ARSENIC TRIOXIDE, 1 MG | ARSENIC TRIOXIDE (SDV,PF,LATEX-FREE) 1 MG/1 ML | IV |
HCPCS Code | Description | Billing Unit | SA Type |
|---|---|---|---|
L3610 | Transfer of an orthosis from one shoe to another, caliper plate, new | Each | Y |
L3620 | Transfer of an orthosis from one shoe to another, solid stirrup, existing | Each | Y |
L3630 | Transfer of an orthosis from one shoe to another, solid stirrup, new | Each | Y |
L3640 | Transfer of an orthosis from one shoe to another, Dennis Brown splint (Riveton), both sides | Each | Y |
L3649 | Orthopedic shoe, modification, addition or transfer, NOS (Providers need to determine if an alternative HCPCS code better describes the service being reported or that is not already included in the main code. This code should only be used if a more specific code is unavailable) | Each | Y |
L3650 | Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf | Each | Y |
L3660 | Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf | Each | Y |
L3670 | Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf | Each | Y |
L3671 | SO, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment | Each | Y |
L3674 | Shoulder orthosis, abduction positioning (airplane design), thoracic component and support bar, with or without nontorsion joint/turnbuckle, may include soft interface, straps, custon fabricated, includes fitting and adjustment | Each | Y |
L3675 | Shoulder orthosis, vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf | Each | Y |
L3677 | Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, 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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