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NDC | HCPCS | HCPCS Description | NDC Label | Route of Administration |
|---|---|---|---|---|
71839-0105-24 | J2710 | INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG | NEOSTIGMINE METHYLSULFATE (USP, MDV,LATEX-FREE) 0.5 MG/1 ML | IV |
71839-0106-01 | J2710 | INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG | NEOSTIGMINE METHYLSULFATE (USP,SDV,LATEX-FREE) 1 MG/1 ML | IV |
71839-0106-10 | J2710 | INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG | NEOSTIGMINE METHYLSULFATE (MDV,LATEX-FREE) 1 MG/1 ML | IV |
71839-0106-24 | J2710 | INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG | NEOSTIGMINE METHYLSULFATE (USP,SDV,LATEX-FREE) 1 MG/1 ML | IV |
71839-0107-01 | J0878 | INJECTION, DAPTOMYCIN, 1 MG | DAPTOMYCIN (SDV,PF,LYOPHILIZED) 500 MG | IV |
71839-0108-01 | J0878 | INJECTION, DAPTOMYCIN, 1 MG | DAPTOMYCIN (SDV,PF,LATEX-FREE) 350 MG | IV |
71839-0117-25 | J1644 | INJECTION, HEPARIN SODIUM, PER 1000 UNITS | HEPARIN SODIUM (SDV,25X2ML,PF) 1000 U/1 ML | IJ |
71839-0118-25 | J1644 | INJECTION, HEPARIN SODIUM, PER 1000 UNITS | HEPARIN SODIUM (25X0.5ML,SDV,PF) 5000 U/0.5 ML | IJ |
71839-0122-10 | J3490 | UNCLASSIFIED DRUGS | PANTOPRAZOLE SODIUM (SDV,FREEZE-DRIED) 40 MG | IV |
71839-0122-25 | J3490 | UNCLASSIFIED DRUGS | PANTOPRAZOLE SODIUM (SDV,FREEZE-DRIED) 40 MG | IV |
71839-0123-25 | J7643 | GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | GLYCOPYRROLATE (25X1ML;USP;SDV) 0.2 MG/1 ML | IJ |
71839-0123-25 | J7643 | GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | GLYCOPYRROLATE (25X1ML;USP;SDV) 0.2 MG/1 ML | IJ |
71839-0124-25 | J7643 | GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | GLYCOPYRROLATE (25X2ML;USP;SDV) 0.2 MG/1 ML | IJ |
71839-0124-25 | J7643 | GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | GLYCOPYRROLATE (25X2ML;USP;SDV) 0.2 MG/1 ML | IJ |
71839-0125-25 | J7643 | GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | GLYCOPYRROLATE (25X5ML;USP;SDV) 0.2 MG/1 ML | IJ |
71839-0125-25 | J7643 | GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | GLYCOPYRROLATE (25X5ML;USP;SDV) 0.2 MG/1 ML | IJ |
71905-0400-11 | J8540 | DEXAMETHASONE, ORAL, 0.25 MG | DEXABLISS 11-DAY DOSE PACK 1.5 MG | PO |
71930-0017-30 | Q0162 | ONDANSETRON 1 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 | ONDANSETRON HCL (FILM-COATED) 4 MG | PO |
71930-0017-52 | Q0162 | ONDANSETRON 1 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 | ONDANSETRON HCL (FILM-COATED) 4 MG | PO |
71930-0018-30 | Q0162 | ONDANSETRON 1 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 | ONDANSETRON (FILM-COATED) 8 MG | PO |
71930-0018-52 | Q0162 | ONDANSETRON 1 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 | ONDANSETRON (FILM-COATED) 8 MG | PO |
72078-0025-10 | J1327 | INJECTION, EPTIFIBATIDE, 5 MG | EPTIFIBATIDE NOVAPLUS 2 MG/1 ML | IV |
72078-0027-10 | J1327 | INJECTION, EPTIFIBATIDE, 5 MG | EPTIFIBATIDE NOVAPLUS 2 MG/1 ML | IV |
76282-0676-30 | J0604 | CINACALCET, ORAL, 1 MG, (FOR ESRD ON DIALYSIS) | CINACALCET HYDROCHLORIDE (FILM COATED) 60 MG | PO |
76297-0001-01 | J7040 | INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML=1 UNIT) | SODIUM CHLORIDE (500ML FREEFLEX BAG) 0.9% | IV |
76297-0001-11 | J7050 | INFUSION, NORMAL SALINE SOLUTION , 250 CC | SODIUM CHLORIDE (50ML FLEBOFLEX) 0.9% | IV |
76297-0001-21 | J7050 | INFUSION, NORMAL SALINE SOLUTION , 250 CC | SODIUM CHLORIDE (100ML FLEBOFLEX) 0.9% | IV |
76297-0001-31 | J7050 | INFUSION, NORMAL SALINE SOLUTION , 250 CC | SODIUM CHLORIDE (250ML FLEBOFLEX) 0.9% | IV |
76297-0001-41 | J7030 | INFUSION, NORMAL SALINE SOLUTION , 1000 CC | SODIUM CHLORIDE (1000ML FLEBOFLEX) 0.9% | IV |
76310-0017-50 | J0207 | INJECTION, AMIFOSTINE, 500 MG | ETHYOL 500 MG | IV |
76310-0110-01 | J1190 | INJECTION, DEXRAZOXANE HYDROCHLORIDE, PER 250 MG | TOTECT (LYOPHILIZED) 500 MG | IV |
76329-1911-01 | J2270 | INJECTION, MORPHINE SULFATE, UP TO 10 MG | MORPHINE SULFATE (USP, PUMP-JET) 1 MG/ML | IJ |
76329-3302-01 | A4216 | STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML | DEXTROSE (SD;LUERJET,PF) 50% | IV |
76329-3399-05 | J2690 | INJECTION, PROCAINAMIDE HCL, UP TO 1 GM | PROCAINAMIDE HCL (LUER-JET, LUER-LOCK) 100 MG/1 ML | IJ |
76329-9060-00 | J0171 | INJECTION, ADRENALIN, EPINEPHRINE, 0.1 MG | EPINEPHRINE (MDV;USP) 1 MG/1 ML | IJ |
76388-0635-50 | J8999 | PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS | LEUKERAN (FILM-COATED) 2 MG | PO |
76388-0713-25 | None | BUSULFAN; ORAL, 2 MG | MYLERAN, (FILM-COATED), 2 MG | PO |
76420-0018-10 | J0665 | INJECTION, BUPIVACAINE, NOT OTHERWISE SPECIFIED, 0.5 MG | BUPIVACAINE HCL (PF,LATEX-FREE) 0.25% | IJ |
76204-0800-01 | J7614 | LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG | LEVALBUTEROL (PF) 0.63 MG/3 ML | IH |
76204-0800-24 | J7614 | LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG | LEVALBUTEROL (2X12 POUCHES,PF) 0.63 MG/3 ML | IH |
76204-0800-24 | J7614 | LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG | LEVALBUTEROL (2X12 POUCHES,PF) 0.63 MG/3 ML | IH |
76204-0800-25 | J7614 | LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG | LEVALBUTEROL (PF) 0.63 MG/3 ML | IH |
76204-0800-25 | J7614 | LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG | LEVALBUTEROL (PF) 0.63 MG/3 ML | IH |
76204-0900-01 | J7614 | LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG | LEVALBUTEROL (PF) 1.25 MG/3 ML | IH |
76204-0900-01 | J7614 | LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG | LEVALBUTEROL (PF) 1.25 MG/3 ML | IH |
76204-0900-24 | J7614 | LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG | LEVALBUTEROL (2X12 POUCHES,PF) 1.25 MG/3 ML | IH |
76204-0900-24 | J7614 | LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG | LEVALBUTEROL (2X12 POUCHES,PF) 1.25 MG/3 ML | IH |
76204-0900-25 | J7614 | LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG | LEVALBUTEROL (PF) 1.25 MG/3 ML | IH |
76204-0900-25 | J7614 | LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG | LEVALBUTEROL (PF) 1.25 MG/3 ML | IH |
76282-0640-38 | J7626 | BUDESONIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, UP TO 0.5 MG | BUDESONIDE (30X2ML,SINGLE-DOSE) 0.25 MG/2 ML | IH |
76282-0640-38 | J7626 | BUDESONIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, UP TO 0.5 MG | BUDESONIDE (30X2ML,SINGLE-DOSE) 0.25 MG/2 ML | IH |
76282-0641-38 | J7626 | BUDESONIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, UP TO 0.5 MG | BUDESONIDE (30X2ML,SINGLE-DOSE) 0.5 MG/2 ML | IH |
76282-0641-38 | J7626 | BUDESONIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, UP TO 0.5 MG | BUDESONIDE (30X2ML,SINGLE-DOSE) 0.5 MG/2 ML | IH |
76282-0642-38 | J7626 | BUDESONIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, UP TO 0.5 MG | BUDESONIDE (MICRONIZED) 1 MG/2 ML | IH |
76282-0642-38 | J7626 | BUDESONIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, UP TO 0.5 MG | BUDESONIDE (MICRONIZED) 1 MG/2 ML | IH |
76282-0674-30 | J0604 | CINACALCET, ORAL, 1 MG, (FOR ESRD ON DIALYSIS) | CINACALCET HYDROCHLORIDE (FILM COATED) 30 MG | PO |
76282-0675-30 | J0604 | CINACALCET, ORAL, 1 MG, (FOR ESRD ON DIALYSIS) | CINACALCET HYDROCHLORIDE (FILM COATED) 60 MG | PO |
71288-0716-10 | J2800 | INJECTION, METHOCARBAMOL, UP TO 10 ML | METHOCARBAMOL (PF,LATEX-FREE) 100 MG/1 ML | IJ |
71288-0719-11 | J0330 | INJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG | SUCCINYLCHOLINE CHLORIDE (MDV;USP,LATEX-FREE) 20 MG/1 ML | IJ |
71288-0723-52 | J0665 | INJECTION, BUPIVICAINE, NOT OTHERWISE SPECIFIED, 0.5 MG | BUPIVACAINE HCL (1X50ML,MDV,LATEX-FREE) 0.25% | IJ |
71288-0726-52 | J0665 | INJECTION, BUPIVICAINE, NOT OTHERWISE SPECIFIED, 0.5 MG | BUPIVACAINE HCL (1X50ML,MDV,LATEX-FREE) 0.5% | IJ |
71288-0802-03 | J1270 | INJECTION, DOXERCALCIFEROL, 1 MCG | DOXERCALCIFEROL (50X2ML;MDV,LATEX-FREE) 2 MCG/1 ML | IV |
71288-0802-04 | J1270 | INJECTION, DOXERCALCIFEROL, 1 MCG | DOXERCALCIFEROL (MDV,LATEX-FREE) 2 MCG/1 ML | IV |
71288-0806-51 | J3489 | INJECTION, ZOLEDRONIC ACID, 1 MG | ZOLEDRONIC ACID (SINGLE USE,PF) 5 MG/100 ML | IV |
71288-0807-02 | J2370 | INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML | PHENYLEPHRINE HCL (SDV,LATEX-FREE) 10 MG/1 ML | IV |
71288-0807-02 | J2371 | INJECTION, PHENYLEPHRINE HYDROCHLORIDE, 20 MICROGRAMS | PHENYLEPHRINE HCL (SDV,LATEX-FREE) 10 MG/1 ML | IV |
71288-0808-76 | J2370 | INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML | PHENYLEPHRINE HCL (LATEX-FREE) 10 MG/1 ML | IV |
71288-0808-76 | J2371 | INJECTION, PHENYLEPHRINE HYDROCHLORIDE, 20 MICROGRAMS | PHENYLEPHRINE HCL (LATEX-FREE) 10 MG/1 ML | IV |
71288-0808-77 | J2370 | INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML | PHENYLEPHRINE HCL (BULK PACKAGE,LATEX-FREE) 10 MG/1 ML | IV |
71288-0808-77 | J2371 | INJECTION, PHENYLEPHRINE HYDROCHLORIDE, 20 MICROGRAMS | PHENYLEPHRINE HCL (BULK PACKAGE,LATEX-FREE) 10 MG/1 ML | IV |
71297-0127-27 | J8540 | DEXAMETHASONE, ORAL, 0.25 MG | LOCORT (7-DAY) 1.5 MG | PO |
71297-0211-41 | J8540 | DEXAMETHASONE, ORAL, 0.25 MG | LOCORT (11-DAY) 1.5 MG | PO |
71300-6624-02 | J0171 | INJECTION, ADRENALIN, EPINEPHRINE, 0.1 MG | EPINEPHRINE (PF) 0.1 MG/0.1 ML | IJ |
71336-1000-01 | J0222 | INJECTION, PATISIRAN, 0.1 MG | ONPATTRO (PF,LATEX-FREE) 2 MG/1 ML | IV |
71336-1002-01 | J0224 | INJECTION, LUMASIRAN, 0.5 MG | OXLUMO (SDV,PF,LATEX-FREE) 94.5 MG/0.5 ML | SC |
71336-1003-01 | J0225 | INJECTION, VUTRISIRAN, 1 MG | AMVUTTRA (PF,LATEX-FREE) 25 MG/0.5 ML | SC |
71351-0022-10 | J0665 | INJECTION, BUPIVACAINE, NOT OTHERWISE SPECIFIED, 0.5 MG | BUPIVACAINE HCL (SPINAL,PF,LATEX-FREE) 0.75% | IJ |
71351-0022-10 | J3490 | UNCLASSIFIED DRUGS | BUPIVACAINE HCL (SPINAL,PF,LATEX-FREE) 0.75% | IJ |
71390-0011-11 | J2249 | INJECTION, REMIMAZOLAM, 1 MG | BYFAVO (LYOPHILIZED) 20 MG | IV |
71449-0124-83 | J2795 | INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG | ROPIVACAINE HCL (PF) 2 MG/1 ML | IJ |
71715-0001-01 | J0121 | INJECTION, OMADACYCLINE, 1 MG | NUZYRA (LYOPHILIZED) 100 MG | IV |
71715-0001-02 | J0121 | INJECTION, OMADACYCLINE, 1 MG | NUZYRA (LYOPHILIZED) 100 MG | IV |
71754-0001-01 | J0171 | INJECTION, ADRENALIN, EPINEPHRINE, 0.1 MG | EPINEPHRINE CONVENIENCE KIT (1 CONVENIENCE KITS) 1 MG/1 ML | IJ |
71754-0001-05 | J0171 | INJECTION, ADRENALIN, EPINEPHRINE, 0.1 MG | EPINEPHRINE CONVENIENCE KIT (5 CONVENIENCE KITS) 1 MG/1 ML | IJ |
71773-0050-12 | J0122 | INJECTION, ERAVACYCLINE, 1 MG | XERAVA (PF,LYOPHILIZED) 50 MG | IV |
71773-0100-12 | J0122 | INJECTION, ERAVACYCLINE, 1 MG | XERAVA (SDV,PF,LYOPHILIZED) 100 MG | IV |
71839-0104-01 | J1453 | INJECTION, FOSAPREPITANT, 1 MG | FOSAPREPITANT DIMEGLUMINE (SDV,LATEX-FREE) 150 MG | IV |
71839-0105-01 | J2710 | INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG | NEOSTIGMINE METHYLSULFATE (USP, MDV,LATEX-FREE) 0.5 MG/1 ML | IV |
71288-0424-96 | J1644 | INJECTION, HEPARIN SODIUM, PER 1000 UNITS | PREMIERPRO RX HEPARIN SODIUM (MDV;25X1ML,LATEX-FREE) 10000 U/1 ML | IJ |
71288-0427-11 | J0583 | INJECTION, BIVALIRUDIN, 1 MG | BIVALIRUDIN (SD,PF,LATEX-FREE) 250 MG | IV |
71288-0432-81 | J1650 | INJECTION, ENOXAPARIN SODIUM, 10 MG | ENOXAPARIN SODIUM (LIGHT BLUE;10X0.3ML,PF) 30 MG/0.3 ML | SC |
71288-0432-92 | J1650 | INJECTION, ENOXAPARIN SODIUM, 10 MG | HEALTHTRUST ENOXAPARIN SODIUM (SD,PF,LATEX-FREE) 30 MG/0.3 ML | SC |
71288-0433-83 | J1650 | INJECTION, ENOXAPARIN SODIUM, 10 MG | ENOXAPARIN SODIUM (YELLOW;10X0.4ML,PF) 40 MG/0.4 ML | SC |
71288-0433-92 | J1650 | INJECTION, ENOXAPARIN SODIUM, 10 MG | HEALTHTRUST ENOXAPARIN SODIUM (SD,PF,LATEX-FREE) 40 MG/0.4 ML | SC |
71288-0434-92 | J1650 | INJECTION, ENOXAPARIN SODIUM, 10 MG | HEALTHTRUST ENOXAPARIN SODIUM (10X0.6ML,PF,LATEX-FREE) 60 MG/0.6 ML | SC |
71288-0435-92 | J1650 | INJECTION, ENOXAPARIN SODIUM, 10 MG | HEALTHTRUST ENOXAPARIN SODIUM (SD,PF,LATEX-FREE) 80 MG/0.8 ML | SC |
71288-0436-92 | J1650 | INJECTION, ENOXAPARIN SODIUM, 10 MG | HEALTHTRUST ENOXAPARIN SODIUM (SD,PF,LATEX-FREE) 100 MG/1 ML | SC |
71288-0437-94 | J1650 | INJECTION, ENOXAPARIN SODIUM, 10 MG | HEALTHTRUST ENOXAPARIN SODIUM (SD,PF,LATEX-FREE) 120 MG/0.8 ML | SC |
71288-0438-96 | J1650 | INJECTION, ENOXAPARIN SODIUM, 10 MG | HEALTHTRUST ENOXAPARIN SODIUM (SD,PF,LATEX-FREE) 150 MG/1 ML | SC |
71288-0500-11 | J2710 | INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG | NEOSTIGMINE METHYLSULFATE (10X10ML;MDV;USP) 0.5 MG/1 ML | IV |
71288-0501-11 | J2710 | INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG | NEOSTIGMINE METHYLSULFATE (10X10ML;MDV;USP) 1 MG/1 ML | IV |
71288-0502-02 | J1631 | INJECTION, HALOPERIDOL DECANOATE, PER 50 MG | HALOPERIDOL DECANOATE (SDV,LATEX-FREE) 50 MG/1 ML | IM |
71288-0503-02 | J1631 | INJECTION, HALOPERIDOL DECANOATE, PER 50 MG | HALOPERIDOL DECANOATE (SDV,LATEX-FREE) 100 MG/1 ML | IM |
71288-0504-05 | J1631 | INJECTION, HALOPERIDOL DECANOATE, PER 50 MG | HALOPERIDOL DECANOATE (MDV,LATEX-FREE) 100 MG/1 ML | IM |
71288-0600-11 | J3490 | UNCLASSIFIED DRUGS | PANTOPRAZOLE SODIUM (SDV,PF,LATEX-FREE) 40 MG | IV |
76204-0026-01 | J7605 | ARFORMOTEROL, INHALATION SOLUTION, FDA APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, 15 MICROGRAMS | ARFORMOTEROL TARTRATE (30X2ML) 15 MCG/2 ML | IH |
76204-0026-02 | J7605 | ARFORMOTEROL, INHALATION SOLUTION, FDA APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, 15 MICROGRAMS | ARFORMOTEROL TARTRATE (30X2ML) 15 MCG/2 ML | IH |
76204-0026-02 | J7605 | ARFORMOTEROL, INHALATION SOLUTION, FDA APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, 15 MICROGRAMS | ARFORMOTEROL TARTRATE (30X2ML) 15 MCG/2 ML | IH |
76204-0028-60 | J7631 | CROMOLYN SODIUM, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER 10 MILLIGRAMS | CROMOLYN SODIUM (2X30,PF) 10 MG/1 ML | IH |
76204-0028-60 | J7631 | CROMOLYN SODIUM, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER 10 MILLIGRAMS | CROMOLYN SODIUM (2X30,PF) 10 MG/1 ML | IH |
76204-0100-01 | J7644 | IPRATROPIUM BROMIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | IPRATROPIUM BROMIDE (30X2.5ML,PF) 0.02% | IH |
76204-0100-01 | J7644 | IPRATROPIUM BROMIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | IPRATROPIUM BROMIDE (30X2.5ML,PF) 0.02% | IH |
76204-0100-25 | J7644 | IPRATROPIUM BROMIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | IPRATROPIUM BROMIDE (25X2.5ML,PF) 0.02% | IH |
76204-0100-25 | J7644 | IPRATROPIUM BROMIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | IPRATROPIUM BROMIDE (25X2.5ML,PF) 0.02% | IH |
76204-0100-30 | J7644 | IPRATROPIUM BROMIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | IPRATROPIUM BROMIDE (30X2.5ML,PF) 0.02% | IH |
76204-0100-30 | J7644 | IPRATROPIUM BROMIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | IPRATROPIUM BROMIDE (30X2.5ML,PF) 0.02% | IH |
76204-0100-60 | J7644 | IPRATROPIUM BROMIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | IPRATROPIUM BROMIDE (60X2.5ML,PF) 0.02% | IH |
76204-0100-60 | J7644 | IPRATROPIUM BROMIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | IPRATROPIUM BROMIDE (60X2.5ML,PF) 0.02% | IH |
76204-0200-01 | J7613 | ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 1 MG | ALBUTEROL SULFATE (30X3ML) 0.083% | IH |
76204-0200-01 | J7613 | ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 1 MG | ALBUTEROL SULFATE (30X3ML) 0.083% | IH |
76204-0200-25 | J7613 | ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 1 MG | ALBUTEROL SULFATE (25X3ML) 0.083% | IH |
76204-0200-25 | J7613 | ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 1 MG | ALBUTEROL SULFATE (25X3ML) 0.083% | IH |
76204-0200-30 | J7613 | ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 1 MG | ALBUTEROL SULFATE (30X3ML) 0.083% | IH |
76204-0200-30 | J7613 | ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 1 MG | ALBUTEROL SULFATE (30X3ML) 0.083% | IH |
76204-0200-60 | J7613 | ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 1 MG | ALBUTEROL SULFATE (60X3ML) 0.083% | IH |
76204-0200-60 | J7613 | ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 1 MG | ALBUTEROL SULFATE (60X3ML) 0.083% | IH |
76204-0600-01 | J7620 | ALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO 0.5 MG, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME | IPRATROPIUM BROMIDE-ALBUTEROL SULFATE (30X3ML) 3 MG/3 ML-0.5 MG/3 ML | IH |
76204-0600-05 | J7620 | ALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO 0.5 MG, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME | IPRATROPIUM BROMIDE AND ALBUTEROL SULFATE, (30 x 3 ML) 3 MG/3 ML-0.5 MG/3 ML | IH |
76204-0600-12 | J7620 | ALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO 0.5 MG, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME | IPRATROPIUM BROMIDE AND ALBUTEROL SULFATE, (60 x 3 ML) 3 MG/3 ML-0.5 MG/3 ML | IH |
76204-0600-30 | J7620 | ALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO 0.5 MG, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME | IPRATROPIUM BROMIDE-ALBUTEROL SULFATE (30 VIALS X 1 POUCH) 3MG/3ML-0.5MG/3ML | IH |
76204-0600-60 | J7620 | ALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO 0.5 MG, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME | IPRATROPIUM BROMIDE-ALBUTEROL SULFATE (30 VIALS X 2 POUCHES) 3MG/3ML-0.5MG/3ML | IH |
76204-0700-01 | J7614 | LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG | LEVALBUTEROL (PF) 0.31 MG/3 ML | IH |
76204-0700-01 | J7614 | LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG | LEVALBUTEROL (PF) 0.31 MG/3 ML | IH |
76204-0700-24 | J7614 | LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG | LEVALBUTEROL (2X12 POUCHES,PF) 0.31 MG/3 ML | IH |
76204-0700-24 | J7614 | LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG | LEVALBUTEROL (2X12 POUCHES,PF) 0.31 MG/3 ML | IH |
76204-0700-25 | J7614 | LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG | LEVALBUTEROL (PF) 0.31 MG/3 ML | IH |
76204-0700-25 | J7614 | LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG | LEVALBUTEROL (PF) 0.31 MG/3 ML | IH |
76204-0800-01 | J7614 | LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG | LEVALBUTEROL (PF) 0.63 MG/3 ML | IH |
76204-0010-55 | J7613 | ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 1 MG | ALBUTEROL SULFATE (25X3ML,PF) 0.63 MG/3 ML | IH |
76204-0010-55 | J7613 | ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 1 MG | ALBUTEROL SULFATE (25X3ML,PF) 0.63 MG/3 ML | IH |
76204-0011-01 | J7613 | ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 1 MG | ALBUTEROL SULFATE (30X3ML,PF) 1.25 MG/3 ML | IH |
76204-0011-01 | J7613 | ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 1 MG | ALBUTEROL SULFATE (30X3ML,PF) 1.25 MG/3 ML | IH |
76204-0011-55 | J7613 | ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 1 MG | ALBUTEROL SULFATE (25X3ML,PF) 1.25 MG/3 ML | IH |
76204-0011-55 | J7613 | ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 1 MG | ALBUTEROL SULFATE (25X3ML,PF) 1.25 MG/3 ML | IH |
76204-0018-01 | J7626 | BUDESONIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, UP TO 0.5 MG | BUDESONIDE (MICRONIZED) 0.5 MG/2 ML | IH |
76204-0018-01 | J7626 | BUDESONIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, UP TO 0.5 MG | BUDESONIDE (MICRONIZED) 0.5 MG/2 ML | IH |
76204-0021-60 | A4216 | STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML | SODIUM CHLORIDE (60X4ML, USP,PF) 7% | IH |
76204-0025-96 | J8499 | PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS | CROMOLYN SODIUM (PF,CONCENTRATE) 100 MG/5 ML | PO |
76204-0026-01 | J7605 | ARFORMOTEROL, INHALATION SOLUTION, FDA APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, 15 MICROGRAMS | ARFORMOTEROL TARTRATE (30X2ML) 15 MCG/2 ML | IH |
71288-0402-31 | J1644 | INJECTION, HEPARIN SODIUM, PER 1000 UNITS | HEPARIN SODIUM (MDV,LATEX-FREE) 1000 U/1 ML | IJ |
71288-0403-02 | J1644 | INJECTION, HEPARIN SODIUM, PER 1000 UNITS | HEPARIN SODIUM (SDV,LATEX-FREE) 5000 U/1 ML | IJ |
71288-0403-11 | J1644 | INJECTION, HEPARIN SODIUM, PER 1000 UNITS | HEPARIN SODIUM (MDV,LATEX-FREE) 5000 U/1 ML | IJ |
71288-0404-02 | J1644 | INJECTION, HEPARIN SODIUM, PER 1000 UNITS | HEPARIN SODIUM (SDV,LATEX-FREE) 10000 U/1 ML | IJ |
71288-0404-05 | J1644 | INJECTION, HEPARIN SODIUM, PER 1000 UNITS | HEPARIN SODIUM (MDV,LATEX-FREE) 10000 U/1 ML | IJ |
71288-0405-81 | J1644 | INJECTION, HEPARIN SODIUM, PER 1000 UNITS | HEPARIN SODIUM (24X0.5ML,SDS,PF) 5000 U/0.5 ML | IJ |
71288-0406-82 | J1644 | INJECTION, HEPARIN SODIUM, PER 1000 UNITS | HEPARIN SODIUM (24X1ML,SDS,LATEX-FREE) 5000 U/1 ML | IJ |
71288-0407-03 | J7643 | GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | GLYCOPYRROLATE (SDV, USP,LATEX-FREE) 0.2 MG/1 ML | IJ |
71288-0407-03 | J7643 | GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | GLYCOPYRROLATE (SDV, USP,LATEX-FREE) 0.2 MG/1 ML | IJ |
71288-0407-04 | J7643 | GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | GLYCOPYRROLATE (SDV,LATEX-FREE) 0.2 MG/1 ML | IJ |
71288-0407-04 | J7643 | GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | GLYCOPYRROLATE (SDV,LATEX-FREE) 0.2 MG/1 ML | IJ |
71288-0408-06 | J7643 | GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | GLYCOPYRROLATE (MDV, USP,LATEX-FREE) 0.2 MG/1 ML | IJ |
71288-0408-06 | J7643 | GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | GLYCOPYRROLATE (MDV, USP,LATEX-FREE) 0.2 MG/1 ML | IJ |
71288-0408-21 | J7643 | GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | GLYCOPYRROLATE (MDV, UPS,LATEX-FREE) 0.2 MG/1 ML | IJ |
71288-0408-21 | J7643 | GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | GLYCOPYRROLATE (MDV, UPS,LATEX-FREE) 0.2 MG/1 ML | IJ |
71288-0410-81 | J1650 | INJECTION, ENOXAPARIN SODIUM, 10 MG | ENOXAPARIN SODIUM (LIGHT BLUE;10X0.3ML,PF) 30 MG/0.3 ML | SC |
71288-0410-83 | J1650 | INJECTION, ENOXAPARIN SODIUM, 10 MG | ENOXAPARIN SODIUM (YELLOW;10X0.3ML,PF) 40 MG/0.4 ML | SC |
71288-0410-85 | J1650 | INJECTION, ENOXAPARIN SODIUM, 10 MG | ENOXAPARIN SODIUM (ORANGE;10X0.3ML,PF) 60 MG/0.6 ML | SC |
71288-0410-87 | J1650 | INJECTION, ENOXAPARIN SODIUM, 10 MG | ENOXAPARIN SODIUM (BROWN;10X0.8ML,PF) 80 MG/0.8 ML | SC |
71288-0410-89 | J1650 | INJECTION, ENOXAPARIN SODIUM, 10 MG | ENOXAPARIN SODIUM (GRAY;10X1ML,PF) 100 MG/1 ML | SC |
71288-0411-81 | J1650 | INJECTION, ENOXAPARIN SODIUM, 10 MG | ENOXAPARIN SODIUM (PURPLE;10X0.8ML,PF) 120 MG/0.8 ML | SC |
71288-0411-83 | J1650 | INJECTION, ENOXAPARIN SODIUM, 10 MG | ENOXAPARIN SODIUM (NAVY BLUE;10X1ML,PF) 150 MG/1 ML | SC |
71288-0414-03 | J7643 | GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | GLYCOPYRROLATE (SDV, USP,LATEX-FREE) 0.2 MG/1 ML | IJ |
71288-0414-03 | J7643 | GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | GLYCOPYRROLATE (SDV, USP,LATEX-FREE) 0.2 MG/1 ML | IJ |
71288-0414-04 | J7643 | GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | GLYCOPYRROLATE (SDV,LATEX-FREE) 0.2 MG/1 ML | IJ |
71288-0414-04 | J7643 | GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | GLYCOPYRROLATE (SDV,LATEX-FREE) 0.2 MG/1 ML | IJ |
71288-0414-92 | J7643 | GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | HEALTHTRUST GLYCOPYRROLATE (SDV,LATEX-FREE) 0.2 MG/1 ML | IJ |
71288-0414-92 | J7643 | GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | HEALTHTRUST GLYCOPYRROLATE (SDV,LATEX-FREE) 0.2 MG/1 ML | IJ |
71288-0414-94 | J7643 | GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | HEALTHTRUST GLYCOPYRROLATE (SDV,LATEX-FREE) 0.2 MG/1 ML | IJ |
71288-0414-94 | J7643 | GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | HEALTHTRUST GLYCOPYRROLATE (SDV,LATEX-FREE) 0.2 MG/1 ML | IJ |
71288-0415-06 | J7643 | GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | GLYCOPYRROLATE (MDV, USP,LATEX-FREE) 0.2 MG/1 ML | IJ |
71288-0415-06 | J7643 | GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | GLYCOPYRROLATE (MDV, USP,LATEX-FREE) 0.2 MG/1 ML | IJ |
71288-0415-21 | J7643 | GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | GLYCOPYRROLATE (MDV, USP,LATEX-FREE) 0.2 MG/1 ML | IJ |
71288-0415-21 | J7643 | GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM | GLYCOPYRROLATE (MDV, USP,LATEX-FREE) 0.2 MG/1 ML | IJ |
71288-0418-10 | J1453 | INJECTION, FOSAPREPITANT, 1 MG | FOSAPREPITANT DIMEGLUMINE (LATEX-FREE,LYOPHILIZED) 150 MG | IV |
71288-0419-96 | J1644 | INJECTION, HEPARIN SODIUM, PER 1000 UNITS | PREMIERPRO RX HEPARIN SODIUM (SDV;25X1ML,LATEX-FREE) 1000 U/1 ML | IJ |
71288-0420-96 | J1644 | INJECTION, HEPARIN SODIUM, PER 1000 UNITS | PREMIERPRO RX HEPARIN SODIUM (MDV,25X10ML,LATEX-FREE) 1000 U/1 ML | IJ |
71288-0421-96 | J1644 | INJECTION, HEPARIN SODIUM, PER 1000 UNITS | PREMIERPRO RX HEPARIN SODIUM (MDV,25X30ML,LATEX-FREE) 1000 U/1 ML | IJ |
71288-0422-96 | J1644 | INJECTION, HEPARIN SODIUM, PER 1000 UNITS | PREMIERPRO RX HEPARIN SODIUM (SDV;25X1ML,LATEX-FREE) 5000 U/1 ML | IJ |
75834-0132-05 | None | TEMOZOLOMIDE, 5 MG, ORAL | TEMOZOLOMIDE 5 MG | PO |
75834-0132-14 | None | TEMOZOLOMIDE, 5 MG, ORAL | TEMOZOLOMIDE 5 MG | PO |
75834-0142-05 | None | TEMOZOLOMIDE, 20 MG, ORAL | TEMOZOLOMIDE 20 MG | PO |
75834-0142-14 | None | TEMOZOLOMIDE, 20 MG, ORAL | TEMOZOLOMIDE 20 MG | PO |
70332-0103-01 | Q0163 | DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT TIME OF CHEMOTHERAPY TREATMENT NOT TO EXCEED A 48 HOUR DOSAGE REGIMEN | RAPIDPAQ DICOPANOL (1X150ML) 5 MG/1 ML | PO |
75834-0143-05 | None | TEMOZOLOMIDE, 100 MG, ORAL | TEMOZOLOMIDE 100 MG | PO |
75834-0143-14 | None | TEMOZOLOMIDE, 100 MG, ORAL | TEMOZOLOMIDE 100 MG | PO |
75834-0144-05 | None | TEMOZOLOMIDE, 20 MG, ORAL | TEMOZOLOMIDE 140 MG | PO |
75834-0144-14 | None | TEMOZOLOMIDE, 20 MG, ORAL | TEMOZOLOMIDE 140 MG | PO |
75834-0145-05 | None | TEMOZOLOMIDE, 20 MG, ORAL | TEMOZOLOMIDE 180 MG | PO |
75834-0145-14 | None | TEMOZOLOMIDE, 20 MG, ORAL | TEMOZOLOMIDE 180 MG | PO |
75834-0146-05 | None | TEMOZOLOMIDE, 250 MG, ORAL | TEMOZOLOMIDE 250 MG | PO |
HCPCS Code | Description | Billing Unit | SA Type |
|---|---|---|---|
K0108 | Hardware For Custom Seat And/Or Back | Each | Y |
K0108 | Leg Trough | Each | Y |
K0108 | Misc. Part Or Component For Use With Medical Stroller. | Each | Y |
K0108 | Wheelchair Tiedowns (also known as transit option or transit bracket) | Each | Y |
K0108 | Shoe Holders | Each | Y |
K0108 | Special/Miscellaneous Hardware or Component For Power or Manual Wheelchair Not Otherwise Specified. | Each | Y |
K0108 | Standby Switch For Use With Specially Controlled Power Mobility Device. | Each | Y |
K0108 | Subasis Bar (Swing Away Or Stationary) | Each | Y |
K0108 | Thoracic Pads With Hardware | Each | Y |
K0108 | Wheelchair Mount For Communication Device | Each | Y |
K0857 | Power Wheelchair, Group 3 Standard, Single Power Option, Captains Chair, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0857 RR | Power Wheelchair, Group 3 Standard, Single Power Option, Captains Chair, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0858 | Power Wheelchair, Group 3 Heavy Duty, Single Power Option, Sling/Solid Seat/Back, Patient Weight Capacity 301 To 450 Pounds | Each | Y |
K0858 RR | Power Wheelchair, Group 3 Heavy Duty, Single Power Option, Sling/Solid Seat/Back, Patient Weight Capacity 301 To 450 Pounds | Day | Y |
K0859 | Power Wheelchair, Group 3 Heavy Duty, Single Power Option, Captains Chair, Patient Weight Capacity 301 To 450 Pounds | Each | Y |
K0859 RR | Power Wheelchair, Group 3 Heavy Duty, Single Power Option, Captains Chair, Patient Weight Capacity 301 To 450 Pounds | Day | Y |
K0860 | Power Wheelchair, Group 3 Very Heavy Duty, Single Power Option, Sling/Solid Seat/Back, Patient Weight Capacity 451 To 600 Pounds | Each | Y |
K0860 RR | Power Wheelchair, Group 3 Very Heavy Duty, Single Power Option, Sling/Solid Seat/Back, Patient Weight Capacity 451 To 600 Pounds | Day | Y |
K0861 | Power Wheelchair, Group 3 Standard, Multiple Power Option, Sling/Solid Seat/Back, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0861 RR | Power Wheelchair, Group 3 Standard, Multiple Power Option, Sling/Solid Seat/Back, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0862 | Power Wheelchair, Group 3 Heavy Duty, Multiple Power Option, Sling/Solid Seat/Back, Patient Weight Capacity 301 To 450 Pounds | Each | Y |
K0862 RR | Power Wheelchair, Group 3 Heavy Duty, Multiple Power Option, Sling/Solid Seat/Back, Patient Weight Capacity 301 To 450 Pounds | Day | Y |
K0863 | Power Wheelchair, Group 3 Very Heavy Duty, Multiple Power Option, Sling/Solid Seat/Back, Patient Weight Capacity 451 To 600 Pounds | Each | Y |
K0863 RR | Power Wheelchair, Group 3 Very Heavy Duty, Multiple Power Option, Sling/Solid Seat/Back, Patient Weight Capacity 451 To 600 Pounds | Day | Y |
K0864 | Power Wheelchair, Group 3 Extra Heavy Duty, Multiple Power Option, Sling/Solid Seat/Back, Patient Weight Capacity 601 Pounds Or More | Each | Y |
K0864 RR | Power Wheelchair, Group 3 Extra Heavy Duty, Multiple Power Option, Sling/Solid Seat/Back, Patient Weight Capacity 601 Pounds Or More | Day | Y |
K0868 | Power Wheelchair, Group 4 Standard, Sling/Solid Seat/Back, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0868 RR | Power Wheelchair, Group 4 Standard, Sling/Solid Seat/Back, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0869 | Power Wheelchair, Group 4 Standard, Captains Chair, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0869 RR | Power Wheelchair, Group 4 Standard, Captains Chair, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0870 | Power Wheelchair, Group 4 Heavy Duty, Sling/Solid Seat/Back, Patient Weight Capacity 301 To 450 Pounds | Each | Y |
K0870 RR | Power Wheelchair, Group 4 Heavy Duty, Sling/Solid Seat/Back, Patient Weight Capacity 301 To 450 Pounds | Day | Y |
K0871 | Power Wheelchair, Group 4 Very Heavy Duty, Sling/Solid Seat/Back, Patient Weight Capacity 451 To 600 Pounds | Each | Y |
K0871 RR | Power Wheelchair, Group 4 Very Heavy Duty, Sling/Solid Seat/Back, Patient Weight Capacity 451 To 600 Pounds | Day | Y |
K0877 | Power Wheelchair, Group 4 Standard, Single Power Option, Sling/Solid Seat/Back, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0877 RR | Power Wheelchair, Group 4 Standard, Single Power Option, Sling/Solid Seat/Back, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0878 | Power Wheelchair, Group 4 Standard, Single Power Option, Captains Chair, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0878 RR | Power Wheelchair, Group 4 Standard, Single Power Option, Captains Chair, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0879 | Power Wheelchair, Group 4 Heavy Duty, Single Power Option, Sling/Solid Seat/Back, Patient Weight Capacity 301 To 450 Pounds | Each | Y |
K0879 RR | Power Wheelchair, Group 4 Heavy Duty, Single Power Option, Sling/Solid Seat/Back, Patient Weight Capacity 301 To 450 Pounds | Day | Y |
K0880 | Power Wheelchair, Group 4 Very Heavy Duty, Single Power Option, Sling/Solid Seat/Back, Patient Weight 451 To 600 Pounds | Each | Y |
K0880 RR | Power Wheelchair, Group 4 Very Heavy Duty, Single Power Option, Sling/Solid Seat/Back, Patient Weight 451 To 600 Pounds | Day | Y |
K0884 | Power Wheelchair, Group 4 Standard, Multiple Power Option, Sling/Solid Seat/Back, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0884 RR | Power Wheelchair, Group 4 Standard, Multiple Power Option, Sling/Solid Seat/Back, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0885 | Power Wheelchair, Group 4 Standard, Multiple Power Option, Captains Chair, Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0885 RR | Power Wheelchair, Group 4 Standard, Multiple Power Option, Captains Chair, Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0886 | Power Wheelchair, Group 4 Heavy Duty, Multiple Power Option, Sling/Solid Seat/Back, Patient Weight Capacity 301 To 450 Pounds | Each | Y |
K0886 RR | Power Wheelchair, Group 4 Heavy Duty, Multiple Power Option, Sling/Solid Seat/Back, Patient Weight Capacity 301 To 450 Pounds | Day | Y |
K0890 | Power Wheelchair, Group 5 Pediatric, Single Power Option, Sling/Solid Seat/Back, Patient Weight Capacity Up To And Including 125 Pounds | Each | Y |
K0890 RR | Power Wheelchair, Group 5 Pediatric, Single Power Option, Sling/Solid Seat/Back, Patient Weight Capacity Up To And Including 125 Pounds | Day | Y |
K0891 | Power Wheelchair, Group 5 Pediatric, Multiple Power Option, Sling/Solid Seat/Back, Patient Weight Capacity Up To And Including 125 Pounds | Each | Y |
K0891 RR | Power Wheelchair, Group 5 Pediatric, Multiple Power Option, Sling/Solid Seat/Back, Patient Weight Capacity Up To And Including 125 Pounds | Day | Y |
K0108 | Medical Stroller Type Mobility Device. | Each | Y |
K0108 | Chest Strap | Each | Y |
K0108 | Cushion Cover (Incontinence Cover) | Each | Y |
K0108 | Custom Seat And/Or Back For Wheelchair | Each | Y |
K0108 | Custom Seat Insert (Manufactured Specifically Per Patient Order) (have codes designated by cushion height) | Each | Y |
K0108 | Custom, Complex, 3 Piece Occipital Head Rest With Hardware. | Each | Y |
K0108 | Extra-Large (Greater Than 18 Wide Or 18 Deep) Low Pressure And Positioning Cushion. | Each | Y |
K0108 | Fluid Supplement Pads | Each | Y |
K0825 | Power Wheelchair, Group 2 Heavy Duty, Captains Chair, Patient Weight Capacity 301 To 450 Pounds | Each | Y |
K0825 RR | Power Wheelchair, Group 2 Heavy Duty, Captains Chair, Patient Weight Capacity 301 To 450 Pounds | Day | Y |
K0826 | Power Wheelchair, Group 2 Very Heavy Duty, Sling/Solid Seat/Back, Patient Weight Capacity 451 To 600 Pounds | Each | Y |
K0826 RR | Power Wheelchair, Group 2 Very Heavy Duty, Sling/Solid Seat/Back, Patient Weight Capacity 451 To 600 Pounds | Day | Y |
K0827 | Power Wheelchair, Group 2 Very Heavy Duty, Captains Chair, Patient Weight Capacity 451 To 600 Pounds | Each | Y |
K0827 RR | Power Wheelchair, Group 2 Very Heavy Duty, Captains Chair, Patient Weight Capacity 451 To 600 Pounds | Day | Y |
K0828 | Power Wheelchair, Group 2 Extra Heavy Duty, Sling/Solid Seat/Back, Patient Weight Capacity 601 Pounds Or More | Each | Y |
K0828 RR | Power Wheelchair, Group 2 Extra Heavy Duty, Sling/Solid Seat/Back, Patient Weight Capacity 601 Pounds Or More | Day | Y |
K0829 | Power Wheelchair, Group 2 Extra Heavy Duty, Captains Chair, Patient Weight Capacity 601 Pounds Or More | Each | Y |
K0829 RR | Power Wheelchair, Group 2 Extra Heavy Duty, Captains Chair, Patient Weight Capacity 601 Pounds Or More | Day | Y |
K0830 | Power Wheelchair, Group 2 Standard, Seat Elevator, Sling/Solid Seat/Back, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0830 RR | Power Wheelchair, Group 2 Standard, Seat Elevator, Sling/Solid Seat/Back, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0831 | Power Wheelchair, Group 2 Standard, Seat Elevator, Captains Chair, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0831 RR | Power Wheelchair, Group 2 Standard, Seat Elevator, Captains Chair, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0835 | Power Wheelchair, Group 2 Standard, Single Power Option, Sling/Solid Seat/Back, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0835 RR | Power Wheelchair, Group 2 Standard, Single Power Option, Sling/Solid Seat/Back, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0836 | Power Wheelchair, Group 2 Standard, Single Power Option, Captains Chair, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0836 RR | Power Wheelchair, Group 2 Standard, Single Power Option, Captains Chair, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0837 | Power Wheelchair, Group 2 Heavy Duty, Single Power Option, Sling/Solid Seat/Back, Patient Weight Capacity 301 To 450 Pounds | Each | Y |
K0837 RR | Power Wheelchair, Group 2 Heavy Duty, Single Power Option, Sling/Solid Seat/Back, Patient Weight Capacity 301 To 450 Pounds | Day | Y |
K0838 | Power Wheelchair, Group 2 Heavy Duty, Single Power Option, Captains Chair, Patient Weight Capacity 301 To 450 Pounds | Each | Y |
K0838 RR | Power Wheelchair, Group 2 Heavy Duty, Single Power Option, Captains Chair, Patient Weight Capacity 301 To 450 Pounds | Day | Y |
K0839 | Power Wheelchair, Group 2 Very Heavy Duty, Single Power Option, Sling/Solid Seat/Back, Patient Weight Capacity 451 To 600 Pounds | Each | Y |
K0839 RR | Power Wheelchair, Group 2 Very Heavy Duty, Single Power Option, Sling/Solid Seat/Back, Patient Weight Capacity 451 To 600 Pounds | Day | Y |
K0840 | Power Wheelchair, Group 2 Extra Heavy Duty, Single Power Option, Sling/Solid Seat/Back, Patient Weight Capacity 601 Pounds Or More | Each | Y |
K0840 RR | Power Wheelchair, Group 2 Extra Heavy Duty, Single Power Option, Sling/Solid Seat/Back, Patient Weight Capacity 601 Pounds Or More | Day | Y |
K0841 | Power Wheelchair, Group 2 Standard, Multiple Power Option, Sling/Solid Seat/Back, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0841 RR | Power Wheelchair, Group 2 Standard, Multiple Power Option, Sling/Solid Seat/Back, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0842 | Power Wheelchair, Group 2 Standard, Multiple Power Option, Captains Chair, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0842 RR | Power Wheelchair, Group 2 Standard, Multiple Power Option, Captains Chair, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0843 | Power Wheelchair, Group 2 Heavy Duty, Multiple Power Option, Sling/Solid Seat/Back, Patient Weight Capacity 301 To 450 Pounds | Each | Y |
K0843 RR | Power Wheelchair, Group 2 Heavy Duty, Multiple Power Option, Sling/Solid Seat/Back, Patient Weight Capacity 301 To 450 Pounds | Day | Y |
K0848 | Power Wheelchair, Group 3 Standard, Sling/Solid Seat/Back, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0848 RR | Power Wheelchair, Group 3 Standard, Sling/Solid Seat/Back, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0849 | Power Wheelchair, Group 3 Standard, Captains Chair, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0849 RR | Power Wheelchair, Group 3 Standard, Captains Chair, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0850 | Power Wheelchair, Group 3 Heavy Duty, Sling/Solid Seat/Back, Patient Weight Capacity 301 To 450 Pounds | Each | Y |
K0850 RR | Power Wheelchair, Group 3 Heavy Duty, Sling/Solid Seat/Back, Patient Weight Capacity 301 To 450 Pounds | Day | Y |
K0851 | Power Wheelchair, Group 3 Heavy Duty, Captains Chair, Patient Weight Capacity 301 To 450 Pounds | Each | Y |
K0851 RR | Power Wheelchair, Group 3 Heavy Duty, Captains Chair, Patient Weight Capacity 301 To 450 Pounds | Day | Y |
K0852 | Power Wheelchair, Group 3 Very Heavy Duty, Sling/Solid Seat/Back, Patient Weight Capacity 451 To 600 Pounds | Each | Y |
K0852 RR | Power Wheelchair, Group 3 Very Heavy Duty, Sling/Solid Seat/Back, Patient Weight Capacity 451 To 600 Pounds | Day | Y |
K0853 | Power Wheelchair, Group 3 Very Heavy Duty, Captains Chair, Patient Weight Capacity, 451 To 600 Pounds | Each | Y |
K0853 RR | Power Wheelchair, Group 3 Very Heavy Duty, Captains Chair, Patient Weight Capacity, 451 To 600 Pounds | Day | Y |
K0854 | Power Wheelchair, Group 3 Extra Heavy Duty, Sling/Solid Seat/Back, Patient Weight Capacity 601 Pounds Or More | Each | Y |
K0854 RR | Power Wheelchair, Group 3 Extra Heavy Duty, Sling/Solid Seat/Back, Patient Weight Capacity 601 Pounds Or More | Day | Y |
K0855 | Power Wheelchair, Group 3 Extra Heavy Duty, Captains Chair, Patient Weight Capacity 601 Pounds Or More | Each | Y |
K0855 RR | Power Wheelchair, Group 3 Extra Heavy Duty, Captains Chair, Patient Weight Capacity 601 Pounds Or More | Day | Y |
K0856 | Power Wheelchair, Group 3 Standard, Single Power Option, Sling/Solid Seat/Back, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0856 RR | Power Wheelchair, Group 3 Standard, Single Power Option, Sling/Solid Seat/Back, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0010 RR | Standard weight frame motorized/power wheelchair (Rental Only) | Day | Y |
K0011RR | Standard weight frame motorized/power wheelchair with programmable contol (Rental Only) | Day | Y |
K0012 RR | Light weight portable motorized/power wheelchair (Rental Only) | Day | Y |
K0013 | Custom motorized/power wheelchair base | Each | Y |
K0813 | Power Wheelchair, Group 1 Standard, Portable, Sling/Solid Seat And Back, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0813 RR | Power Wheelchair, Group 1 Standard, Portable, Sling/Solid Seat And Back, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0814 | Power Wheelchair, Group 1 Standard, Portable, Captains Chair, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0814 RR | Power Wheelchair, Group 1 Standard, Portable, Captains Chair, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0815 | Power Wheelchair, Group 1 Standard, Sling/Solid Seat And Back, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0815 RR | Power Wheelchair, Group 1 Standard, Sling/Solid Seat And Back, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0816 | Power Wheelchair, Group 1 Standard, Captains Chair, Patient Weight Capactiy Up To And Including 300 Pounds | Each | Y |
K0816 RR | Power Wheelchair, Group 1 Standard, Captains Chair, Patient Weight Capactiy Up To And Including 300 Pounds | Day | Y |
K0813 | Power Wheelchair, Group 1 Standard, Portable, Sling/Solid Seat And Back, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0813 RR | Power Wheelchair, Group 1 Standard, Portable, Sling/Solid Seat And Back, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0814 | Power Wheelchair, Group 1 Standard, Portable, Captains Chair, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0814 RR | Power Wheelchair, Group 1 Standard, Portable, Captains Chair, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0815 | Power Wheelchair, Group 1 Standard, Sling/Solid Seat And Back, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0815 RR | Power Wheelchair, Group 1 Standard, Sling/Solid Seat And Back, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0816 | Power Wheelchair, Group 1 Standard, Captains Chair, Patient Weight Capactiy Up To And Including 300 Pounds | Each | Y |
K0816 RR | Power Wheelchair, Group 1 Standard, Captains Chair, Patient Weight Capactiy Up To And Including 300 Pounds | Day | Y |
K0813 | Power Wheelchair, Group 1 Standard, Portable, Sling/Solid Seat And Back, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0813 RR | Power Wheelchair, Group 1 Standard, Portable, Sling/Solid Seat And Back, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0814 | Power Wheelchair, Group 1 Standard, Portable, Captains Chair, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0814 RR | Power Wheelchair, Group 1 Standard, Portable, Captains Chair, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0815 | Power Wheelchair, Group 1 Standard, Sling/Solid Seat And Back, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0815 RR | Power Wheelchair, Group 1 Standard, Sling/Solid Seat And Back, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0816 | Power Wheelchair, Group 1 Standard, Captains Chair, Patient Weight Capactiy Up To And Including 300 Pounds | Each | Y |
K0816 RR | Power Wheelchair, Group 1 Standard, Captains Chair, Patient Weight Capactiy Up To And Including 300 Pounds | Day | Y |
K0806 | Power Operated Vehicle, Group 2 Standard, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0806 RR | Power Operated Vehicle, Group 2 Standard, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0807 | Power Operated Vehicle, Group 2 Heavy Duty, Patient Weight Capacity 301 To 450 Pounds | Each | Y |
K0807 RR | Power Operated Vehicle, Group 2 Heavy Duty, Patient Weight Capacity 301 To 450 Pounds | Day | Y |
K0808 | Power Operated Vehicle, Group 2 Very Heavy Duty, Patient Weight Capacity 451 To 600 Pounds | Each | Y |
K0808 RR | Power Operated Vehicle, Group 2 Very Heavy Duty, Patient Weight Capacity 451 To 600 Pounds | Day | Y |
K0806 | Power Operated Vehicle, Group 2 Standard, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0806 RR | Power Operated Vehicle, Group 2 Standard, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0807 | Power Operated Vehicle, Group 2 Heavy Duty, Patient Weight Capacity 301 To 450 Pounds | Each | Y |
K0807 RR | Power Operated Vehicle, Group 2 Heavy Duty, Patient Weight Capacity 301 To 450 Pounds | Day | Y |
K0808 | Power Operated Vehicle, Group 2 Very Heavy Duty, Patient Weight Capacity 451 To 600 Pounds | Each | Y |
K0808 RR | Power Operated Vehicle, Group 2 Very Heavy Duty, Patient Weight Capacity 451 To 600 Pounds | Day | Y |
K0820 | Power Wheelchair, Group 2 Standard, Portable, Sling/Solid Seat/Back, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0820 RR | Power Wheelchair, Group 2 Standard, Portable, Sling/Solid Seat/Back, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0821 | Power Wheelchair, Group 2 Standard, Portable, Captains Chair, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0821 RR | Power Wheelchair, Group 2 Standard, Portable, Captains Chair, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0822 | Power Wheelchair, Group 2 Standard, Sling/Solid Seat/Back, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0822 RR | Power Wheelchair, Group 2 Standard, Sling/Solid Seat/Back, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0823 | Power Wheelchair, Group 2 Standard, Captains Chair, Patient Weight Capacity Up To And Including 300 Pounds | Each | Y |
K0823 RR | Power Wheelchair, Group 2 Standard, Captains Chair, Patient Weight Capacity Up To And Including 300 Pounds | Day | Y |
K0824 | Power Wheelchair, Group 2 Heavy Duty, Sling/Solid Seat/Back, Patient Weight Capacity 301 To 450 Pounds | Each | Y |
K0824 RR | Power Wheelchair, Group 2 Heavy Duty, Sling/Solid Seat/Back, Patient Weight Capacity 301 To 450 Pounds | Day | Y |
E1171 RR | Amputee Wheelchair, Fixed Full Length Arms, Without Foot Rests Or Leg Rests | Day | N |
E1172 | Amputee Wheelchair, Detachable Arms (Desk Or Full Length), W/O Foot Or Leg Rests | Each | N |
E1172 RR | Amputee Wheelchair, Detachable Arms (Desk Or Full Length), W/O Foot Or Leg Rests | Day | N |
E1180 | Amputee Wheelchair, Detachable Arms (Desk Or Full Length), Swing Away Det. Foot Rests | Each | N |
E1180 RR | Amputee Wheelchair, Detachable Arms (Desk Or Full Length), Swing Away Detachable Foot Rests | Day | N |
E1190 | Amputee Wheelchair, Detachable Arms (Desk Or Full Length) Swing Away, Detachable, Elevating Leg Rests | Each | N |
E1190 RR | Amputee Wheelchair, Detachable Arms (Desk Or Full Length), Swing Away, Detachable, Elevating Leg Rests | Day | N |
E1200 | Amputee Wheelchair, Fixed Full Length Arms, Swing Away, Detachable Foot Rests | Each | N |
E1200 RR | Amputee Wheelchair, Fixed Full Length Arms, Swing Away Detachable Foot Rests | Day | N |
E1231 | Wheelchair, Pediatric Size, Tilt-In-Space, Rigid, Adjustable, With Seating System | Each | Y |
E1231 RR | Wheelchair, Pediatric Size, Tilt-In-Space, Rigid, Adjustable, With Seating System | Day | Y |
E1232 | Wheelchair, Pediatric Size, Tilt-In-Space, Folding, Adjustable, With Seating System | Each | Y |
E1232 RR | Wheelchair, Pediatric Size, Tilt-In-Space, Folding, Adjustable, With Seating System | Day | Y |
E1233 | Wheelchair, Pediatric Size, Tilt-In-Space, Rigid, Adjustable, Without Seating System | Each | Y |
E1233 RR | Wheelchair, Pediatric Size, Tilt-In-Space, Rigid, Adjustable, Without Seating System | Day | Y |
E1234 | Wheelchair, Pediatric Size, Tilt-In-Space, Folding, Adjustable, Without Seating System | Each | Y |
E1234 RR | Wheelchair, Pediatric Size, Tilt-In-Space, Folding, Adjustable, Without Seating System | Day | Y |
E1235 | Wheelchair, Pediatric Size, Rigid, Adjustable, With Seating System | Each | Y |
E1235 RR | Wheelchair, Pediatric Size, Rigid, Adjustable, With Seating System | Day | Y |
E1236 | Wheelchair, Pediatric Size, Folding, Adjustable, With Seating System | Each | Y |
E1236 RR | Wheelchair, Pediatric Size, Folding, Adjustable, With Seating System | Day | Y |
E1237 | Wheelchair, Pediatric Size, Rigid, Adjustable, Without Seating System | Each | Y |
E1237 RR | Wheelchair, Pediatric Size, Rigid, Adjustable, Without Seating System | Day | Y |
E1238 | Wheelchair, Pediatric Size, Folding, Adjustable, Without Seating System | Each | Y |
E1238 RR | Wheelchair, Pediatric Size, Folding, Adjustable, Without Seating System | Day | Y |
E1240 | Lightweight Wheelchair, Detachable Arms, (Desk Or Full Length) Swing Away, Detachable Elevating Leg Rests | Each | N |
E1240 RR | Lightweight Wheelchair, Detachable Arms, (Desk Or Full Length), Swing Away, Detachable Elevating Leg Rests | Day | N |
E1250 | Lightweight Wheelchair, Fixed Full Length Arms, Swing Away, Detachable Foot Rests | Each | N |
E1250 RR | Lightweight Wheelchair, Fixed Full Length Arms, Swing Away, Detachable Foot Rests | Day | N |
E1260 | Lightweight Wheelchair, Detachable Arms Desk Or Full Length, Swing Away, Detachable Footrests | Each | N |
E1260 RR | Lightweight Wheelchair, Detachable Arms, Desk Or Full Length, Swing Away, Detachable Footrests | Day | N |
E1270 | Lightweight Wheelchair, Fixed Full Length Arms, Swing Away, Detachable Elevating Leg Rests | Each | N |
E1270 RR | Lightweight Wheelchair, Fixed Full Length Arms, Swing Away, Detachable Elevating Leg Rests | Day | N |
K0003 | Lightweight Wheelchair | Each | Y |
K0003 RR | Lightweight Wheelchair | Day | N |
K0001 | Standard Wheelchair | Each | Y |
K0001 RR | Standard Wheelchair | Day | N |
K0004 | High Strength Wheelchair | Each | Y |
K0004 RR | High Strength Wheelchair | Day | N |
K0005 | Ultralightweight Wheelchair | Each | Y |
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