top of page
NDC | HCPCS | HCPCS Description | NDC Label | Route of Administration |
|---|---|---|---|---|
69117-0019-01 | J8499 | PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS | ACYCLOVIR 800 MG | PO |
69117-0019-02 | J8499 | PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS | ACYCLOVIR 800 MG | PO |
69238-1056-01 | 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 (FILM-COATED) 25 MG | PO |
69238-1076-01 | J7500 | AZATHIOPRINE, ORAL, 50MG | AZATHIOPRINE (USP)50 MG | PO |
69238-1423-01 | None | METHOTREXATE, 2.5 MG, ORAL | METHOTREXATE 2.5 MG | PO |
69238-1423-06 | None | METHOTREXATE, 2.5 MG, ORAL | METHOTREXATE 2.5 MG | PO |
69238-1594-03 | J7520 | SIROLIMUS, ORAL, 1 MG | SIROLIMUS (PATIENT KIT) 1 MG/1 ML | PO |
69238-1595-02 | J7517 | MYCOPHENOLATE MOFETIL, ORAL, 250 MG | MYCOPHENOLATE MOFETIL (USP,MIXED FRUIT) 200 MG/1 ML | PO |
68001-0465-62 | J3370 | INJECTION, VANCOMYCIN HCL, 500 MG | VANCOMYCIN HCL (USP,PF,LATEX-FREE) 500 MG | IV |
68001-0466-63 | J3370 | INJECTION, VANCOMYCIN HCL, 500 MG | VANCOMYCIN HCL (USP,PF,LATEX-FREE) 1 GM | IV |
68001-0466-64 | J3370 | INJECTION, VANCOMYCIN HCL, 500 MG | VANCOMYCIN HCL (USP,PF,LATEX-FREE) 1 GM | IV |
68001-0467-41 | J0878 | INJECTION, DAPTOMYCIN, 1 MG | DAPTOMYCIN (SDV,PF,LATEX-FREE) 350 MG | IV |
HCPCS Code | Description | Billing Unit | SA Type |
|---|---|---|---|
L2810 | Addition to lower extremity orthosis, knee control, condylar pad | Each | Y |
L2820 | Addition to lower extremity orthosis, soft interface for molded plastic, below knee section | Each | Y |
L2830 | Addition to lower extremity orthosis, soft interface for molded plastic, above knee section | Each | Y |
L2840 | Addition to lower extremity orthosis, tibial length sock, fracture or equal, each | Each | Y |
L2850 | Addition to lower extremity orthosis, femoral length sock, fracture or equal, each | Each | Y |
L2861 | Addition to lower extremity joint, knee or ankle, concentric adjustable torsion style mechanism for custom frabicated orthotics only, each | Each | Y |
L2999 | Lower extremity orthoses, 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 |
L3000 | Foot insert, removable, molded to patient model, UCB type, Berkeley shell, each | Each | Y |
L3001 | Foot insert, removable, molded to patient model, Spenco, each | Each | Y |
L3002 | Foot insert, removable, molded to patient model, Plastazote or equal, each | Each | Y |
L3003 | Foot insert, removable, molded to patient model, silicone gel, each | Each | Y |
L3010 | Foot insert, removable, molded to patient model, longitudinal arch support | Each | Y |
bottom of page