NDC Crosswalk

Transcription

NDC Crosswalk
HCPCS - NDC Crosswalk
HCPCS
NDC
90378
90378
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
60574411301
60574411401
00074108101
00074158401
00074181222
00074210205
00074402702
00074488750
00074488820
00074536505
00223849602
00223849605
00223849710
00223850030
00264180031
00264180036
00338004910
00338004911
00338004931
00338004941
00338055311
00409108151
00409191832
00409191833
00409191835
00409196604
00409196605
00409196607
00409196612
00409196614
00409210202
00409210205
00409397703
00409402903
00409404402
00409488710
00409488720
00409488750
00409488799
00409488810
00409488812
00409488820
00409488850
00409710166
00409798413
00409798420
00409798436
00487930102
00487930103
00487930133
00517064825
00517066225
00517280225
00517281025
00517300525
00517301025
00517302025
00517305025
08166110903
08166110905
08166110910
08290031002
08290031003
08290031102
12/19/2013
Earliest Start
Date
HCPCS Description
RSV-IGIM, 50MG, (SYNAGIS)
RSV-IGIM, 50MG, (SYNAGIS)
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
STERILE WATER, SALINE AND/OR
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
01/01/2007
01/01/2007
04/25/2005
01/01/2004
01/01/2007
01/01/2007
01/01/2004
01/01/2004
01/01/2004
01/01/2007
01/01/2007
01/01/2007
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
12/27/2006
01/01/2007
01/01/2007
01/01/2007
08/30/2005
05/02/2005
04/05/2005
10/06/2005
06/01/2005
01/01/2007
01/01/2007
04/07/2005
03/01/2005
02/09/2006
08/18/2005
06/16/2005
08/05/2005
08/03/2005
04/22/2005
07/15/2005
02/23/2005
02/14/2005
07/28/2005
06/20/2005
06/17/2005
07/14/2005
01/01/2006
01/01/2006
01/01/2006
01/01/2004
01/01/2004
01/01/2007
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2007
01/01/2007
01/01/2004
01/01/2007
01/01/2007
01/01/2004
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
11/01/2006
12/31/2078
10/01/2006
10/01/2007
06/01/2008
12/01/2006
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
10/01/2011
12/31/2078
12/31/2078
12/31/2078
09/01/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
11/01/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/31/2012
12/31/2078
01/31/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/30/2014
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
08290031103
08290032003
08290032005
08290032103
08290032105
08290033003
08290033005
08290033006
08290033010
08290033103
08290033105
08290033110
08290091002
08290091003
08290091102
08290091103
08290092005
08290092105
08290093010
08290094010
08290094110
08290095010
08450090102
08450090303
08450090505
08450090610
08450601102
08450601203
08450601305
08450601410
08881570128
08881570129
12280023301
15686011103
15686011105
35356018130
48879000101
48879000102
48879000201
48879000202
48879000301
48879000302
48879000307
49072066930
49502064015
49502081003
49502081005
49502082003
49502082005
49502083003
49502083005
49502083050
50486007822
50486007823
50962065001
53298010106
54569152200
54569307800
54569403700
54868011600
54868018300
54868071005
54868252700
54868397500
54868446400
12/19/2013
HCPCS Description
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
WATER,
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
SALINE
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
AND/OR
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
Earliest Start
Date
01/01/2004
01/01/2007
01/01/2007
01/01/2004
01/01/2004
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2004
01/01/2004
01/01/2004
01/01/2007
01/01/2007
01/01/2004
01/01/2004
01/01/2007
01/01/2004
01/01/2007
01/01/2007
01/01/2004
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2004
01/01/2004
01/01/2004
01/01/2004
07/01/2006
07/01/2006
08/18/2005
04/02/2007
04/02/2007
05/16/2008
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2004
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2004
01/01/2004
01/18/2007
01/01/2006
01/01/2004
01/01/2004
12/15/2006
06/28/2007
01/01/2004
01/01/2004
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4216
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
54868502600
54868571400
55045371001
58016060301
58016483801
58016499501
58016946401
59930160901
59930160902
63323018500
63323018505
63323018510
63323018520
63323018550
63323018602
63323018610
63323018620
63323024930
63323025910
63323025930
63323092410
63323092430
63807010011
63807010020
63807010030
63807010033
63807010035
63807010050
63807010051
63807010055
63807010056
63807010075
63807010092
63807010211
64054090203
64054090302
64054090306
64054090502
64054090506
64054091002
64253011121
64253011122
64253011123
64253011125
64253011130
64253011133
64253011135
68883090001
68883090003
68883090004
68883090005
68883090010
68883090016
83490010760
00074614736
00264210100
00264210110
00264210150
00264210170
00264220100
00264220110
00264220150
00264220170
00264785000
00264785010
12/19/2013
HCPCS Description
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
STERILE
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER, SALINE AND/OR
WATER/SALINE, 500 ML
WATER/SALINE, 500 ML
WATER/SALINE, 500 ML
WATER/SALINE, 500 ML
WATER/SALINE, 500 ML
WATER/SALINE, 500 ML
WATER/SALINE, 500 ML
WATER/SALINE, 500 ML
WATER/SALINE, 500 ML
WATER/SALINE, 500 ML
WATER/SALINE, 500 ML
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DEXTROSE,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
DILUENT/FLUSH,
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
ML
Earliest Start
Date
01/01/2006
12/11/2006
01/01/2007
01/01/2006
02/01/2006
01/01/2007
01/01/2004
01/01/2006
01/01/2006
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2007
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2007
04/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
04/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
10/01/2007
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
05/30/2006
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/01/2006
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4217
A4218
C9272
C9272
C9276
G9017
J0120
J0128
J0129
J0130
J0132
00264785020
00264920055
00264920155
00264920555
00338000344
00338000346
00338000347
00338000349
00338000402
00338000403
00338000404
00338000405
00338001304
00338001306
00338001308
00338001329
00338004146
00338004724
00338004727
00338004729
00338004744
00338004746
00338004747
00338004802
00338004803
00338004804
00338004805
00338005047
00409159002
00409159005
00409402702
00409613803
00409613822
00409613903
00409613922
00409711807
00409713809
00409713836
00409713909
00409713936
00409797205
00409797207
00409797208
00409797305
00409797307
00409797308
00409797507
00409799009
08080100000
08080102000
08080102200
54868071002
54868390500
54868429600
54868431100
49502050120
55513071001
55513073001
00024582411
00781204805
51927244900
68158014951
00003218710
00002714001
66220010730
12/19/2013
HCPCS Description
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE WATER/SALINE, 500 ML
STERILE SALINE OR WATER, METERED DOSE DISPENSER, 10 ML
DENOSUMAB, PER 1 MG
INJECTION, DENOSUMAB, 1 MG
CABAZITAXEL, PER 1MG
AMANTADINE HYDROCHLORIDE, ORAL, PER 100 MG (FOR USE IN A MED
INJECTION, TETRACYCLINE, UP TO 250 MG
INJECTION, ABARELIX, 10 MG
INJECTION, ABATACEPT, 10 MG
INJECTION ABCIXIMAB, 10 MG
INJECTION, ACETYLCYSTEINE, 100 MG
Earliest Start
Date
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
08/05/2005
06/28/2005
05/26/2006
06/01/2005
09/01/2005
05/09/2005
05/04/2005
08/16/2005
05/11/2005
06/09/2005
03/02/2005
05/04/2005
09/01/2005
04/05/2005
05/18/2005
03/16/2005
08/09/2005
07/14/2005
04/26/2006
09/02/2005
03/01/2006
03/01/2006
03/01/2006
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2006
06/05/2010
06/05/2010
01/01/2011
01/20/2005
09/08/2003
01/01/2005
01/01/2006
01/01/2002
01/01/2006
Latest End
Date
12/31/2078
08/31/2013
09/30/2013
02/28/2011
12/31/2078
12/31/2078
12/31/2078
05/31/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/01/2011
03/01/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J0133
J0133
J0133
J0133
J0133
J0133
J0133
J0133
J0133
J0133
J0133
J0133
J0133
J0133
J0133
J0133
J0133
J0133
J0133
J0133
J0133
J0133
J0133
J0135
J0135
J0135
J0135
J0135
J0150
J0150
J0150
J0150
J0150
J0150
J0150
J0150
J0150
J0150
J0150
J0150
J0150
J0150
J0150
J0150
J0152
J0152
J0152
J0152
J0152
J0152
J0170
J0170
J0170
J0170
J0170
J0170
J0170
J0170
J0170
J0170
J0170
J0170
J0170
J0170
J0170
38779017301
38779017304
38779017305
38779017308
49452000103
49452000104
51552067101
51552067102
51552067103
51552067104
51552067105
51552067106
51927299400
55390061210
55390061320
62991100401
62991100402
63323010510
63323032510
63323032520
63370000725
63370000735
63370000750
00074379902
00074433902
00074433906
00074937402
54868482200
00469823412
00469823414
00703877103
00703877301
10019006302
10019006303
10019006307
10019006308
10019006334
25021030102
54569561000
54868555100
55390006710
55390006801
63323065102
63323065104
00469087120
00469087130
51927211600
51927213200
54868582500
54868582501
00074492134
00074724101
00143998490
00409490118
00409492134
00409724101
00517107125
00517113005
00548101400
00548101600
00548201600
00548331600
00548906100
13436070001
13436070002
12/19/2013
HCPCS Description
INJECTION, ACYCLOVIR, 5 MG
INJECTION, ACYCLOVIR, 5 MG
INJECTION, ACYCLOVIR, 5 MG
INJECTION, ACYCLOVIR, 5 MG
INJECTION, ACYCLOVIR, 5 MG
INJECTION, ACYCLOVIR, 5 MG
INJECTION, ACYCLOVIR, 5 MG
INJECTION, ACYCLOVIR, 5 MG
INJECTION, ACYCLOVIR, 5 MG
INJECTION, ACYCLOVIR, 5 MG
INJECTION, ACYCLOVIR, 5 MG
INJECTION, ACYCLOVIR, 5 MG
INJECTION, ACYCLOVIR, 5 MG
INJECTION, ACYCLOVIR, 5 MG
INJECTION, ACYCLOVIR, 5 MG
INJECTION, ACYCLOVIR, 5 MG
INJECTION, ACYCLOVIR, 5 MG
INJECTION, ACYCLOVIR, 5 MG
INJECTION, ACYCLOVIR, 5 MG
INJECTION, ACYCLOVIR, 5 MG
INJECTION, ACYCLOVIR, 5 MG
INJECTION, ACYCLOVIR, 5 MG
INJECTION, ACYCLOVIR, 5 MG
INJECTION, ADALIMUMAB, 20 MG
INJECTION, ADALIMUMAB, 20 MG
INJECTION, ADALIMUMAB, 20 MG
INJECTION, ADALIMUMAB, 20 MG
INJECTION, ADALIMUMAB, 20 MG
INJECTION, ADENOSINE FOR THERAPEUTIC USE, 6 MG (NOT TO BE U
INJECTION, ADENOSINE FOR THERAPEUTIC USE, 6 MG (NOT TO BE U
INJECTION, ADENOSINE FOR THERAPEUTIC USE, 6 MG (NOT TO BE U
INJECTION, ADENOSINE FOR THERAPEUTIC USE, 6 MG (NOT TO BE U
INJECTION, ADENOSINE FOR THERAPEUTIC USE, 6 MG (NOT TO BE U
INJECTION, ADENOSINE FOR THERAPEUTIC USE, 6 MG (NOT TO BE U
INJECTION, ADENOSINE FOR THERAPEUTIC USE, 6 MG (NOT TO BE U
INJECTION, ADENOSINE FOR THERAPEUTIC USE, 6 MG (NOT TO BE U
INJECTION, ADENOSINE FOR THERAPEUTIC USE, 6 MG (NOT TO BE U
ADENOSINE, PER 6 MG
INJECTION, ADENOSINE FOR THERAPEUTIC USE, 6 MG (NOT TO BE U
INJECTION, ADENOSINE FOR THERAPEUTIC USE, 6 MG (NOT TO BE U
INJECTION, ADENOSINE FOR THERAPEUTIC USE, 6 MG (NOT TO BE U
INJECTION, ADENOSINE FOR THERAPEUTIC USE, 6 MG (NOT TO BE U
INJECTION, ADENOSINE FOR THERAPEUTIC USE, 6 MG (NOT TO BE U
INJECTION, ADENOSINE FOR THERAPEUTIC USE, 6 MG (NOT TO BE U
INJECTION, ADENOSINE FOR DIAGNOSTIC USE, 30 MG (NOT TO BE US
INJECTION, ADENOSINE FOR DIAGNOSTIC USE, 30 MG (NOT TO BE US
INJECTION, ADENOSINE FOR DIAGNOSTIC USE, 30 MG (NOT TO BE US
INJECTION, ADENOSINE FOR DIAGNOSTIC USE, 30 MG (NOT TO BE US
INJECTION, ADENOSINE FOR DIAGNOSTIC USE, 30 MG (NOT TO BE US
INJECTION, ADENOSINE FOR DIAGNOSTIC USE, 30 MG (NOT TO BE US
INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
Earliest Start
Date
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2005
07/17/2006
02/27/2007
02/22/2008
01/01/2005
06/14/2002
06/14/2002
06/16/2004
06/16/2004
05/05/2007
06/17/2004
05/24/2005
05/24/2005
05/05/2007
11/24/2009
09/30/2004
03/16/2006
06/16/2004
09/01/2004
06/27/2005
06/27/2005
01/01/2004
01/01/2004
01/01/2004
01/01/2004
10/18/2007
10/18/2007
01/01/2002
04/09/2002
07/20/2005
09/23/2005
12/23/2005
09/13/2005
01/01/2002
08/01/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
08/03/2005
08/03/2005
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
10/31/2011
09/30/2011
03/31/2013
03/31/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/01/2007
06/01/2007
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/31/2009
05/31/2011
09/30/2011
01/31/2014
07/31/2014
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J0170
J0170
J0170
J0170
J0170
J0170
J0170
J0170
J0170
J0170
J0170
J0170
J0170
J0170
J0170
J0170
J0170
J0170
J0170
J0171
J0171
J0180
J0180
J0205
J0207
J0207
J0207
J0207
J0207
J0210
J0215
J0215
J0215
J0215
J0257
J0270
J0270
J0270
J0270
J0270
J0270
J0270
J0270
J0270
J0270
J0270
J0270
J0270
J0270
J0270
J0270
J0270
J0270
J0270
J0270
J0270
J0270
J0270
J0270
J0270
J0270
J0270
J0270
J0270
J0270
13436070101
13436070102
23490549702
42023010101
42023012225
49502050001
54569594600
54569594900
54868136300
54868206500
54868206501
54868364100
54868572500
55045369603
55045990303
61570040111
61570041881
66860002001
66860002102
00409492134
00409724101
58468004001
58468004101
58468106001
55390030803
58178001701
58178001703
62756058140
62756058142
00517890510
00469002103
00469002104
59627002103
59627002104
00944288401
00009316906
00009370105
00009377805
00009518101
00009518201
00009765002
00009768604
00091111016
00091111020
00091112016
00091112020
00091114016
00091114020
00703150102
38779094407
38779094409
49452007303
49452007304
51552049801
51552049803
51552049805
51552049809
51927219600
54868489000
55390050310
55390050610
62991112802
62991112806
62991112807
62991112808
12/19/2013
HCPCS Description
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
ADRENALIN(EPINEPHRINE) UP TO 1 ML
ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
ADRENALIN, EPINEPHRINE, 0.1 MG
ADRENALIN, EPINEPHRINE, 0.1 MG
AGALSIDASE BETA, 1 MG
AGALSIDASE BETA, 1 MG
ALGLUCERASE, PER 10 UNITS
AMIFOSTINE, 500 MG
AMIFOSTINE, 500 MG
AMIFOSTINE, 500 MG
AMIFOSTINE, 500 MG
AMIFOSTINE, 500 MG
METHYLDOPATE HCL, UP TO 250 MG
ALEFACEPT, 0.5 MG
ALEFACEPT, 0.5 MG
ALEFACEPT, 0.5 MG
ALEFACEPT, 0.5 MG
ALPHA 1 PROTEINASE INHIBITOR (HUMAN), (GLASSIA),
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
Earliest Start
Date
08/03/2005
08/03/2005
04/30/2007
02/28/2008
06/04/2008
01/01/2010
08/13/2007
08/14/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
12/11/2006
08/17/2006
03/15/2003
09/07/2002
01/01/2002
01/01/2003
01/01/2002
09/30/1990
09/30/1990
01/01/2005
01/01/2005
01/01/2002
04/08/2008
01/01/2002
01/01/2002
03/26/2008
03/26/2008
02/26/2003
02/28/2008
12/31/2007
01/01/2004
01/01/2004
01/01/2012
01/01/2002
01/01/2002
01/01/2002
06/25/2002
06/25/2002
01/01/2002
01/01/2002
09/02/2004
09/02/2004
09/02/2004
09/02/2004
09/02/2004
09/02/2004
01/01/2002
01/01/2002
01/01/2002
02/05/2002
11/15/2004
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/08/2003
08/28/2003
01/01/2002
01/01/2002
09/15/2003
09/15/2003
09/15/2003
09/15/2003
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
11/30/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
11/30/2009
05/31/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
05/31/2013
05/31/2013
08/31/2008
06/30/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
05/08/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
Earliest Start
Date
Latest End
Date
62541011006 ALPROSTADIL URETHRAL SUPPOSITORY (CODE MAY BE USED FOR MEDIC
01/01/2002
03/31/2012
J0275
62541012001 ALPROSTADIL URETHRAL SUPPOSITORY (CODE MAY BE USED FOR MEDIC
01/01/2002
12/31/2012
J0275
62541012006 ALPROSTADIL URETHRAL SUPPOSITORY (CODE MAY BE USED FOR MEDIC
01/01/2002
12/31/2012
J0275
62541013001 ALPROSTADIL URETHRAL SUPPOSITORY (CODE MAY BE USED FOR MEDIC
01/01/2002
07/31/2013
J0275
62541013006 ALPROSTADIL URETHRAL SUPPOSITORY (CODE MAY BE USED FOR MEDIC
01/01/2002
07/31/2013
J0275
62541014001 ALPROSTADIL URETHRAL SUPPOSITORY (CODE MAY BE USED FOR MEDIC
01/01/2002
07/31/2013
J0275
62541014006 ALPROSTADIL URETHRAL SUPPOSITORY (CODE MAY BE USED FOR MEDIC
01/01/2002
07/31/2013
J0278
J0278
J0278
J0278
J0278
J0278
J0278
J0278
J0278
J0278
J0278
J0278
J0278
J0278
J0278
J0278
J0278
J0278
J0278
J0278
J0278
J0278
J0278
J0278
J0278
J0280
J0280
J0280
J0280
J0280
J0280
J0280
J0280
J0280
J0280
J0280
J0280
J0280
J0280
J0280
J0280
J0280
J0280
J0280
J0280
J0280
00015301520
00015302320
00409195501
00409195601
00409195701
00703903203
00703904003
38779029503
38779029504
38779029505
51927270400
54569591000
55390022302
55390022402
55390022404
55390022502
55390022602
55390022604
62991200201
62991200202
62991200203
63370001615
63370001625
63370001635
63370001650
00074490918
00409592101
00409592201
00409738501
00409738601
00517381025
00517382025
17317002201
17317002204
17317002205
38779057105
38779057108
49452043001
49452043002
49452043006
51552031305
51552031306
51927144400
54868000400
62991200301
62991200302
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
05/07/2007
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2002
04/25/2005
12/24/2004
12/29/2005
11/29/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
09/08/2003
01/01/2002
01/01/2002
01/01/2002
12/31/2078
12/31/2078
12/31/2078
11/01/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/01/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
HCPCS
NDC
J0270
J0270
J0270
J0270
J0275
63275998809
63370021004
63370021006
63370021010
62541011001
J0275
12/19/2013
HCPCS Description
INJECTION, ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
INJECTION, ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
INJECTION, ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
INJECTION, ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDIC
ALPROSTADIL URETHRAL SUPPOSITORY (CODE MAY BE USED FOR MEDIC
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
AMIKACIN SULFATE, 100 MG
AMIKACIN SULFATE, 100 MG
AMIKACIN SULFATE, 100 MG
AMIKACIN SULFATE, 100 MG
AMIKACIN SULFATE, 100 MG
AMIKACIN SULFATE, 100 MG
AMIKACIN SULFATE, 100 MG
AMIKACIN SULFATE, 100 MG
AMIKACIN SULFATE, 100 MG
AMIKACIN SULFATE, 100 MG
AMIKACIN SULFATE, 100 MG
AMIKACIN SULFATE, 100 MG
AMIKACIN SULFATE, 100 MG
AMIKACIN SULFATE, 100 MG
AMIKACIN SULFATE, 100 MG
AMIKACIN SULFATE, 100 MG
AMIKACIN SULFATE, 100 MG
AMIKACIN SULFATE, 100 MG
AMIKACIN SULFATE, 100 MG
AMIKACIN SULFATE, 100 MG
AMIKACIN SULFATE, 100 MG
AMIKACIN SULFATE, 100 MG
AMIKACIN SULFATE, 100 MG
AMIKACIN SULFATE, 100 MG
AMIKACIN SULFATE, 100 MG
AMINOPHYLLIN, UP TO 250 MG
AMINOPHYLLIN, UP TO 250 MG
AMINOPHYLLIN, UP TO 250 MG
AMINOPHYLLIN, UP TO 250 MG
AMINOPHYLLIN, UP TO 250 MG
AMINOPHYLLIN, UP TO 250 MG
AMINOPHYLLIN, UP TO 250 MG
AMINOPHYLLIN, UP TO 250 MG
AMINOPHYLLIN, UP TO 250 MG
AMINOPHYLLIN, UP TO 250 MG
AMINOPHYLLIN, UP TO 250 MG
AMINOPHYLLIN, UP TO 250 MG
AMINOPHYLLIN, UP TO 250 MG
AMINOPHYLLIN, UP TO 250 MG
AMINOPHYLLIN, UP TO 250 MG
AMINOPHYLLIN, UP TO 250 MG
AMINOPHYLLIN, UP TO 250 MG
AMINOPHYLLIN, UP TO 250 MG
AMINOPHYLLIN, UP TO 250 MG
AMINOPHYLLIN, UP TO 250 MG
AMINOPHYLLIN, UP TO 250 MG
12/04/2002
07/08/2003
07/08/2003
07/08/2003
01/01/2002
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/31/2012
Page 1 of 1
HCPCS
NDC
J0280
J0282
J0282
J0282
J0282
J0282
J0282
J0282
J0282
J0282
J0282
J0282
J0282
J0282
J0282
J0282
J0282
J0282
J0282
J0282
J0282
J0282
J0282
J0282
J0282
J0285
J0285
J0285
J0285
J0285
J0285
J0285
J0285
J0285
J0285
J0285
J0285
J0285
J0285
J0285
J0285
J0285
J0285
J0285
J0285
J0285
J0285
J0285
J0285
J0285
J0285
J0285
J0285
J0285
J0285
J0285
J0285
J0287
J0288
J0288
J0288
J0289
J0290
J0290
J0290
62991200303
00074434835
00409434835
00548338000
00703133501
10019013301
10019013302
10019013304
10019013313
10019013319
51927376000
54868572200
55390005701
55390005710
55390009710
55390010501
60505072200
60505072201
61703024103
63323061603
63323061609
63323061613
67457015303
67457015309
67457015318
00013140544
00703978501
38779019103
38779019104
38779019105
38779019106
38779019108
38779019109
39822105505
39822105507
49452002301
49452002302
49452002303
51552030401
51552030402
51552030403
51552030404
51552030405
51552030406
51552030407
51552030409
51927172600
54868575200
62263041411
62991117302
62991117304
62991117305
63370002010
63370002015
63370002025
63370002035
63370002050
57665010141
64116002101
66435030151
66435030201
00469305130
00015740220
00015740320
00015740418
12/19/2013
HCPCS Description
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
AMINOPHYLLIN, UP TO 250 MG
AMIODARONE HYDROCHLORIDE, 30 MG
AMIODARONE HYDROCHLORIDE, 30 MG
AMIODARONE HYDROCHLORIDE, 30 MG
AMIODARONE HYDROCHLORIDE, 30 MG
AMIODARONE HYDROCHLORIDE, 30 MG
AMIODARONE HYDROCHLORIDE, 30 MG
AMIODARONE HYDROCHLORIDE, 30 MG
AMIODARONE HYDROCHLORIDE, 30 MG
AMIODARONE HYDROCHLORIDE, 30 MG
AMIODARONE HYDROCHLORIDE, 30 MG
AMIODARONE HYDROCHLORIDE, 30 MG
AMIODARONE HYDROCHLORIDE, 30 MG
AMIODARONE HYDROCHLORIDE, 30 MG
AMIODARONE HYDROCHLORIDE, 30 MG
AMIODARONE HYDROCHLORIDE, 30 MG
AMIODARONE HYDROCHLORIDE, 30 MG
AMIODARONE HYDROCHLORIDE, 30 MG
AMIODARONE HYDROCHLORIDE, 30 MG
AMIODARONE HYDROCHLORIDE, 30 MG
AMIODARONE HYDROCHLORIDE, 30 MG
AMIODARONE HYDROCHLORIDE, 30 MG
AMIODARONE HYDROCHLORIDE, 30 MG
AMIODARONE HYDROCHLORIDE, 30 MG
AMIODARONE HYDROCHLORIDE, 30 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B, 50 MG
AMPHOTERICIN B LIPID COMPLEX, 10 MG
AMPHOTERICIN B CHOLESTERYL SULFATE COMPLEX, 10 MG
AMPHOTERICIN B CHOLESTERYL SULFATE COMPLEX, 10 MG
AMPHOTERICIN B CHOLESTERYL SULFATE COMPLEX, 10 MG
AMPHOTERICIN B LIPOSOME, 10 MG
AMPICILLIN SODIUM, 500 MG
AMPICILLIN SODIUM, 500 MG
AMPICILLIN SODIUM, 500 MG
Earliest Start
Date
01/01/2002
05/01/2004
09/27/2006
02/01/2004
12/04/2003
11/20/2003
11/20/2003
06/16/2004
05/05/2007
05/05/2007
01/04/2008
12/11/2006
10/25/2002
12/01/2003
03/05/2008
09/07/2005
06/01/2003
12/20/2005
02/12/2003
08/02/2002
12/16/2003
01/06/2003
07/01/2005
11/29/2005
11/29/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
11/27/2003
01/01/2002
01/01/2002
01/01/2002
03/20/2006
01/24/2002
01/24/2002
01/01/2002
09/01/2003
09/01/2003
09/01/2003
09/01/2003
01/01/2002
09/01/2003
09/01/2003
09/01/2003
09/08/2003
01/25/2007
09/07/2004
01/01/2002
01/01/2002
01/01/2008
07/08/2003
09/04/2002
09/04/2002
09/04/2002
09/04/2002
01/01/2004
01/01/2003
11/01/2006
08/14/2008
01/01/2003
01/01/2002
01/01/2002
01/01/2002
Latest End
Date
12/31/2078
04/01/2007
12/31/2078
12/31/2078
02/28/2011
10/30/2009
05/30/2010
11/30/2009
10/30/2009
11/30/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/31/2007
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0290
J0295
J0295
J0295
J0295
J0295
J0295
J0295
J0295
J0295
J0295
J0295
J0295
J0295
J0295
J0295
J0295
J0295
J0295
J0295
J0295
J0295
J0295
J0295
J0295
J0295
J0295
J0295
J0295
J0295
00015740489
00015740518
00015740520
00015740589
00781340095
00781340278
00781340295
00781340495
00781340795
00781340895
00781340995
00781341292
00781341392
00781940178
00781940195
00781940278
00781940295
00781940485
00781940495
00781940778
00781940795
00781940880
00781940892
00781940895
00781940995
00781940996
00781941215
00781941292
00781941392
25021013720
54868348100
54868404700
63323038710
63323038810
63323038910
63323039923
00049001383
00049001483
00049002283
00049002383
00049002428
00049003183
00049003283
00409268715
00409268901
00409268911
00409298703
00409298713
00409298801
00409299803
00781303295
00781303395
00781303446
10019063002
10019063033
10019063101
10019063131
10019063203
10019063302
10019063333
10019063401
10019063431
10019063503
10019063601
10019063631
12/19/2013
Earliest Start
Date
HCPCS Description
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
AMPICILLIN SODIUM, 500MG INJECTION
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
AMPICILLIN SODIUM, 500MG INJECTION
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM, 500 MG
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
INJECTION, AMPICILLIN SODIUM/SULBACTAM
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
1.5
GM
GM
GM
GM
GM
GM
GM
GM
GM
GM
GM
GM
GM
GM
GM
GM
GM
GM
GM
GM
GM
GM
GM
GM
GM
GM
GM
GM
GM
01/01/2002
01/01/2002
01/01/2002
01/01/2002
05/12/2004
01/01/2009
12/01/2005
12/01/2005
12/01/2005
12/01/2005
05/12/2004
03/20/2007
03/20/2007
02/01/2007
02/01/2006
01/24/2006
02/01/2006
01/24/2006
02/01/2006
01/24/2006
02/01/2006
01/24/2006
02/01/2007
02/01/2006
02/01/2006
02/01/2007
02/01/2007
03/20/2007
03/20/2007
09/21/2010
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
06/22/2007
10/09/2006
07/01/2007
10/09/2006
07/01/2007
07/20/2007
07/20/2007
09/05/2006
09/05/2006
09/05/2006
12/15/2003
05/05/2007
11/18/2005
05/05/2007
11/18/2005
03/10/2006
05/05/2007
03/10/2006
05/05/2007
12/14/2005
05/02/2006
05/05/2007
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2013
12/31/2013
12/31/2078
06/30/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
10/31/2013
10/31/2013
10/31/2013
10/31/2013
10/31/2013
07/31/2013
07/31/2013
07/31/2013
07/31/2013
02/28/2013
10/31/2013
10/31/2013
Page 1 of 1
HCPCS
NDC
J0295
J0295
J0295
J0295
J0295
J0295
J0295
J0295
J0295
J0300
J0330
J0330
J0330
J0330
J0330
J0330
J0330
J0330
J0348
J0360
J0360
J0360
J0360
J0360
J0360
J0360
J0360
J0360
J0360
J0364
J0364
J0364
J0364
J0364
J0364
J0364
J0364
J0364
J0364
J0364
J0364
J0364
J0364
J0364
J0365
J0365
J0400
J0456
J0456
J0456
J0456
J0456
J0456
J0456
J0456
J0456
J0456
J0456
J0456
J0456
J0456
J0456
J0456
J0456
J0456
10019063702
10019063733
10019063803
10139007011
10139007110
25021014330
63323036820
63323036920
63323037062
63304030310
00074662902
00074697010
00074806515
00409662902
00409662961
00409697010
00781300995
51927353600
00049101028
00517090125
17478093401
49452354401
49452354402
49452354403
49452354503
51552080202
51927197900
63323061401
63323061455
16887021101
16887021105
38779176400
38779176403
38779176406
51552065201
51552065202
51552065204
51927230300
62991151301
62991151302
62991151303
63370002206
63370002209
63370002215
00026819636
00026819763
59148001665
00069315014
00069315083
00409014411
00703908503
00703908901
10019064802
10019064871
25021011210
50111079478
54868452700
62991257701
62991257702
62991257703
63275996502
63275996503
63275996504
63275996505
63323039810
12/19/2013
HCPCS Description
INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER
INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER
INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER
INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER
INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER
AMPICILLIN NA/ SULBACTAM 1.5GM
INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER
INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER
INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER
INJECTION, AMOBARBITAL, UP TO 125 MG
INJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG
INJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG
INJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG
INJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG
INJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG
INJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG
INJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG
INJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG
INJECTION, ANIDULAFUNGIN, 1 MG
INJECTION, HYDRALAZINE HCL, UP TO 20 MG
HYDRALAZINE 20MG INJ
INJECTION, HYDRALAZINE HCL, UP TO 20 MG
INJECTION, HYDRALAZINE HCL, UP TO 20 MG
INJECTION, HYDRALAZINE HCL, UP TO 20 MG
INJECTION, HYDRALAZINE HCL, UP TO 20 MG
INJECTION, HYDRALAZINE HCL, UP TO 20 MG
INJECTION, HYDRALAZINE HCL, UP TO 20 MG
INJECTION, HYDRALAZINE HCL, UP TO 20 MG
INJECTION, HYDRALAZINE HCL, UP TO 20 MG
INJECTION, APOMORPHINE HYDROCHLORIDE, 1 MG
INJECTION, APOMORPHINE HYDROCHLORIDE, 1 MG
INJECTION, APOMORPHINE HYDROCHLORIDE, 1 MG
INJECTION, APOMORPHINE HYDROCHLORIDE, 1 MG
INJECTION, APOMORPHINE HYDROCHLORIDE, 1 MG
INJECTION, APOMORPHINE HYDROCHLORIDE, 1 MG
INJECTION, APOMORPHINE HYDROCHLORIDE, 1 MG
INJECTION, APOMORPHINE HYDROCHLORIDE, 1 MG
INJECTION, APOMORPHINE HYDROCHLORIDE, 1 MG
INJECTION, APOMORPHINE HYDROCHLORIDE, 1 MG
INJECTION, APOMORPHINE HYDROCHLORIDE, 1 MG
INJECTION, APOMORPHINE HYDROCHLORIDE, 1 MG
INJECTION, APOMORPHINE HYDROCHLORIDE, 1 MG
INJECTION, APOMORPHINE HYDROCHLORIDE, 1 MG
INJECTION, APOMORPHINE HYDROCHLORIDE, 1 MG
INJECTION, APROTONIN, 10,000 KIU
INJECTION, APROTONIN, 10,000 KIU
INJECTION, ARIPIPRAZOLE, INTRAMUSCULAR, 0.25 MG
INJECTION, AZITHROMYCIN, 500 MG
INJECTION, AZITHROMYCIN, 500 MG
AZITHROMYCIN INJ, PER 500MG
INJECTION, AZITHROMYCIN, 500 MG
INJECTION, AZITHROMYCIN, 500 MG
INJECTION, AZITHROMYCIN, 500 MG
INJECTION, AZITHROMYCIN, 500 MG
AZITHROMYCIN INJ, PER 500MG
INJECTION, AZITHROMYCIN, 500 MG
INJECTION, AZITHROMYCIN, 500 MG
INJECTION, AZITHROMYCIN, 500 MG
INJECTION, AZITHROMYCIN, 500 MG
INJECTION, AZITHROMYCIN, 500 MG
INJECTION, AZITHROMYCIN, 500 MG
INJECTION, AZITHROMYCIN, 500 MG
INJECTION, AZITHROMYCIN, 500 MG
INJECTION, AZITHROMYCIN, 500 MG
INJECTION, AZITHROMYCIN, 500 MG
1.5
1.5
1.5
1.5
1.5
GM
GM
GM
GM
GM
1.5 GM
1.5 GM
1.5 GM
Earliest Start
Date
05/02/2006
05/05/2007
05/02/2006
07/03/2007
07/03/2007
08/13/2010
11/30/2005
11/30/2005
11/08/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
04/25/2005
04/20/2006
09/30/2005
04/15/2005
09/08/2003
01/01/2007
01/01/2002
11/06/2009
02/04/2002
02/04/2002
04/01/2005
02/04/2002
09/01/2003
09/08/2003
01/01/2002
03/26/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2006
01/01/2006
01/01/2008
02/25/2002
01/01/2002
06/26/2009
03/01/2007
03/01/2007
04/12/2006
05/05/2007
05/01/2009
07/25/2007
01/01/2002
10/01/2007
10/01/2007
10/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
02/27/2006
Latest End
Date
10/31/2013
10/31/2013
10/31/2013
12/31/2078
02/28/2014
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/01/2006
04/01/2006
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/01/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/28/2010
02/28/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
05/31/2014
12/31/2078
12/31/2078
07/31/2010
11/30/2011
01/13/2012
01/13/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J0456
J0460
J0460
J0460
J0460
J0460
J0460
J0460
J0460
J0460
J0460
J0460
J0460
J0460
J0460
J0460
J0460
J0460
J0460
J0460
J0460
J0460
J0460
J0460
J0460
J0460
J0460
J0460
J0460
J0460
J0460
J0460
J0460
J0470
J0475
J0475
J0475
J0475
J0475
J0475
J0475
J0475
J0475
J0475
J0475
J0475
J0475
J0475
J0475
J0475
J0475
J0475
J0475
J0475
J0475
J0475
J0475
J0475
J0475
J0475
J0475
J0476
J0480
J0480
J0485
63323039812
00074491134
00223719125
00223719200
00223719325
00223720601
00409163010
00409491034
00409491134
00409962905
00409963005
00517010125
00517040125
00517080525
00517101025
00548103900
00548203900
00548333800
00548333900
10019025012
10019025020
10019025037
10019025039
10019025112
10019025139
54569560700
54868000600
54868074000
54868074001
54868389300
63323023401
63323023420
63323024601
11098052603
38779038803
38779038804
38779038805
38779038809
49452080702
49452080703
49452080704
51552061302
51552061304
51552061305
51927200700
58281056001
58281056002
58281056102
58281056301
58281056302
62991101301
62991101302
62991101303
62991101304
63275999202
63275999204
63275999205
63370002615
63370002625
63370002635
63370002645
58281056201
00078033184
00078039361
00003037113
12/19/2013
HCPCS Description
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
AZITHROMYCIN, 500 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
ATROPINE SULFATE, UP TO 0.3 MG
DIMERCAPROL, PER 100 MG
BACLOFEN, 10 MG
BACLOFEN, 10 MG
BACLOFEN, 10 MG
BACLOFEN, 10 MG
BACLOFEN, 10 MG
BACLOFEN, 10 MG
BACLOFEN, 10 MG
BACLOFEN, 10 MG
BACLOFEN, 10 MG
BACLOFEN, 10 MG
BACLOFEN, 10 MG
BACLOFEN, 10 MG
BACLOFEN, 10 MG
BACLOFEN, 10 MG
BACLOFEN, 10 MG
BACLOFEN, 10 MG
BACLOFEN, 10 MG
BACLOFEN, 10 MG
BACLOFEN, 10 MG
BACLOFEN, 10 MG
BACLOFEN, 10 MG
BACLOFEN, 10 MG
BACLOFEN, 10 MG
BACLOFEN, 10 MG
BACLOFEN, 10 MG
BACLOFEN, 10 MG
BACLOFEN, 10 MG
BACLOFEN, 50 MCG FOR INTRATHECAL TRIAL
BASILIXIMAB, 20 MG
BASILIXIMAB, 20 MG
BELATACEPT, 1MG
Earliest Start
Date
02/27/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/11/2006
08/18/2005
11/14/2005
04/26/2006
10/19/2004
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/09/1997
09/09/1997
01/01/2002
09/09/1997
09/29/2004
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
04/22/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
09/01/2003
09/08/2003
01/01/2002
04/02/2004
01/01/2002
10/21/2003
04/02/2004
01/01/2002
01/01/2002
01/01/2002
09/15/2003
12/04/2002
12/04/2002
12/04/2002
07/08/2003
07/08/2003
07/08/2003
07/08/2003
01/01/2002
01/01/2006
01/01/2006
01/01/2013
Latest End
Date
12/31/2078
08/01/2007
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
05/31/2012
12/31/2078
03/31/2012
12/31/2078
01/31/2011
02/28/2011
09/30/2009
12/31/2013
12/31/2013
12/31/2013
12/31/2013
12/31/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
11/30/2009
09/30/2010
12/31/2078
02/28/2014
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J0490
J0490
J0500
J0500
J0500
J0500
J0500
J0500
J0515
J0515
J0515
J0515
J0515
J0515
J0515
J0515
J0515
J0515
J0520
J0520
J0520
J0520
J0520
J0520
J0520
J0520
J0520
J0520
J0520
J0520
J0530
J0530
J0530
J0530
J0530
J0530
J0540
J0540
J0540
J0540
J0540
J0540
J0540
J0540
J0540
J0540
J0540
J0540
J0550
J0550
J0550
J0550
J0550
J0550
J0560
J0560
J0560
J0560
J0560
J0560
J0560
J0560
J0560
J0560
J0560
49401010101
49401010201
00068080923
00463110410
51552074104
51927134700
55390006610
58914008052
00143972905
38779019403
38779019404
38779019406
49452101601
49452101602
49452101603
51552095201
54868242901
67386061152
38779039303
38779039304
38779039305
38779039306
49452108301
49452108302
49452108303
51552087902
51552087904
51927209700
62991153002
62991153003
61570013910
61570014010
61570014110
61570014210
61570014310
61570014410
54569595700
54569595800
55045368402
60793060010
60793060110
60793060210
61570013910
61570014010
61570014110
61570014210
61570014310
61570014410
61570013910
61570014010
61570014110
61570014210
61570014310
61570014410
54569140901
54569587600
54569587700
54569587701
54868075300
54868075301
54868246600
54868334900
60793070010
60793070110
60793070210
12/19/2013
HCPCS Description
BELIMUMAB PER 10MG
BELIMUMAB PER 10MG
INJECTION, DICYCLOMINE HCL, UP TO 20 MG
INJECTION, DICYCLOMINE HCL, UP TO 20 MG
INJECTION, DICYCLOMINE HCL, UP TO 20 MG
INJECTION, DICYCLOMINE HCL, UP TO 20 MG
INJECTION, DICYCLOMINE HCL, UP TO 20 MG
INJECTION, DICYCLOMINE HCL, UP TO 20 MG
BENZTROPINE MES. INJ. PER 1MG
INJECTION, BENZTROPINE MESYLATE, PER 1 MG
INJECTION, BENZTROPINE MESYLATE, PER 1 MG
INJECTION, BENZTROPINE MESYLATE, PER 1 MG
INJECTION, BENZTROPINE MESYLATE, PER 1 MG
INJECTION, BENZTROPINE MESYLATE, PER 1 MG
INJECTION, BENZTROPINE MESYLATE, PER 1 MG
INJECTION, BENZTROPINE MESYLATE, PER 1 MG
INJECTION, BENZTROPINE MESYLATE, PER 1 MG
INJECTION, BENZTROPINE MESYLATE, PER 1 MG
INJECTION, BETHANECHOL CHLORIDE, MYOTONACHOL OR URECHOLINE,
INJECTION, BETHANECHOL CHLORIDE, MYOTONACHOL OR URECHOLINE,
INJECTION, BETHANECHOL CHLORIDE, MYOTONACHOL OR URECHOLINE,
INJECTION, BETHANECHOL CHLORIDE, MYOTONACHOL OR URECHOLINE,
INJECTION, BETHANECHOL CHLORIDE, MYOTONACHOL OR URECHOLINE,
INJECTION, BETHANECHOL CHLORIDE, MYOTONACHOL OR URECHOLINE,
INJECTION, BETHANECHOL CHLORIDE, MYOTONACHOL OR URECHOLINE,
INJECTION, BETHANECHOL CHLORIDE, MYOTONACHOL OR URECHOLINE,
INJECTION, BETHANECHOL CHLORIDE, MYOTONACHOL OR URECHOLINE,
INJECTION, BETHANECHOL CHLORIDE, MYOTONACHOL OR URECHOLINE,
INJECTION, BETHANECHOL CHLORIDE, MYOTONACHOL OR URECHOLINE,
INJECTION, BETHANECHOL CHLORIDE, MYOTONACHOL OR URECHOLINE,
INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE
INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE
600000 UNITS
INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE
600000 UNITS
600000 UNITS
INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE
INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE
INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE
INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE
INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE
INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE
INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE
INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE
INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE
INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE
INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE
INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE
UP TO 2400000 UNITS
UP TO 2400000 UNITS
UP TO 2400000 UNITS
UP TO 2400000 UNITS
UP TO 2400000 UNITS
UP TO 2400000 UNITS
INJECTION, PENICILLIN G BENZATHINE, UP TO 600,000 UNITS
INJECTION, PENICILLIN G BENZATHINE, UP TO 600,000 UNITS
INJECTION, PENICILLIN G BENZATHINE, UP TO 600,000 UNITS
INJECTION, PENICILLIN G BENZATHINE, UP TO 600,000 UNITS
INJECTION, PENICILLIN G BENZATHINE, UP TO 600,000 UNITS
INJECTION, PENICILLIN G BENZATHINE, UP TO 600,000 UNITS
INJECTION, PENICILLIN G BENZATHINE, UP TO 600,000 UNITS
INJECTION, PENICILLIN G BENZATHINE, UP TO 600,000 UNITS
INJECTION, PENICILLIN G BENZATHINE, UP TO 600,000 UNITS
INJECTION, PENICILLIN G BENZATHINE, UP TO 600,000 UNITS
INJECTION, PENICILLIN G BENZATHINE, UP TO 600,000 UNITS
Earliest Start
Date
01/01/2012
01/01/2012
01/01/2002
01/01/2002
09/01/2003
09/08/2003
07/14/2003
06/22/2004
04/01/2010
01/01/2002
04/19/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2005
09/01/2003
01/01/2002
01/21/2006
01/01/2002
01/01/2002
04/19/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
09/08/2003
09/15/2003
09/15/2003
01/19/2002
01/01/2002
01/01/2006
01/01/2002
01/01/2006
01/01/2006
09/05/2007
09/05/2007
11/15/2005
08/15/2007
08/15/2007
08/15/2007
01/01/2006
01/01/2002
05/29/2002
01/01/2006
01/01/2002
01/01/2002
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2002
01/17/2007
01/17/2007
01/17/2007
01/01/2002
01/01/2002
06/12/2006
01/01/2002
11/21/2006
11/21/2006
11/21/2006
Latest End
Date
12/31/2078
12/31/2078
09/30/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
11/30/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J0570
J0570
J0570
J0570
J0570
J0570
J0580
J0580
J0580
J0580
J0580
J0580
J0583
J0585
J0585
J0585
J0585
J0587
J0587
J0587
J0588
J0588
J0592
J0592
J0592
J0592
J0592
J0592
J0592
J0592
J0592
J0592
J0592
J0592
J0592
J0592
J0592
J0592
J0592
J0592
J0594
J0594
J0595
J0595
J0595
J0595
J0595
J0595
J0595
J0595
J0595
J0595
J0595
J0595
J0595
J0595
J0595
J0595
J0595
J0595
J0595
J0595
J0595
J0595
J0595
60793060010
60793070010
60793070110
61570014610
61570014710
61570014810
60793070010
60793070110
60793070210
61570014610
61570014710
61570014810
65293000101
00023114501
00023392102
00023923201
54868412300
10454071010
10454071110
10454071210
00259160501
00259161001
00409201232
12496075701
38779088800
38779088806
38779088809
49452825301
49452825302
49452825303
49452825304
51927101200
55390010010
62991158301
62991158302
62991158303
63370090506
63370090509
63370090510
63370090515
67286005308
67286005408
00015564520
00015564620
00074230101
00074230201
00409162301
00409162349
00409162601
00409162602
00409162649
00409162651
10019046101
10019046201
23490518602
49452131701
49452131702
51927298600
54868018600
55045253300
55045296801
55045296802
55390018301
55390018401
55390018402
12/19/2013
Earliest Start
Date
HCPCS Description
PEN G BENZ, 1.2 MILLION UNITS
PEN G BENZ, 1.2 MILLION UNITS
PEN G BENZ, 1.2 MILLION UNITS
UP TO 1200000 UNITS
UP TO 1200000 UNITS
UP TO 1200000 UNITS
INJECTION, PENICILLIN G BENZATHINE, UP TO 2,400,000
INJECTION, PENICILLIN G BENZATHINE, UP TO 2,400,000
INJECTION, PENICILLIN G BENZATHINE, UP TO 2,400,000
UP TO 2400000 UNITS
UP TO 2400000 UNITS
INJECTION, PENICILLIN G BENZATHINE, UP TO 2,400,000
INJECTION, BIVALIRUDIN, 1 MG
INJECTION, ONABOTULINUMTOXINA, 1 UNIT
BOTULINUM TOXIN A, PER 1 UNIT
INJECTION, ONABOTULINUMTOXINA, 1 UNIT
INJECTION, ONABOTULINUMTOXINA, 1 UNIT
INJECTION, RIMABOTULINUMTOXINB, 100 UNITS
INJECTION, RIMABOTULINUMTOXINB, 100 UNITS
INJECTION, RIMABOTULINUMTOXINB, 100 UNITS
INJ, INCOBOTULINUMTOXIN A, 1 UNIT
INJ, INCOBOTULINUMTOXIN A, 1 UNIT
INJECTION, BUPRENORPHINE HYDROCHLORIDE, 0.1 MG
INJECTION, BUPRENORPHINE HYDROCHLORIDE, 0.1 MG
INJECTION, BUPRENORPHINE HYDROCHLORIDE, 0.1 MG
INJECTION, BUPRENORPHINE HYDROCHLORIDE, 0.1 MG
INJECTION, BUPRENORPHINE HYDROCHLORIDE, 0.1 MG
INJECTION, BUPRENORPHINE HYDROCHLORIDE, 0.1 MG
INJECTION, BUPRENORPHINE HYDROCHLORIDE, 0.1 MG
INJECTION, BUPRENORPHINE HYDROCHLORIDE, 0.1 MG
INJECTION, BUPRENORPHINE HYDROCHLORIDE, 0.1 MG
INJECTION, BUPRENORPHINE HYDROCHLORIDE, 0.1 MG
INJECTION, BUPRENORPHINE HYDROCHLORIDE, 0.1 MG
INJECTION, BUPRENORPHINE HYDROCHLORIDE, 0.1 MG
INJECTION, BUPRENORPHINE HYDROCHLORIDE, 0.1 MG
INJECTION, BUPRENORPHINE HYDROCHLORIDE, 0.1 MG
INJECTION, BUPRENORPHINE HYDROCHLORIDE, 0.1 MG
INJECTION, BUPRENORPHINE HYDROCHLORIDE, 0.1 MG
INJECTION, BUPRENORPHINE HYDROCHLORIDE, 0.1 MG
INJECTION, BUPRENORPHINE HYDROCHLORIDE, 0.1 MG
INJECTION, BUSULFAN, 1 MG
INJECTION, BUSULFAN, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
UNITS
UNITS
UNITS
UNITS
09/30/1990
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2004
01/01/2002
01/01/2010
06/07/2002
01/01/2002
08/01/2005
08/01/2005
06/30/2006
01/01/2012
01/01/2012
06/17/2005
01/01/2003
01/01/2003
01/01/2003
01/01/2003
01/01/2003
01/01/2003
01/01/2003
01/01/2004
09/08/2003
06/03/2005
09/15/2003
09/15/2003
09/15/2003
07/08/2003
07/08/2003
07/08/2003
07/08/2003
01/01/2007
07/30/2007
01/01/2004
01/01/2004
01/01/2004
01/01/2004
09/20/2005
10/19/2005
03/21/2006
12/21/2005
05/24/2006
12/08/2005
01/01/2004
01/01/2004
04/09/2007
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2005
04/11/2006
01/01/2004
01/01/2004
01/01/2004
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
10/31/2007
12/31/2007
10/31/2007
12/31/2078
12/31/2078
12/31/2078
10/31/2007
12/31/2007
10/31/2007
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J0595
J0595
J0595
J0595
J0595
J0595
J0595
J0597
J0598
J0600
J0600
J0600
J0600
J0600
J0600
J0600
J0610
J0610
J0610
J0610
J0610
J0610
J0610
J0620
J0630
J0636
J0636
J0636
J0636
J0636
J0636
J0636
J0637
J0637
J0638
J0640
J0640
J0640
J0640
J0640
J0640
J0640
J0640
J0640
J0640
J0640
J0640
J0640
J0640
J0640
J0640
J0640
J0640
J0640
J0641
J0670
J0670
J0670
J0670
J0670
J0670
J0670
J0670
J0670
J0670
55390018510
58016486801
60505065800
60505065900
60505066000
61703031745
61703031845
63833082502
42227008105
00089051006
17317240902
49452269701
49452269702
49452269703
51552043505
51927205900
00517390025
00517391025
00517395025
63323031110
63323031150
63323031161
63323031163
00516006060
00078014923
00074811031
00517013225
00703731104
51927342200
61703023429
63323073101
68830031980
00006382210
00006382310
00078058261
00703279301
00703279701
00703514001
00703514501
49452403601
49452403602
49452403604
51927269200
55390000901
55390005110
55390005210
55390005301
55390005401
55390081810
55390082401
55390082501
55390082601
63323071050
63323071100
68152010100
00074103850
00074106720
00074204750
00186041001
00186041201
00186041801
00186042001
00186042201
00409103630
00409103850
12/19/2013
HCPCS Description
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, BUTORPHANOL TARTRATE, 1 MG
INJECTION, C-1 ESTERASE INHIBITOR (HUMAN), BERINERT, 10 UNIT
INJECTION, C-1 ESTERASE INHIBITOR (HUMAN), CINRYZE, 10 UNITS
INJECTION, EDETATE CALCIUM DISODIUM, UP TO 1000 MG
INJECTION, EDETATE CALCIUM DISODIUM, UP TO 1000 MG
INJECTION, EDETATE CALCIUM DISODIUM, UP TO 1000 MG
INJECTION, EDETATE CALCIUM DISODIUM, UP TO 1000 MG
INJECTION, EDETATE CALCIUM DISODIUM, UP TO 1000 MG
INJECTION, EDETATE CALCIUM DISODIUM, UP TO 1000 MG
INJECTION, EDETATE CALCIUM DISODIUM, UP TO 1000 MG
INJECTION, CALCIUM GLUCONATE, PER 10 ML
INJECTION, CALCIUM GLUCONATE, PER 10 ML
INJECTION, CALCIUM GLUCONATE, PER 10 ML
INJECTION, CALCIUM GLUCONATE, PER 10 ML
INJECTION, CALCIUM GLUCONATE, PER 10 ML
INJECTION, CALCIUM GLUCONATE, PER 10 ML
INJECTION, CALCIUM GLUCONATE, PER 10 ML
INJECTION, CALCIUM GLYCEROPHOSPHATE AND CALCIUM LACTATE, PER
INJECTION, CALCITONIN SALMON, UP TO 400 UNITS
INJECTION, CALCITRIOL, 0.1 MCG
INJECTION, CALCITRIOL, 0.1 MCG
INJECTION, CALCITRIOL, 0.1 MCG
INJECTION, CALCITRIOL, 0.1 MCG
INJECTION, CALCITRIOL, 0.1 MCG
INJECTION, CALCITRIOL, 0.1 MCG
INJECTION, CALCITRIOL, 0.1 MCG
INJECTION, CASPOFUNGIN ACETATE, 5 MG
INJECTION, CASPOFUNGIN ACETATE, 5 MG
INJECTION, CANAKINUMAB, 1 MG
LEUCOVORIN CALCIUM PER 50MG
LEUCOVORIN CALCIUM PER 50MG
INJECTION, LEUCOVORIN CALCIUM, PER 50 MG
INJECTION, LEUCOVORIN CALCIUM, PER 50 MG
INJECTION, LEUCOVORIN CALCIUM, PER 50 MG
INJECTION, LEUCOVORIN CALCIUM, PER 50 MG
INJECTION, LEUCOVORIN CALCIUM, PER 50 MG
INJECTION, LEUCOVORIN CALCIUM, PER 50 MG
INJECTION, LEUCOVORIN CALCIUM, PER 50 MG
INJECTION, LEUCOVORIN CALCIUM, PER 50 MG
INJECTION, LEUCOVORIN CALCIUM, PER 50 MG
INJECTION, LEUCOVORIN CALCIUM, PER 50 MG
INJECTION, LEUCOVORIN CALCIUM, PER 50 MG
INJECTION, LEUCOVORIN CALCIUM, PER 50 MG
INJECTION, LEUCOVORIN CALCIUM, PER 50 MG
INJECTION, LEUCOVORIN CALCIUM, PER 50 MG
INJECTION, LEUCOVORIN CALCIUM, PER 50 MG
LEUCOVORIN CALCIUM PER 50MG
INJECTION, LEUCOVORIN CALCIUM, PER 50 MG
INJECTION, LEVOLEUCOVORIN CALCIUM, 0.5 MG
INJECTION, MEPIVACAINE HYDROCHLORIDE, PER 10 ML
INJECTION, MEPIVACAINE HYDROCHLORIDE, PER 10 ML
INJECTION, MEPIVACAINE HYDROCHLORIDE, PER 10 ML
INJECTION, MEPIVACAINE HYDROCHLORIDE, PER 10 ML
INJECTION, MEPIVACAINE HYDROCHLORIDE, PER 10 ML
INJECTION, MEPIVACAINE HYDROCHLORIDE, PER 10 ML
INJECTION, MEPIVACAINE HYDROCHLORIDE, PER 10 ML
INJECTION, MEPIVACAINE HYDROCHLORIDE, PER 10 ML
INJECTION, MEPIVACAINE HYDROCHLORIDE, PER 10 ML
INJECTION, MEPIVACAINE HYDROCHLORIDE, PER 10 ML
Earliest Start
Date
01/01/2004
03/15/2006
01/01/2004
01/01/2004
01/01/2004
06/25/2004
06/25/2004
12/03/2009
12/15/2008
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
12/04/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2003
03/14/2005
01/17/2005
09/08/2003
04/02/2004
03/17/2003
09/17/2003
01/01/2003
01/01/2003
01/01/2012
07/08/2011
07/13/2011
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/16/2002
09/08/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
03/08/2000
01/01/2002
08/15/2008
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
03/21/2006
10/08/2007
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/01/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/28/2014
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/31/2014
04/30/2014
05/31/2013
06/30/2013
12/31/2078
12/31/2078
12/31/2078
10/01/2008
09/01/2008
10/01/2008
12/31/2011
12/31/2078
08/31/2011
09/30/2011
03/31/2012
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J0670
J0670
J0670
J0670
J0670
J0670
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0690
J0692
J0692
J0692
J0692
J0692
J0692
J0692
00409104130
00409106720
00409204750
00409755101
66312044014
66312046014
00015733812
00069031220
00074473203
00264310211
00264310311
00264310511
00338350341
00409080501
00409258501
00591236569
00591354969
00591355068
00781333870
00781334646
00781345095
00781345196
00781345295
00781933746
00781933795
00781933885
00781933895
00781933985
00781933996
00781945196
00781945295
10019061001
10019061010
10019061103
10019061110
10019061205
10019061211
54868055900
54868465100
55045323201
60505074804
60505074805
60505074904
60505074905
60505076900
63304094025
63304094110
63323023610
63323023710
63323023765
63323023861
63323044661
66288110001
66288130001
66860000103
66860000203
66860000302
66860090203
00264319511
00781322280
00781322295
00781322391
00781322395
25021012250
51479005301
12/19/2013
HCPCS Description
INJECTION, MEPIVACAINE HYDROCHLORIDE, PER
INJECTION, MEPIVACAINE HYDROCHLORIDE, PER
INJECTION, MEPIVACAINE HYDROCHLORIDE, PER
INJECTION, MEPIVACAINE HYDROCHLORIDE, PER
INJECTION, MEPIVACAINE HYDROCHLORIDE, PER
INJECTION, MEPIVACAINE HYDROCHLORIDE, PER
INJECTION, CEFAZOLIN SODIUM, 500 MG
CEFAZOLIN, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
CEFAZOLIN, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
CEFAZOLIN, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFAZOLIN SODIUM, 500 MG
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
CEFEPIME INJ, PER 500MG
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
10
10
10
10
10
10
ML
ML
ML
ML
ML
ML
Earliest Start
Date
04/26/2006
01/15/2007
09/22/2006
05/05/2008
08/15/2006
08/15/2006
01/01/2002
10/07/2009
01/01/2002
01/01/2002
03/05/2003
01/01/2012
01/01/2002
03/27/2009
06/27/2007
01/22/2003
01/03/2007
08/25/2006
08/23/2004
06/18/2004
11/08/2006
09/13/2006
09/13/2006
04/25/2007
04/25/2007
02/27/2006
02/27/2006
05/15/2007
05/15/2007
01/04/2007
01/09/2007
03/01/2004
05/05/2007
03/01/2004
05/05/2007
10/05/2006
05/05/2007
01/01/2002
09/15/2003
09/01/2004
09/19/2005
09/19/2005
09/19/2005
09/16/2005
06/13/2006
12/07/2004
04/13/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
10/01/2002
10/01/2002
07/10/2002
07/10/2002
06/01/2002
09/01/2005
10/12/2010
04/14/2008
04/14/2008
04/14/2008
04/14/2008
04/01/2008
11/08/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/31/2012
03/01/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2008
04/30/2010
10/31/2009
12/31/2078
04/30/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/30/2014
12/31/2078
12/31/2078
12/31/2078
06/30/2014
09/30/2008
11/30/2008
01/13/2012
12/31/2078
01/13/2012
12/31/2078
01/13/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/31/2010
06/30/2010
12/31/2078
12/31/2078
11/30/2006
12/31/2078
03/30/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J0692
J0692
J0692
J0692
J0692
J0692
J0692
J0692
J0692
J0692
J0692
J0692
J0692
J0692
J0692
J0692
J0692
J0692
J0692
J0692
J0692
J0692
J0694
J0694
J0694
J0694
J0694
J0694
J0694
J0694
J0694
J0694
J0694
J0694
J0694
J0694
J0694
J0694
J0694
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
51479005310
51479005401
51479005402
51479005403
51479005410
51479005420
51479005430
51479005501
51479005502
51479005503
51479005510
51479005520
51479005530
60505068100
60505068104
60505083400
60505083404
60505603004
60505603104
63323032620
63323034020
63323034050
00006354524
00006354725
00264312311
00264312511
10019066071
10019066127
10019066211
25021010910
60505075905
60505076005
60505076104
60505602505
60505602605
63323034120
63323034125
63323034220
63323034361
00004196301
00004196302
00004196401
00004196404
00004196501
00004196505
00069448210
00264315311
00264315511
00338500241
00338500341
00409733201
00409733304
00409733349
00409733410
00409733503
00409733604
00409733649
00409733701
00409733801
00517871110
00517872210
00517872510
00517875010
00703031503
00703032503
12/19/2013
HCPCS Description
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
CEFEPIME INJ, PER 500MG
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
INJECTION, CEFOXITIN SODIUM, 1 GM
INJECTION, CEFOXITIN SODIUM, 1 GM
INJECTION, CEFOXITIN SODIUM, 1 GM
INJECTION, CEFOXITIN SODIUM, 1 GM
INJECTION, CEFOXITIN SODIUM, 1 GM
INJECTION, CEFOXITIN SODIUM, 1 GM
INJECTION, CEFOXITIN SODIUM, 1 GM
INJECTION, CEFOXITIN SODIUM, 1 GM
INJECTION, CEFOXITIN SODIUM, 1 GM
INJECTION, CEFOXITIN SODIUM, 1 GM
INJECTION, CEFOXITIN SODIUM, 1 GM
INJECTION, CEFOXITIN SODIUM, 1 GM
INJECTION, CEFOXITIN SODIUM, 1 GM
INJECTION, CEFOXITIN SODIUM, 1 GM
INJECTION, CEFOXITIN SODIUM, 1 GM
INJECTION, CEFOXITIN SODIUM, 1 GM
INJECTION, CEFOXITIN SODIUM, 1 GM
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
CEFTRIAXONE 250MG INJ
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
Earliest Start
Date
11/08/2002
11/08/2002
11/08/2002
11/08/2002
01/01/2002
01/01/2002
01/01/2002
11/08/2002
11/08/2002
11/08/2002
01/01/2002
01/01/2002
01/01/2002
06/19/2007
06/19/2007
06/19/2007
06/19/2007
04/11/2008
04/11/2008
03/17/2008
03/26/2008
03/17/2008
01/01/2002
01/01/2002
07/01/2006
07/01/2006
05/05/2007
05/05/2007
05/05/2007
12/08/2009
01/23/2006
01/23/2006
02/13/2006
02/27/2008
02/27/2008
01/01/2002
07/01/2011
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
10/01/2009
07/20/2005
07/20/2005
09/06/2005
09/06/2005
07/20/2005
07/20/2005
07/20/2005
07/20/2005
07/20/2005
07/20/2005
07/20/2005
07/20/2005
07/20/2005
05/06/2008
05/06/2008
05/06/2008
05/06/2008
12/21/2007
12/21/2007
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
06/30/2007
08/30/2012
12/31/2010
12/31/2078
12/31/2078
12/31/2078
11/30/2012
12/31/2078
12/31/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
05/30/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/30/2012
12/31/2078
08/30/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/31/2008
12/31/2078
05/31/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/31/2013
09/30/2011
Page 1 of 1
HCPCS
NDC
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
00703033504
00703034603
00703035901
00781320685
00781320695
00781320785
00781320795
00781320885
00781320895
00781320995
00781321046
00781932695
00781932785
00781932795
00781932885
00781932895
00781932990
00781932995
00781933046
10019009801
10019009871
10019068501
10019068571
10019068602
10019068671
10019068703
10019068771
10019068804
10019068827
10019068905
12280007310
21695020210
35356017715
49999058601
49999058610
54569137700
54569572000
54569572100
54569572200
54569572300
54569572400
54569572500
54868093400
54868093401
54868248801
54868322100
54868322101
54868553300
54868558900
55045350301
55045351101
55045351102
55045351601
55390030910
55390031110
55390031210
58016478601
58016479001
58016483401
58016943801
58016945301
58016955101
60505067905
60505067908
60505067909
12/19/2013
HCPCS Description
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
CEFTRIAXONE, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM,
CEFTRIAXONE, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM,
CEFTRIAXONE, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
CEFTRIAXONE, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM,
CEFTRIAXONE, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
CEFTRIAXONE 250MG INJ
CEFTRIAXONE, PER 250 MG
CEFTRIAXONE, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
INJECTION, CEFTRIAXONE SODIUM,
PER 250 MG
PER 250 MG
PER 250 MG
PER 250 MG
PER 250 MG
PER
PER
PER
PER
250
250
250
250
MG
MG
MG
MG
PER 250 MG
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
250
250
250
250
250
250
250
250
250
250
250
250
250
250
250
250
250
250
250
250
250
250
250
250
250
250
250
250
250
250
250
250
250
250
250
250
250
250
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
PER
PER
PER
PER
PER
PER
PER
PER
PER
250
250
250
250
250
250
250
250
250
MG
MG
MG
MG
MG
MG
MG
MG
MG
Earliest Start
Date
12/21/2007
12/21/2007
12/21/2007
01/01/2006
07/19/2005
01/01/2006
07/19/2005
01/01/2006
07/19/2005
07/19/2005
07/19/2005
07/19/2005
01/01/2007
07/19/2005
01/01/2007
07/19/2005
03/31/2007
07/19/2005
07/19/2005
07/05/2005
05/05/2007
07/05/2005
05/05/2007
07/05/2005
05/05/2007
07/05/2005
05/05/2007
07/05/2005
05/05/2007
10/05/2006
03/21/2005
02/01/2007
05/16/2008
02/24/2005
02/24/2005
01/01/2002
07/26/2005
07/26/2005
07/26/2005
07/27/2005
07/27/2005
07/27/2005
01/01/2002
06/11/2003
01/01/2002
01/01/2002
01/01/2002
02/17/2006
05/12/2006
06/28/2006
07/11/2006
07/14/2006
07/12/2006
07/29/2009
07/20/2009
07/20/2009
02/01/2006
02/01/2006
02/01/2006
02/22/2002
01/01/2002
01/01/2002
09/01/2005
09/01/2005
09/01/2005
Latest End
Date
04/30/2013
01/31/2013
01/31/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/31/2015
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/31/2015
06/30/2015
12/31/2078
12/31/2078
01/13/2012
12/31/2078
01/13/2012
12/31/2078
01/13/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0696
J0697
J0697
J0697
J0697
J0697
J0697
J0697
J0697
J0697
J0697
J0697
J0697
J0697
J0697
J0697
J0697
J0697
J0697
J0697
J0697
J0697
J0697
J0697
J0697
J0697
60505075000
60505075004
60505075100
60505075104
60505075200
60505075204
60505075300
60505075304
63323034410
63323034510
63323034610
63323034720
63323034861
64679070101
64679070102
64679070103
64679070201
64679070202
64679070301
64679070302
64679098301
64679098302
68180061101
68180061110
68180062201
68180062210
68180063301
68180063310
68180064401
68180064410
68330000101
68330000110
68330000201
68330000210
68330000301
68330000310
68330000401
68330000410
68330000501
68330000601
00173035210
00173035332
00173035410
00173035632
00173040000
00173042400
00173042500
00173043600
00173043700
00264311211
00264311411
00409080201
00781920570
00781920680
00781920746
10019062001
10019062010
10019062103
10019062120
10019062205
10019062211
63323035210
63323035320
63323035461
66860003003
12/19/2013
Earliest Start
Date
HCPCS Description
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
INJECTION, STERILE CEFUROXIME SODIUM, PER 750
INJECTION, STERILE CEFUROXIME SODIUM, PER 750
INJECTION, STERILE CEFUROXIME SODIUM, PER 750
INJECTION, STERILE CEFUROXIME SODIUM, PER 750
INJECTION, STERILE CEFUROXIME SODIUM, PER 750
INJECTION, STERILE CEFUROXIME SODIUM, PER 750
INJECTION, STERILE CEFUROXIME SODIUM, PER 750
INJECTION, STERILE CEFUROXIME SODIUM, PER 750
INJECTION, STERILE CEFUROXIME SODIUM, PER 750
INJECTION, STERILE CEFUROXIME SODIUM, PER 750
INJECTION, STERILE CEFUROXIME SODIUM, PER 750
CEFUROXIME, INJ, PER 750MG
INJECTION, STERILE CEFUROXIME SODIUM, PER 750
INJECTION, STERILE CEFUROXIME SODIUM, PER 750
INJECTION, STERILE CEFUROXIME SODIUM, PER 750
INJECTION, STERILE CEFUROXIME SODIUM, PER 750
INJECTION, STERILE CEFUROXIME SODIUM, PER 750
INJECTION, STERILE CEFUROXIME SODIUM, PER 750
INJECTION, STERILE CEFUROXIME SODIUM, PER 750
INJECTION, STERILE CEFUROXIME SODIUM, PER 750
INJECTION, STERILE CEFUROXIME SODIUM, PER 750
INJECTION, STERILE CEFUROXIME SODIUM, PER 750
INJECTION, STERILE CEFUROXIME SODIUM, PER 750
INJECTION, STERILE CEFUROXIME SODIUM, PER 750
INJECTION, STERILE CEFUROXIME SODIUM, PER 750
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
08/02/2005
08/02/2005
08/02/2005
08/02/2005
08/02/2005
08/02/2005
08/02/2005
08/02/2005
02/16/2006
02/16/2006
02/16/2006
02/16/2006
02/16/2006
05/18/2007
05/18/2007
05/18/2007
05/18/2007
05/18/2007
05/18/2007
05/18/2007
05/26/2006
05/26/2006
07/20/2005
07/20/2005
07/20/2005
07/20/2005
07/20/2005
07/20/2005
07/20/2005
07/20/2005
09/15/2007
09/15/2007
09/15/2007
09/15/2007
09/15/2007
09/15/2007
09/15/2007
09/15/2007
11/05/2007
11/05/2007
02/01/2005
01/01/2002
02/01/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/15/2003
03/01/2004
05/08/2009
05/01/2003
05/01/2003
05/01/2003
03/01/2004
05/05/2007
03/01/2004
05/05/2007
03/01/2004
05/05/2007
01/01/2002
01/01/2002
01/13/2003
06/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/30/2007
12/31/2078
09/30/2007
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/13/2012
12/31/2078
01/13/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
Earliest Start
Date
Latest End
Date
00517072001 BETAMETHASONE ACE/BETAMETH NA PHOS, PER 3MG
35356008401 INJECTION, BETAMETHASONE ACETATE 3MG AND BETAMETHASONE SODIU
04/28/2010
02/08/2008
12/31/2078
12/31/2078
J0702
J0702
40042004805 BETAMETHASONE ACE/BETAMETH NA PHOS, PER 3MG
54868020600 INJECTION, BETAMETHASONE ACETATE 3MG AND BETAMETHASONE SODIU
01/01/1990
01/01/2002
12/31/2011
12/31/2078
J0702
58016919101 INJECTION, BETAMETHASONE ACETATE 3MG AND BETAMETHASONE SODIU
01/01/2002
12/31/2078
J0706
J0706
J0706
J0706
J0706
J0706
J0706
J0706
J0706
J0706
J0706
J0706
J0706
00087601142
00406064602
00517002010
00574082301
00574082381
10106164901
10106164904
17317007301
17317007304
17317007305
17317007308
38779107305
38779107308
01/01/2004
01/01/2002
09/10/2007
09/21/2006
09/28/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/28/2002
01/28/2002
12/31/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
HCPCS
NDC
J0697
J0697
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0698
J0702
66860003103
66860003202
00039001710
00039001810
00039001811
00039001825
00039001849
00039001850
00039001910
00039001911
00039001925
00039001949
00039001950
00039002001
00039002049
00039002325
00039002349
00039002350
00039002361
00039002425
00039002449
00039002450
10019068001
10019068015
10019068102
10019068115
10019068203
10019068215
54569248400
54868342900
54868342901
63323033115
63323033215
63323033361
63323033461
63323033510
64679098601
64679098602
64679098603
64679098604
66860004203
66860004303
66860004401
00085056605
J0702
J0702
12/19/2013
HCPCS Description
INJECTION, STERILE CEFUROXIME SODIUM, PER 750 MG
INJECTION, STERILE CEFUROXIME SODIUM, PER 750 MG
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
INJECTION, CEFOTAXIME SODIUM, PER GM
CEFOTAXIME INJ, PER GM
CEFOTAXIME INJ, PER GM
CEFOTAXIME INJ, PER GM
INJECTION, BETAMETHASONE ACETATE 3MG AND BETAMETHASONE SODIU
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
CAFFEINE
CAFFEINE
CAFFEINE
CAFFEINE
CAFFEINE
CAFFEINE
CAFFEINE
CAFFEINE
CAFFEINE
CAFFEINE
CAFFEINE
CAFFEINE
CAFFEINE
CITRATE,
CITRATE,
CITRATE,
CITRATE,
CITRATE,
CITRATE,
CITRATE,
CITRATE,
CITRATE,
CITRATE,
CITRATE,
CITRATE,
CITRATE,
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
06/01/2002
01/01/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
04/01/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
06/01/2005
01/01/2002
01/01/2002
06/01/2005
01/01/2002
06/01/2005
01/01/2002
04/03/2006
01/01/2002
06/01/2005
01/01/2002
07/05/2005
05/05/2007
07/05/2005
05/05/2007
07/05/2005
05/05/2007
01/01/2002
01/01/2002
01/01/2002
01/29/2002
01/29/2002
01/29/2002
01/29/2002
01/29/2002
09/20/2006
09/20/2006
09/20/2006
09/20/2006
10/01/2009
10/01/2009
10/01/2009
01/01/2002
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/13/2012
12/31/2078
01/13/2012
12/31/2078
01/13/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
11/30/2010
12/31/2011
12/31/2011
10/31/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J0706
J0706
J0706
J0706
J0706
J0706
J0706
J0706
J0706
J0712
J0712
J0713
J0713
J0713
J0713
J0713
J0713
J0713
J0713
J0713
J0713
J0713
J0713
J0713
J0713
J0713
J0713
J0713
J0713
J0713
J0713
J0713
J0713
J0713
J0713
J0713
J0713
J0713
J0713
J0713
J0713
J0713
J0715
J0715
J0716
J0718
J0718
J0718
J0720
J0725
J0725
J0725
J0725
J0725
J0725
J0725
J0735
J0735
J0735
J0735
J0735
J0735
J0735
J0735
J0735
49452133001
49452133002
49452133003
51552017805
51552017806
51927120200
62991150901
62991150902
63323040703
00456040010
00456060010
00074508216
00074508411
00074508611
00074509216
00173037710
00173037810
00173037934
00173038032
00173038237
00173043400
00173043500
00409508216
00409508252
00409508411
00409508451
00409508611
00409508651
00409509216
00409509252
00409509311
00409509351
00781317796
00781317895
00781317986
10019069102
10019069127
10019069203
10019069250
10019069304
10019069311
62991270301
00469722001
00469722102
66621015001
50474070062
50474071079
50474071081
63323001115
00052031510
52637012610
54569266000
54868412100
54868499700
55566150101
63323002510
38779056101
38779056103
38779056104
38779056106
49452214702
49452214703
49452214704
51552048001
51552048002
12/19/2013
HCPCS Description
INJECTION, CAFFEINE CITRATE, 5MG
INJECTION, CAFFEINE CITRATE, 5MG
INJECTION, CAFFEINE CITRATE, 5MG
INJECTION, CAFFEINE CITRATE, 5MG
INJECTION, CAFFEINE CITRATE, 5MG
INJECTION, CAFFEINE CITRATE, 5MG
INJECTION, CAFFEINE CITRATE, 5MG
INJECTION, CAFFEINE CITRATE, 5MG
INJECTION, CAFFEINE CITRATE, 5MG
INJECTION, CEFTAROLINE FOSAMIL, 10 MG
INJECTION, CEFTAROLINE FOSAMIL, 10 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTAZIDIME, PER 500 MG
INJECTION, CEFTIZOXIME SODIUM, PER 500 MG
INJECTION, CEFTIZOXIME SODIUM, PER 500 MG
INJ, CENTRURIODES IMMUNE FAB, UP TO 120MG
INJECTION, CERTOLIZUMAB PEGOL, 1 MG
INJECTION, CERTOLIZUMAB PEGOL, 1 MG
INJECTION, CERTOLIZUMAB PEGOL, 1 MG
INJECTION, CHLORAMPHENICOL SODIUM SUCCINATE, UP TO 1 GM
INJECTION, CHORIONIC GONADOTROPIN, PER 1,000 USP UNITS
INJECTION, CHORIONIC GONADOTROPIN, PER 1,000 USP UNITS
INJECTION, CHORIONIC GONADOTROPIN, PER 1,000 USP UNITS
INJECTION, CHORIONIC GONADOTROPIN, PER 1,000 USP UNITS
INJECTION, CHORIONIC GONADOTROPIN, PER 1,000 USP UNITS
INJECTION, CHORIONIC GONADOTROPIN, PER 1,000 USP UNITS
INJECTION, CHORIONIC GONADOTROPIN, PER 1,000 USP UNITS
INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG
INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG
INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG
INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG
INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG
INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG
INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG
INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG
INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG
Earliest Start
Date
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
12/04/2003
09/15/2003
09/15/2003
08/03/2007
01/26/2011
01/26/2011
01/01/2002
01/01/2002
01/01/2002
01/01/2002
02/01/2005
02/01/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
10/24/2005
10/04/2005
12/05/2005
10/04/2005
04/19/2006
10/04/2005
05/02/2006
06/27/2006
04/03/2006
10/01/2006
02/23/2007
02/23/2007
02/23/2007
03/22/2007
05/05/2007
03/22/2007
05/05/2007
03/22/2007
05/05/2007
01/01/2008
01/01/2002
01/01/2002
09/12/2011
05/13/2009
05/13/2009
05/13/2009
01/01/2002
01/01/2002
01/01/2002
01/01/2002
07/13/2007
02/18/2004
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/03/2002
01/01/2002
01/01/2002
01/01/2002
11/15/2004
01/01/2002
09/01/2003
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
10/01/2007
06/01/2007
09/01/2007
06/01/2007
12/31/2078
12/31/2078
12/31/2078
02/28/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/13/2012
12/31/2078
01/13/2012
12/31/2078
01/13/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J0735
J0735
J0735
J0735
J0735
J0735
J0735
J0735
J0735
J0735
J0735
J0735
J0740
J0740
J0743
J0743
J0743
J0743
J0743
J0743
J0743
J0744
J0744
J0744
J0744
J0744
J0744
J0744
J0744
J0744
J0744
J0744
J0744
J0744
J0744
J0744
J0744
J0744
J0744
J0744
J0744
J0744
J0744
J0744
J0744
J0744
J0745
J0745
J0745
J0745
J0745
J0745
J0745
J0745
J0745
J0745
J0745
J0745
J0745
J0745
J0745
J0745
J0745
J0745
J0745
51927237900
62991142201
62991142202
63275997401
63275997402
63275997403
63370005210
63370005215
63370005225
66479052001
66479052101
67457021810
54868397900
61958010101
00006351458
00006351659
00006351775
00006355158
00006355259
00006358275
00006366659
00085173101
00085174102
00085175502
00085176201
00085176303
00085178101
00338096037
00338096048
00409476586
00409477702
00409477723
00409477761
00409477762
00409477886
00703095601
00703095603
00703095803
00703096036
00703096936
00781323909
00781324009
54868454700
55390019701
55390019801
55390019901
00406154832
00406154835
00409109732
00409110232
38779067903
38779067904
38779067905
49452002702
49452002703
49452002704
51552068802
51552068803
51552068804
51552068806
51927101300
63275810003
63275810004
63275810005
63304074801
12/19/2013
Earliest Start
Date
HCPCS Description
INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG
INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG
INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG
INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG
INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG
INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG
INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG
INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG
INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG
INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG
INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG
CLONIDINE, PER 1 MG
INJECTION, CIDOFOVIR, 375 MG
INJECTION, CIDOFOVIR, 375 MG
INJECTION, CILASTATIN SODIUM; IMIPENEM, PER 250 MG
INJECTION, CILASTATIN SODIUM; IMIPENEM, PER 250 MG
INJECTION, CILASTATIN SODIUM; IMIPENEM, PER 250 MG
INJECTION, CILASTATIN SODIUM; IMIPENEM, PER 250 MG
INJECTION, CILASTATIN SODIUM; IMIPENEM, PER 250 MG
INJECTION, CILASTATIN SODIUM; IMIPENEM, PER 250 MG
INJECTION, CILASTATIN SODIUM; IMIPENEM, PER 250 MG
INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION,
INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION,
INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION,
INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION,
INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION,
INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION,
INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION,
INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION,
INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION,
INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION,
INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION,
INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION,
INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION,
INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION,
CIPROFLOXACIN 200MG IV
INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION,
INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION,
INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION,
INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION,
INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION,
INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION,
INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION,
INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION,
INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION,
INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION,
INJECTION, CODEINE PHOSPHATE, PER 30 MG
INJECTION, CODEINE PHOSPHATE, PER 30 MG
INJECTION, CODEINE PHOSPHATE, PER 30 MG
INJECTION, CODEINE PHOSPHATE, PER 30 MG
INJECTION, CODEINE PHOSPHATE, PER 30 MG
INJECTION, CODEINE PHOSPHATE, PER 30 MG
INJECTION, CODEINE PHOSPHATE, PER 30 MG
INJECTION, CODEINE PHOSPHATE, PER 30 MG
INJECTION, CODEINE PHOSPHATE, PER 30 MG
INJECTION, CODEINE PHOSPHATE, PER 30 MG
INJECTION, CODEINE PHOSPHATE, PER 30 MG
INJECTION, CODEINE PHOSPHATE, PER 30 MG
INJECTION, CODEINE PHOSPHATE, PER 30 MG
INJECTION, CODEINE PHOSPHATE, PER 30 MG
INJECTION, CODEINE PHOSPHATE, PER 30 MG
INJECTION, CODEINE PHOSPHATE, PER 30 MG
INJECTION, CODEINE PHOSPHATE, PER 30 MG
INJECTION, CODEINE PHOSPHATE, PER 30 MG
INJECTION, CODEINE PHOSPHATE, PER 30 MG
200
200
200
200
200
200
200
200
200
200
200
200
200
200
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
200
200
200
200
200
200
200
200
200
200
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
09/08/2003
09/15/2003
09/15/2003
01/01/2003
01/01/2003
01/01/2003
07/08/2003
07/08/2003
07/08/2003
06/28/2006
06/14/2006
02/01/2011
04/12/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
08/17/2005
08/17/2005
08/17/2005
08/17/2005
08/17/2005
08/17/2005
03/18/2008
03/18/2008
08/29/2006
03/19/2008
03/19/2008
05/19/2008
05/19/2008
08/29/2006
01/01/2007
08/28/2006
08/28/2006
03/18/2008
03/18/2008
03/18/2008
03/18/2008
01/01/2002
08/28/2006
08/28/2006
11/06/2006
01/01/2002
01/01/2002
11/15/2005
10/05/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/08/2003
12/03/2002
12/03/2002
12/03/2002
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/31/2012
07/31/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
05/31/2009
12/31/2078
12/31/2078
12/31/2078
04/30/2009
04/30/2009
11/14/2012
11/14/2012
05/31/2010
12/31/2078
06/30/2010
07/31/2011
05/31/2011
12/31/2078
12/31/2078
12/31/2078
04/01/2012
08/01/2011
12/31/2078
12/31/2078
03/31/2012
03/31/2012
03/31/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
Earliest Start
Date
Latest End
Date
60574310101 INJECTION, CYTOMEGALOVIRUS IMMUNE GLOBULIN INTRAVENOUS (HUMA
01/01/2002
12/14/2009
15054050001
15054053006
67919001101
54868542800
54868542900
54868586700
55513000201
55513000204
55513000301
55513000304
55513000401
55513000404
55513000501
55513000504
55513000601
55513001001
55513001004
55513001101
55513001104
55513001201
55513001204
55513001301
55513001304
01/01/2012
01/01/2012
01/01/2005
08/10/2007
03/20/2008
03/20/2008
09/11/2006
09/11/2006
09/11/2006
09/11/2006
09/11/2006
09/11/2006
09/11/2006
09/11/2006
09/11/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/31/2009
03/31/2009
11/30/2008
11/30/2008
12/31/2008
12/31/2008
04/30/2009
04/30/2009
HCPCS
NDC
J0745
J0745
J0745
J0745
J0760
J0760
J0760
J0760
J0760
J0770
J0770
J0770
J0770
J0770
J0770
J0770
J0770
J0770
J0775
J0780
J0780
J0780
J0780
J0780
J0780
J0780
J0780
J0780
J0780
J0780
J0780
J0780
J0795
J0800
J0835
J0835
J0835
J0840
J0850
63304074901
63370091015
63370091025
63370091035
49452221002
49452221003
51552099101
51927189500
55390060502
00574085801
00591355911
38779120303
38779120306
39822061501
51927210100
54868561200
61570041451
63323039306
66887000301
00641049121
00641049125
00703717104
00703717501
10019004301
10019004344
38779216503
38779216506
51927220600
54868026100
54868413700
55390007701
55390007710
55566030201
63004773101
00548590000
00781305271
00781305295
00281033010
44206310101
J0850
J0856
J0856
J0878
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
12/19/2013
HCPCS Description
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
CODEINE PHOSPHATE, PER 30 MG
CODEINE PHOSPHATE, PER 30 MG
CODEINE PHOSPHATE, PER 30 MG
CODEINE PHOSPHATE, PER 30 MG
COLCHICINE, PER 1MG
COLCHICINE, PER 1MG
COLCHICINE, PER 1MG
COLCHICINE, PER 1MG
COLCHICINE, PER 1MG
COLISTIMETHATE SODIUM, UP TO 150 MG
COLISTIMETHATE SODIUM, UP TO 150 MG
COLISTIMETHATE SODIUM, UP TO 150 MG
COLISTIMETHATE SODIUM, UP TO 150 MG
COLISTIMETHATE SODIUM, UP TO 150 MG
COLISTIMETHATE SODIUM, UP TO 150 MG
COLISTIMETHATE SODIUM, UP TO 150 MG
COLISTIMETHATE SODIUM, UP TO 150 MG
COLISTIMETHATE SODIUM, UP TO 150 MG
COLLAGENASE, CLOSTRIDIUM HISTOLYTICUM, 0.01 MG
PROCHLORPERAZINE, UP TO 10 MG
PROCHLORPERAZINE, UP TO 10 MG
PROCHLORPERAZINE, UP TO 10 MG
PROCHLORPERAZINE, UP TO 10 MG
PROCHLORPERAZINE, UP TO 10 MG
PROCHLORPERAZINE, UP TO 10 MG
PROCHLORPERAZINE, UP TO 10 MG
PROCHLORPERAZINE, UP TO 10 MG
PROCHLORPERAZINE, UP TO 10 MG
PROCHLORPERAZINE, UP TO 10 MG
PROCHLORPERAZINE, UP TO 10 MG
PROCHLORPERAZINE, UP TO 10 MG
PROCHLORPERAZINE, UP TO 10 MG
CORTICORELIN OVINE TRIFLUTATE, 1 MICROGRAM
CORTICOTROPIN, UP TO 40 UNITS
COSYNTROPIN, PER 0.25 MG
COSYNTROPIN, PER 0.25 MG
COSYNTROPIN, PER 0.25 MG
CROTALIDAE POLYVALENT IMMUNE FAB (OVINE), UP TO 1
CYTOMEGALOVIRUS IMMUNE GLOBULIN INTRAVENOUS (HUMA
ABOBOTULINUMTOXINA, 5 UNITS
ABOBOTULINUMTOXINA, 5 UNITS
DAPTOMYCIN, 1 MG
DARBEPOETIN ALFA, 1 MICROGRAM
DARBEPOETIN ALFA, 1 MICROGRAM
DARBEPOETIN ALFA, 1 MICROGRAM
DARBEPOETIN ALFA, 1 MICROGRAM
DARBEPOETIN ALFA, 1 MICROGRAM
DARBEPOETIN ALFA, 1 MICROGRAM
DARBEPOETIN ALFA, 1 MICROGRAM
DARBEPOETIN ALFA, 1 MICROGRAM
DARBEPOETIN ALFA, 1 MICROGRAM
DARBEPOETIN ALFA, 1 MICROGRAM
DARBEPOETIN ALFA, 1 MICROGRAM
DARBEPOETIN ALFA, 1 MICROGRAM
DARBEPOETIN ALFA, 1 MICROGRAM
DARBEPOETIN ALFA, 1 MICROGRAM
DARBEPOETIN ALFA, 1 MICROGRAM
DARBEPOETIN ALFA, 1 MICROGRAM
DARBEPOETIN ALFA, 1 MICROGRAM
DARBEPOETIN ALFA, 1 MICROGRAM
DARBEPOETIN ALFA, 1 MICROGRAM
DARBEPOETIN ALFA, 1 MICROGRAM
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
01/01/2002
07/08/2003
07/08/2003
07/08/2003
01/01/2002
01/01/2002
09/01/2003
09/08/2003
01/01/2002
03/11/2005
01/30/2007
02/07/2002
02/07/2002
01/01/2002
09/08/2003
06/12/2006
01/01/2002
03/10/2008
03/31/2010
12/08/2004
01/01/2002
06/17/2003
06/17/2003
01/14/2005
05/05/2007
04/25/2002
04/25/2002
09/08/2003
01/01/2002
01/01/2002
07/22/2004
07/22/2004
01/01/2006
01/01/2002
06/26/2003
03/26/2008
03/26/2008
01/01/2012
02/20/2007
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/31/2009
12/31/2078
10/31/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
10/31/2009
12/31/2078
12/31/2078
07/28/2010
07/28/2010
12/31/2078
12/31/2078
11/28/2008
11/28/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
06/30/2013
12/31/2078
Page 1 of 1
HCPCS
NDC
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0881
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
55513001401
55513001404
55513001501
55513002101
55513002104
55513002301
55513002304
55513002501
55513002504
55513002701
55513002704
55513002801
55513003201
55513003701
55513003704
55513003901
55513003904
55513004101
55513004104
55513004301
55513004304
55513004401
55513004601
55513004801
55513005301
55513005304
55513005401
55513005404
55513005701
55513005704
55513005801
55513005804
55513009001
55513009101
55513009201
55513009301
55513009401
55513009501
55513009601
55513009701
55513011001
55513011101
55513000201
55513000204
55513000301
55513000304
55513000401
55513000404
55513000501
55513000504
55513000601
55513001001
55513001004
55513001101
55513001104
55513001201
55513001204
55513001301
55513001304
55513001401
55513001404
55513001501
55513002101
55513002104
55513002301
12/19/2013
HCPCS Description
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
DARBEPOETIN
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
ALFA,
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
MICROGRAM
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(NON-ESRD
(DIALYSIS)
(DIALYSIS)
(DIALYSIS)
(DIALYSIS)
(DIALYSIS)
(DIALYSIS)
(DIALYSIS)
(DIALYSIS)
(DIALYSIS)
(DIALYSIS)
(DIALYSIS)
(DIALYSIS)
(DIALYSIS)
(DIALYSIS)
(DIALYSIS)
(DIALYSIS)
(DIALYSIS)
(DIALYSIS)
(DIALYSIS)
(DIALYSIS)
(DIALYSIS)
(DIALYSIS)
(DIALYSIS)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
USE)
Earliest Start
Date
01/01/2006
02/08/2008
01/01/2006
08/14/2006
08/14/2006
08/14/2006
08/14/2006
08/14/2006
08/14/2006
09/11/2006
09/11/2006
08/14/2006
06/07/2006
02/08/2008
02/08/2008
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
09/11/2006
09/11/2006
02/08/2008
02/08/2008
08/14/2006
08/14/2006
01/01/2006
01/01/2006
09/25/2006
09/25/2006
09/25/2006
09/25/2006
09/25/2006
09/25/2006
09/25/2006
09/25/2006
08/14/2006
08/14/2006
09/11/2006
09/11/2006
09/11/2006
09/11/2006
09/11/2006
09/11/2006
09/11/2006
09/11/2006
09/11/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
08/14/2006
08/14/2006
08/14/2006
Latest End
Date
02/28/2009
11/30/2007
04/30/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
11/30/2008
11/30/2008
02/28/2009
02/28/2009
02/28/2009
02/28/2009
12/31/2008
12/31/2008
02/28/2009
04/30/2009
02/28/2009
12/31/2078
12/31/2078
12/31/2008
12/31/2008
12/31/2078
12/31/2078
03/31/2009
03/31/2009
02/28/2009
02/28/2009
02/28/2009
02/28/2009
02/28/2009
02/28/2009
02/28/2009
02/28/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/31/2009
03/31/2009
11/30/2008
11/30/2008
12/31/2008
12/31/2008
04/30/2009
04/30/2009
02/28/2009
11/30/2007
04/30/2009
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0882
J0885
J0885
J0885
J0885
J0885
J0885
J0885
J0885
J0885
J0885
J0885
J0885
J0885
J0885
J0885
J0885
J0885
J0885
J0885
J0885
J0885
J0885
J0885
J0885
J0885
J0885
J0885
J0885
J0885
55513002304
55513002501
55513002504
55513002701
55513002704
55513002801
55513003201
55513003701
55513003704
55513003901
55513003904
55513004101
55513004104
55513004301
55513004304
55513004401
55513004601
55513004801
55513005301
55513005304
55513005401
55513005404
55513005701
55513005704
55513005801
55513005804
55513009001
55513009101
55513009201
55513009301
55513009401
55513009501
55513009601
55513009701
55513011001
55513011101
54868252300
54868252301
54868567301
54868580200
55513012601
55513012610
55513014401
55513014410
55513014801
55513014810
55513026701
55513026710
55513028301
55513028310
55513047801
55513047810
55513082301
55513082310
59676030201
59676030202
59676030301
59676030302
59676030401
59676030402
59676031001
59676031002
59676031201
59676031204
59676032001
12/19/2013
HCPCS Description
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
DARBEPOETIN ALFA, 1 MICROGRAM (DIALYSIS)
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
Earliest Start
Date
08/14/2006
08/14/2006
08/14/2006
09/11/2006
09/11/2006
08/14/2006
06/07/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
09/11/2006
09/11/2006
01/01/2006
01/01/2006
08/14/2006
08/14/2006
01/01/2006
01/01/2006
09/25/2006
09/25/2006
09/25/2006
09/25/2006
09/25/2006
09/25/2006
09/25/2006
09/25/2006
08/14/2006
08/14/2006
01/01/2006
01/01/2006
03/24/2008
08/13/2007
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/18/2008
01/01/2006
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
11/30/2008
11/30/2008
02/28/2009
02/28/2009
02/28/2009
02/28/2009
12/31/2008
12/31/2008
02/28/2009
04/30/2009
02/28/2009
12/31/2078
12/31/2078
12/31/2008
12/31/2008
12/31/2078
12/31/2078
03/31/2009
03/31/2009
02/28/2009
02/28/2009
02/28/2009
02/28/2009
02/28/2009
02/28/2009
02/28/2009
02/28/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/31/2010
07/31/2010
12/31/2078
07/01/2013
12/31/2078
09/01/2013
12/31/2078
09/01/2013
12/31/2078
12/31/2078
10/31/2009
12/31/2078
12/31/2009
Page 1 of 1
HCPCS
NDC
J0885
J0885
J0886
J0886
J0886
J0886
J0886
J0886
J0886
J0886
J0886
J0886
J0886
J0886
J0886
J0886
J0886
J0886
J0886
J0886
J0886
J0886
J0886
J0886
J0886
J0886
J0886
J0886
J0886
J0890
J0890
J0894
J0895
J0895
J0895
J0895
J0895
J0895
J0895
J0895
J0895
J0895
J0895
J0895
J0895
J0897
J0897
J0945
J0945
J0945
J0945
J0945
J0945
J0945
J0970
J0970
J0970
J0970
J0970
J0970
J0970
J0970
J0970
J0970
J0970
59676032004
59676034001
54868252300
54868252301
55513012601
55513012610
55513014401
55513014410
55513014801
55513014810
55513026701
55513026710
55513028301
55513028310
55513047801
55513047810
55513082301
55513082310
59676030201
59676030202
59676030301
59676030302
59676030401
59676030402
59676031001
59676031002
59676031204
59676032004
59676034001
64764061010
64764062020
62856060001
00078034751
00078046761
00078046791
00083380104
00409233610
00409233725
00555113111
00555113212
00703846309
00703846501
55390026310
55390026501
63323059710
55513071001
55513073001
49452130901
49452130904
49452130905
51552089402
51552089404
51552089405
51927195000
00781303175
38779056803
38779056804
38779056806
42023011201
49452279101
49452279102
49452279103
51552088801
51552088802
51552088804
12/19/2013
HCPCS Description
INJECTION, EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
INJECTION, EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 1000 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 1000 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 1000 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 1000 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 1000 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 1000 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 1000 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 1000 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 1000 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 1000 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 1000 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 1000 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 1000 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 1000 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 1000 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 1000 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 1000 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 1000 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 1000 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 1000 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 1000 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 1000 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 1000 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 1000 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 1000 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 1000 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 1000 UNITS
INJECTION, PEGINESATIDE, 0.1 MG (FOR ESRD ON DIALYSIS)
INJECTION, PEGINESATIDE, 0.1 MG (FOR ESRD ON DIALYSIS)
DECITABINE INJ, PER 1 MG
INJECTION, DEFEROXAMINE MESYLATE, 500 MG
INJECTION, DEFEROXAMINE MESYLATE, 500 MG
INJECTION, DEFEROXAMINE MESYLATE, 500 MG
INJECTION, DEFEROXAMINE MESYLATE, 500 MG
INJECTION, DEFEROXAMINE MESYLATE, 500 MG
INJECTION, DEFEROXAMINE MESYLATE, 500 MG
INJECTION, DEFEROXAMINE MESYLATE, 500 MG
INJECTION, DEFEROXAMINE MESYLATE, 500 MG
INJECTION, DEFEROXAMINE MESYLATE, 500 MG
INJECTION, DEFEROXAMINE MESYLATE, 500 MG
INJECTION, DEFEROXAMINE MESYLATE, 500 MG
INJECTION, DEFEROXAMINE MESYLATE, 500 MG
INJECTION, DEFEROXAMINE MESYLATE, 500 MG
INJECTION, DENOSUMAB, 1 MG
INJECTION, DENOSUMAB, 1 MG
INJECTION, BROMPHENIRAMINE MALEATE, PER 10 MG
INJECTION, BROMPHENIRAMINE MALEATE, PER 10 MG
INJECTION, BROMPHENIRAMINE MALEATE, PER 10 MG
INJECTION, BROMPHENIRAMINE MALEATE, PER 10 MG
INJECTION, BROMPHENIRAMINE MALEATE, PER 10 MG
INJECTION, BROMPHENIRAMINE MALEATE, PER 10 MG
INJECTION, BROMPHENIRAMINE MALEATE, PER 10 MG
INJECTION, ESTRADIOL VALERATE, UP TO 40 MG
INJECTION, ESTRADIOL VALERATE, UP TO 40 MG
INJECTION, ESTRADIOL VALERATE, UP TO 40 MG
INJECTION, ESTRADIOL VALERATE, UP TO 40 MG
INJECTION, ESTRADIOL VALERATE, UP TO 40 MG
INJECTION, ESTRADIOL VALERATE, UP TO 40 MG
INJECTION, ESTRADIOL VALERATE, UP TO 40 MG
INJECTION, ESTRADIOL VALERATE, UP TO 40 MG
INJECTION, ESTRADIOL VALERATE, UP TO 40 MG
INJECTION, ESTRADIOL VALERATE, UP TO 40 MG
INJECTION, ESTRADIOL VALERATE, UP TO 40 MG
Earliest Start
Date
07/01/2003
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2013
01/01/2013
12/15/2009
01/01/2002
01/05/2012
05/01/2007
01/01/2002
04/25/2005
03/21/2005
09/05/2007
09/05/2007
03/31/2006
03/31/2006
06/18/2007
06/18/2007
12/21/2009
01/01/2012
01/01/2012
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
09/01/2003
09/08/2003
10/04/2007
01/01/2002
01/01/2002
01/01/2002
03/31/2008
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
09/01/2003
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/31/2010
07/31/2010
12/31/2078
07/01/2013
12/31/2078
09/01/2013
12/31/2078
09/01/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
06/30/2013
06/30/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/31/2014
03/31/2014
03/31/2010
08/31/2009
12/31/2078
07/30/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/31/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J0970
J0970
J0970
J0970
J0970
J0970
J0970
J0970
J0970
J1000
J1000
J1000
J1000
J1000
J1000
J1000
J1000
J1000
J1000
J1020
J1020
J1020
J1020
J1020
J1020
J1020
J1020
J1020
J1020
J1020
J1020
J1020
J1020
J1020
J1020
J1020
J1020
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
51927169800
61570018101
61570018201
62991166202
62991166203
62991166204
63370008610
63370008615
63370008625
00009027101
38779190103
38779190104
38779190105
51927316300
54569258000
54868172900
63370008410
63370008415
63370008425
00009027401
00009028002
00009028003
00009028051
00009028052
00009030602
00009030612
00009307301
00009307303
00009347501
00009347503
00703003101
00703003104
00703004301
00703004501
00703005101
00703005104
00703006301
00009027401
00009028002
00009028003
00009028051
00009028052
00009030602
00009030612
00009307301
00009307303
00009347501
00009347503
00703003101
00703003104
00703004301
00703004501
00703005101
00703005104
00703006301
00781313171
12280025601
12280025605
35356008301
38779014403
38779014404
38779014405
38779014406
49452468801
49452468802
12/19/2013
HCPCS Description
INJECTION, ESTRADIOL VALERATE, UP TO 40 MG
INJECTION, ESTRADIOL VALERATE, UP TO 40 MG
INJECTION, ESTRADIOL VALERATE, UP TO 40 MG
INJECTION, ESTRADIOL VALERATE, UP TO 40 MG
INJECTION, ESTRADIOL VALERATE, UP TO 40 MG
INJECTION, ESTRADIOL VALERATE, UP TO 40 MG
INJECTION, ESTRADIOL VALERATE, UP TO 40 MG
INJECTION, ESTRADIOL VALERATE, UP TO 40 MG
INJECTION, ESTRADIOL VALERATE, UP TO 40 MG
INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
METHYLPREDNISOLONE ACETATE, PER 20MG
METHYLPREDNISOLONE ACETATE, PER 20MG
METHYLPREDNISOLONE ACETATE, PER 20MG
METHYLPREDNISOLONE ACETATE, PER 20MG
METHYLPREDNISOLONE ACETATE, PER 20MG
METHYLPREDNISOLONE ACETATE, PER 20MG
METHYLPREDNISOLONE ACETATE, PER 20MG
METHYLPREDNISOLONE ACETATE, PER 20MG
METHYLPREDNISOLONE ACETATE, PER 20MG
METHYLPREDNISOLONE ACETATE, PER 20MG
METHYLPREDNISOLONE ACETATE, PER 20MG
METHYLPREDNISOLONE ACETATE, PER 20MG
METHYLPREDNISOLONE ACETATE, PER 20MG
METHYLPREDNISOLONE ACETATE, PER 20MG
METHYLPREDNISOLONE ACETATE, PER 20MG
METHYLPREDNISOLONE ACETATE, PER 20MG
METHYLPREDNISOLONE ACETATE, PER 20MG
METHYLPREDNISOLONE ACETATE, PER 20MG
METHYLPREDNISOLONE ACETATE, PER 40MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
METHYLPREDNISOLONE ACETATE, PER 40MG
METHYLPREDNISOLONE ACETATE, PER 40MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
METHYLPREDNISOLONE ACETATE, PER 40MG
METHYLPREDNISOLONE ACETATE, PER 40MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
METHYLPREDNISOLONE ACETATE, PER 40MG
METHYLPREDNISOLONE ACETATE, PER 40MG
METHYLPREDNISOLONE ACETATE, PER 40MG
METHYLPREDNISOLONE ACETATE, PER 40MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
Earliest Start
Date
09/08/2003
10/24/2002
10/24/2002
11/01/2005
11/01/2005
11/01/2005
07/08/2003
07/08/2003
07/08/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/08/2003
01/01/2002
01/01/2002
07/08/2003
07/08/2003
07/08/2003
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2006
01/01/2006
01/01/2002
01/01/2002
01/01/2006
01/01/2006
03/09/2005
03/09/2005
10/31/2006
10/31/2006
01/01/2006
01/01/2006
01/01/2006
04/21/2009
05/19/2006
12/14/2005
02/08/2008
01/01/2002
01/01/2002
09/03/2002
01/01/2002
01/01/2002
01/01/2002
Latest End
Date
12/31/2078
07/31/2008
03/31/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1030
J1040
J1040
J1040
J1040
J1040
J1040
J1040
J1040
J1040
J1040
J1040
J1040
J1040
J1040
J1040
J1040
J1040
J1040
J1040
J1040
J1040
J1050
J1050
J1050
J1050
J1050
J1050
J1050
J1050
J1050
J1051
J1051
J1051
J1051
J1051
J1051
J1051
J1051
J1051
J1051
J1051
49452468803
51552095802
51552095804
51552095805
51552095806
51927133200
54569190101
54569394600
54569426500
54868389600
54868389601
54868389602
55045324202
55045324205
62991163502
62991163503
62991163504
62991163505
62991163506
63370013810
63370013815
63370013825
63370013835
63370013850
00009027401
00009028002
00009028003
00009028051
00009028052
00009030602
00009030612
00009307301
00009307303
00009347501
00009347503
00703003101
00703003104
00703004301
00703004501
00703005101
00703005104
00703006301
35356017805
55045324301
58016489301
00009062601
00009074630
00009074635
00009737607
00009737611
00703680101
00703680104
59762453701
59762453802
00009062601
00009062602
00009062603
00009074630
00009074631
00009074634
00009074635
00009470901
00009737601
00009737602
00009737603
12/19/2013
HCPCS Description
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
METHYLPREDNISOLONE 80MG INJ
METHYLPREDNISOLONE 80MG INJ
METHYLPREDNISOLONE 80MG INJ
METHYLPREDNISOLONE 80MG INJ
METHYLPREDNISOLONE 80MG INJ
METHYLPREDNISOLONE 80MG INJ
METHYLPREDNISOLONE ACETATE, PER 80MG
METHYLPREDNISOLONE 80MG INJ
METHYLPREDNISOLONE 80MG INJ
INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
MEDROXYPROGESTERONE INJ ACETATE, PER 1 MG
MEDROXYPROGESTERONE INJ ACETATE, PER 1 MG
MEDROXYPROGESTERONE INJ ACETATE, PER 1 MG
MEDROXYPROGESTERONE INJ ACETATE, PER 1 MG
MEDROXYPROGESTERONE INJ ACETATE, PER 1 MG
MEDROXYPROGESTERONE INJ ACETATE, PER 1 MG
MEDROXYPROGESTERONE INJ ACETATE, PER 1 MG
MEDROXYPROGESTERONE INJ ACETATE, PER 1 MG
MEDROXYPROGESTERONE INJ ACETATE, PER 1 MG
INJECTION, MEDROXYPROGESTERONE ACETATE, 50 MG
MEDROXYPROGESTERONE INJ ACETATE, PER 50 MG
MEDROXYPROGESTERONE INJ ACETATE, PER 50 MG
MEDROXYPROGESTERONE INJ ACETATE, PER 50 MG
MEDROXYPROGESTERONE INJ ACETATE, PER 50 MG
MEDROXYPROGESTERONE INJ ACETATE, PER 50 MG
MEDROXYPROGESTERONE INJ ACETATE, PER 50 MG
INJECTION, MEDROXYPROGESTERONE ACETATE, 50 MG
MEDROXYPROGESTERONE INJ ACETATE, PER 50 MG
MEDROXYPROGESTERONE INJ ACETATE, PER 50 MG
MEDROXYPROGESTERONE INJ ACETATE, PER 50 MG
Earliest Start
Date
01/01/2002
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/08/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
05/03/2005
02/02/2007
07/01/2006
07/01/2006
09/01/2002
09/01/2002
09/15/2003
09/15/2003
09/15/2003
10/25/2006
10/25/2006
10/25/2006
10/25/2006
10/25/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
03/09/2005
03/09/2005
10/31/2006
05/16/2008
07/20/2006
06/01/2006
09/30/1990
12/01/1992
12/01/1992
04/08/1996
04/08/1996
09/14/2004
09/14/2004
12/01/1992
04/08/1996
01/01/2003
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
04/06/2005
01/01/2006
01/01/2006
01/01/2006
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2014
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
05/01/2003
12/31/2078
12/31/2078
03/31/1998
02/28/1999
12/31/2078
04/30/2012
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
Earliest Start
Date
Latest End
Date
00009074631 MEDROXYPROGESTERONE INJ ACETATE, PER 150 MG (CONTRACEPTIVE)
00009074634 MEDROXYPROGESTERONE INJ ACETATE, PER 150 MG (CONTRACEPTIVE)
00009074635 INJECTION, MEDROXYPROGESTERONE ACETATE FOR CONTRACEPTIVE USE
01/01/2006
01/01/2006
01/01/2002
03/31/1998
02/28/1999
12/31/2078
J1055
J1055
00009470901 MEDROXYPROGESTERONE ACETATE FOR CONTRACEPTIVE USE, 150MG
00009737604 INJECTION, MEDROXYPROGESTERONE ACETATE FOR CONTRACEPTIVE USE
01/01/2006
04/21/2003
04/30/2012
04/30/2013
J1055
00703680101 INJECTION, MEDROXYPROGESTERONE ACETATE FOR CONTRACEPTIVE USE
09/13/2004
12/31/2078
J1055
00703680104 INJECTION, MEDROXYPROGESTERONE ACETATE FOR CONTRACEPTIVE USE
09/13/2004
12/31/2078
J1055
00703681121 INJECTION, MEDROXYPROGESTERONE ACETATE FOR CONTRACEPTIVE USE
09/16/2005
04/30/2012
J1055
23490585401 INJECTION, MEDROXYPROGESTERONE ACETATE FOR CONTRACEPTIVE USE
02/07/2007
12/31/2078
J1055
54569370100 INJECTION, MEDROXYPROGESTERONE ACETATE FOR CONTRACEPTIVE USE
01/01/2002
12/31/2078
J1055
54569490400 INJECTION, MEDROXYPROGESTERONE ACETATE FOR CONTRACEPTIVE USE
01/01/2002
12/31/2078
J1055
54569552700 INJECTION, MEDROXYPROGESTERONE ACETATE FOR CONTRACEPTIVE USE
08/15/2003
12/31/2078
J1055
54868361300 INJECTION, MEDROXYPROGESTERONE ACETATE FOR CONTRACEPTIVE USE
01/01/2002
12/31/2078
J1055
54868410000 INJECTION, MEDROXYPROGESTERONE ACETATE FOR CONTRACEPTIVE USE
01/01/2002
12/31/2078
J1055
54868410001 INJECTION, MEDROXYPROGESTERONE ACETATE FOR CONTRACEPTIVE USE
02/11/2002
12/31/2078
J1055
54868525700 INJECTION, MEDROXYPROGESTERONE ACETATE FOR CONTRACEPTIVE USE
03/30/2005
12/31/2078
J1055
55045350501 INJECTION, MEDROXYPROGESTERONE ACETATE FOR CONTRACEPTIVE USE
06/28/2006
12/31/2078
J1055
59762453701 INJECTION, MEDROXYPROGESTERONE ACETATE FOR CONTRACEPTIVE USE
09/27/2004
12/31/2078
J1055
59762453702 INJECTION, MEDROXYPROGESTERONE ACETATE FOR CONTRACEPTIVE USE
09/27/2004
12/31/2078
J1055
59762453801 INJECTION, MEDROXYPROGESTERONE ACETATE FOR CONTRACEPTIVE USE
05/26/2006
11/30/2013
J1055
59762453809 INJECTION, MEDROXYPROGESTERONE ACETATE FOR CONTRACEPTIVE USE
04/01/2008
12/31/2078
J1070
J1070
J1070
J1070
J1070
J1070
J1070
J1070
J1070
J1070
J1070
J1070
J1070
J1070
00009034702
00009041702
00574082010
00781307370
35356005810
38779016403
38779016404
38779016405
38779016408
38779016409
49452766001
49452766002
49452766003
51927270600
01/01/2002
01/01/2006
12/29/2007
10/17/2006
11/09/2007
01/01/2002
01/01/2002
01/01/2002
04/30/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/08/2003
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
HCPCS
NDC
J1051
J1051
J1051
J1051
J1051
J1051
J1051
J1051
J1055
J1055
J1055
J1055
00009737604
00703680101
00703680104
00703681121
54868334801
59762453701
59762453702
59762453801
00009062601
00009062602
00009062603
00009074630
J1055
J1055
J1055
12/19/2013
HCPCS Description
MEDROXYPROGESTERONE INJ ACETATE, PER 50 MG
MEDROXYPROGESTERONE INJ ACETATE, PER 50 MG
MEDROXYPROGESTERONE INJ ACETATE, PER 50 MG
MEDROXYPROGESTERONE INJ ACETATE, PER 50 MG
INJECTION, MEDROXYPROGESTERONE ACETATE, 50 MG
MEDROXYPROGESTERONE INJ ACETATE, PER 50 MG
MEDROXYPROGESTERONE INJ ACETATE, PER 50 MG
MEDROXYPROGESTERONE INJ ACETATE, PER 50 MG
MEDROXYPROGESTERONE INJ ACETATE, PER 150 MG (CONTRACEPTIVE)
MEDROXYPROGESTERONE INJ ACETATE, PER 150 MG (CONTRACEPTIVE)
MEDROXYPROGESTERONE INJ ACETATE, PER 150 MG (CONTRACEPTIVE)
INJECTION, MEDROXYPROGESTERONE ACETATE FOR CONTRACEPTIVE USE
INJECTION, TESTOSTERONE CYPIONATE, UP
TESTOSTERONE CYPIONATE UP TO 100MG
TESTOSTERONE CYPIONATE UP TO 100MG
INJECTION, TESTOSTERONE CYPIONATE, UP
INJECTION, TESTOSTERONE CYPIONATE, UP
INJECTION, TESTOSTERONE CYPIONATE, UP
INJECTION, TESTOSTERONE CYPIONATE, UP
INJECTION, TESTOSTERONE CYPIONATE, UP
INJECTION, TESTOSTERONE CYPIONATE, UP
INJECTION, TESTOSTERONE CYPIONATE, UP
INJECTION, TESTOSTERONE CYPIONATE, UP
INJECTION, TESTOSTERONE CYPIONATE, UP
INJECTION, TESTOSTERONE CYPIONATE, UP
INJECTION, TESTOSTERONE CYPIONATE, UP
TO 100 MG
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
100
100
100
100
100
100
100
100
100
100
100
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2003
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2002
04/30/2013
12/31/2078
12/31/2078
04/30/2012
12/31/2078
12/31/2078
12/31/2078
11/30/2013
12/31/2078
05/01/2003
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J1070
J1070
J1070
J1070
J1070
J1070
J1070
J1070
J1070
J1070
J1070
J1080
J1080
J1080
J1080
J1080
J1080
J1080
J1080
J1080
J1080
J1080
J1080
J1080
J1080
J1080
J1080
J1080
J1094
J1094
J1094
J1094
J1094
J1094
J1094
J1094
J1094
J1094
J1094
J1094
J1094
J1094
J1094
J1094
J1094
J1094
J1094
J1094
J1100
J1100
J1100
J1100
J1100
J1100
J1100
J1100
J1100
J1100
J1100
J1100
J1100
J1100
J1100
J1100
J1100
54868079600
62991170701
62991170702
62991170703
62991170705
63275998204
63275998205
63275998209
63370098025
63370098035
63370098050
00009034702
00009041701
00009041702
00574082001
00574082010
00591322379
00703612101
00703612501
00781307470
00781307471
23490634301
54569141100
54868021600
54868361800
54868361801
55045302902
63874106101
25332001105
38779190501
38779190503
38779190504
38779190505
49452246001
49452246002
49452246003
51552002401
51552002402
51552002403
51552002404
51927223100
51927374700
55553009205
63370006015
63370006020
63370006025
63370006035
63370006050
00069454702
00517490125
00517490525
00517493025
00641036721
00703352401
00703352403
23490541300
49999043425
54569464800
54868087100
54868087101
54868087106
55045321203
55553066110
55553080705
63323016501
12/19/2013
HCPCS Description
INJECTION, TESTOSTERONE CYPIONATE, UP TO 100 MG
INJECTION, TESTOSTERONE CYPIONATE, UP TO 100 MG
INJECTION, TESTOSTERONE CYPIONATE, UP TO 100 MG
INJECTION, TESTOSTERONE CYPIONATE, UP TO 100 MG
INJECTION, TESTOSTERONE CYPIONATE, UP TO 100 MG
INJECTION, TESTOSTERONE CYPIONATE, UP TO 100 MG
INJECTION, TESTOSTERONE CYPIONATE, UP TO 100 MG
INJECTION, TESTOSTERONE CYPIONATE, UP TO 100 MG
INJECTION, TESTOSTERONE CYPIONATE, UP TO 100 MG
INJECTION, TESTOSTERONE CYPIONATE, UP TO 100 MG
INJECTION, TESTOSTERONE CYPIONATE, UP TO 100 MG
TESTOSTERONE CYPIOANTE INJ, 200MG
INJECTION, TESTOSTERONE CYPIONATE, 1 CC, 200 MG
INJECTION, TESTOSTERONE CYPIONATE, 1 CC, 200 MG
INJECTION, TESTOSTERONE CYPIONATE, 1 CC, 200 MG
INJECTION, TESTOSTERONE CYPIONATE, 1 CC, 200 MG
INJECTION, TESTOSTERONE CYPIONATE, 1 CC, 200 MG
INJECTION, TESTOSTERONE CYPIONATE, 1 CC, 200 MG
INJECTION, TESTOSTERONE CYPIONATE, 1 CC, 200 MG
INJECTION, TESTOSTERONE CYPIONATE, 1 CC, 200 MG
INJECTION, TESTOSTERONE CYPIONATE, 1 CC, 200 MG
INJECTION, TESTOSTERONE CYPIONATE, 1 CC, 200 MG
INJECTION, TESTOSTERONE CYPIONATE, 1 CC, 200 MG
INJECTION, TESTOSTERONE CYPIONATE, 1 CC, 200 MG
INJECTION, TESTOSTERONE CYPIONATE, 1 CC, 200 MG
INJECTION, TESTOSTERONE CYPIONATE, 1 CC, 200 MG
INJECTION, TESTOSTERONE CYPIONATE, 1 CC, 200 MG
INJECTION, TESTOSTERONE CYPIONATE, 1 CC, 200 MG
INJECTION, DEXAMETHASONE ACETATE, 1 MG
INJECTION, DEXAMETHASONE ACETATE, 1 MG
INJECTION, DEXAMETHASONE ACETATE, 1 MG
INJECTION, DEXAMETHASONE ACETATE, 1 MG
INJECTION, DEXAMETHASONE ACETATE, 1 MG
INJECTION, DEXAMETHASONE ACETATE, 1 MG
INJECTION, DEXAMETHASONE ACETATE, 1 MG
INJECTION, DEXAMETHASONE ACETATE, 1 MG
INJECTION, DEXAMETHASONE ACETATE, 1 MG
INJECTION, DEXAMETHASONE ACETATE, 1 MG
INJECTION, DEXAMETHASONE ACETATE, 1 MG
INJECTION, DEXAMETHASONE ACETATE, 1 MG
INJECTION, DEXAMETHASONE ACETATE, 1 MG
INJECTION, DEXAMETHASONE ACETATE, 1 MG
INJECTION, DEXAMETHASONE ACETATE, 1 MG
INJECTION, DEXAMETHASONE ACETATE, 1 MG
INJECTION, DEXAMETHASONE ACETATE, 1 MG
INJECTION, DEXAMETHASONE ACETATE, 1 MG
INJECTION, DEXAMETHASONE ACETATE, 1 MG
INJECTION, DEXAMETHASONE ACETATE, 1 MG
DEXAMETH NA PHOS 4MG/ML
INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG
INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG
INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG
INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG
INJ, DEXAMETHASONE NA PHOS, 1MG
INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG
INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG
INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG
INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG
INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG
INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG
INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG
INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG
INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG
INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG
INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG
Earliest Start
Date
10/21/2004
01/01/2002
01/01/2002
01/01/2002
01/01/2002
12/04/2002
12/04/2002
12/04/2002
07/08/2003
07/08/2003
07/08/2003
01/01/2006
01/01/2002
01/01/2002
12/21/2007
12/21/2007
03/29/2004
04/16/2007
04/16/2007
10/17/2006
10/17/2006
02/07/2007
01/01/2002
09/20/2007
01/01/2002
08/10/2007
01/01/2003
01/01/2008
01/01/2003
01/01/2003
01/01/2003
01/01/2003
01/01/2003
01/01/2003
01/01/2003
01/01/2003
01/01/2003
09/01/2003
09/01/2003
09/01/2003
09/08/2003
03/11/2005
01/01/2003
07/08/2003
01/01/2003
07/08/2003
07/08/2003
07/08/2003
07/19/2011
01/01/2002
01/01/2002
01/01/2002
12/08/2004
01/01/2007
02/20/2002
04/09/2007
04/25/2008
01/01/2002
01/01/2002
07/21/2003
01/01/2002
07/01/2006
01/01/2002
01/01/2002
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/31/2011
12/31/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/28/2011
03/31/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J1100
J1100
J1100
J1100
J1110
J1110
J1110
J1110
J1110
J1110
J1110
J1110
J1110
J1110
J1110
J1110
J1120
J1160
J1160
J1160
J1160
J1160
J1160
J1160
J1160
J1160
J1160
J1160
J1162
J1162
J1165
J1165
J1165
J1165
J1165
J1165
J1165
J1165
J1165
J1165
J1165
J1165
J1165
J1165
J1165
J1165
J1165
J1165
J1165
J1165
J1165
J1165
J1165
J1165
J1165
J1165
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
63323016505
63323016530
63323050601
63323051610
00574085005
00574085010
38779030303
38779030306
49452261601
49452261602
49452261603
51552023301
51552023302
51927170600
55390001310
66490004101
55390046001
00173026010
00173026035
00173026210
00409216931
00641141031
00781305995
38779021500
38779021506
38779021509
49452261202
51927174600
00173023044
00281036510
00143988125
00143988225
00409131701
00409131702
00409184432
00641049321
00641255541
00703710104
00703710503
38779021604
38779021605
38779021608
49452534401
49452534402
49452534403
51552053204
51927183800
60505074605
60505076504
62991125401
62991125402
62991125403
63370017625
63370017635
63370017645
63370017653
00074128301
00074233211
00074233311
00074233326
00074233411
00074241421
00074242816
00074245311
00074245327
12/19/2013
HCPCS Description
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
DEXAMETHASONE SODIUM PHOSPHATE, 1MG
DEXAMETHASONE SODIUM PHOSPHATE, 1MG
DEXAMETHASONE SODIUM PHOSPHATE, 1MG
DEXAMETHASONE SODIUM PHOSPHATE, 1MG
DIHYDROERGOTAMINE MESYLATE, PER 1 MG
DIHYDROERGOTAMINE MESYLATE, PER 1 MG
DIHYDROERGOTAMINE MESYLATE, PER 1 MG
DIHYDROERGOTAMINE MESYLATE, PER 1 MG
DIHYDROERGOTAMINE MESYLATE, PER 1 MG
DIHYDROERGOTAMINE MESYLATE, PER 1 MG
DIHYDROERGOTAMINE MESYLATE, PER 1 MG
DIHYDROERGOTAMINE MESYLATE, PER 1 MG
DIHYDROERGOTAMINE MESYLATE, PER 1 MG
DIHYDROERGOTAMINE MESYLATE, PER 1 MG
DIHYDROERGOTAMINE MESYLATE, PER 1 MG
DIHYDROERGOTAMINE MESYLATE, PER 1 MG
ACETAZOLAMIDE SODIUM, UP TO 500 MG
DIGOXIN, UP TO 0.5 MG
DIGOXIN, UP TO 0.5 MG
DIGOXIN, UP TO 0.5 MG
DIGOXIN, UP TO 0.5 MG
DIGOXIN, UP TO 0.5 MG
DIGOXIN, UP TO 0.5 MG
DIGOXIN, UP TO 0.5 MG
DIGOXIN, UP TO 0.5 MG
DIGOXIN, UP TO 0.5 MG
DIGOXIN, UP TO 0.5 MG
DIGOXIN, UP TO 0.5 MG
DIGOXIN IMMUNE FAB (OVINE), PER VIAL
DIGOXIN IMMUNE FAB (OVINE), PER VIAL
PHENYTOIN SODIUM, PER 50 MG
PHENYTOIN SODIUM, PER 50 MG
PHENYTOIN SODIUM, PER 50 MG
PHENYTOIN SODIUM, PER 50 MG
PHENYTOIN SODIUM, PER 50 MG
PHENYTOIN SODIUM, PER 50 MG
PHENYTOIN SODIUM, PER 50 MG
PHENYTOIN SODIUM, PER 50 MG
PHENYTOIN SODIUM, PER 50 MG
PHENYTOIN SODIUM, PER 50 MG
PHENYTOIN SODIUM, PER 50 MG
PHENYTOIN SODIUM, PER 50 MG
PHENYTOIN SODIUM, PER 50 MG
PHENYTOIN SODIUM, PER 50 MG
PHENYTOIN SODIUM, PER 50 MG
PHENYTOIN SODIUM, PER 50 MG
PHENYTOIN SODIUM, PER 50 MG
PHENYTOIN SODIUM, PER 50 MG
PHENYTOIN SODIUM, PER 50 MG
PHENYTOIN SODIUM, PER 50 MG
PHENYTOIN SODIUM, PER 50 MG
PHENYTOIN SODIUM, PER 50 MG
PHENYTOIN SODIUM, PER 50 MG
PHENYTOIN SODIUM, PER 50 MG
PHENYTOIN SODIUM, PER 50 MG
PHENYTOIN SODIUM, PER 50 MG
HYDROMORPHONE, UP TO 4 MG
HYDROMORPHONE, UP TO 4 MG
HYDROMORPHONE, UP TO 4 MG
HYDROMORPHONE, UP TO 4 MG
HYDROMORPHONE, UP TO 4 MG
HYDROMORPHONE, UP TO 4 MG
HYDROMORPHONE, UP TO 4 MG
HYDROMORPHONE, UP TO 4 MG
HYDROMORPHONE, UP TO 4 MG
Earliest Start
Date
01/01/2002
01/01/2002
05/30/2003
08/23/2005
08/04/2003
03/15/2004
01/01/2002
01/01/2002
01/31/2002
01/31/2002
01/31/2002
01/01/2002
09/01/2003
09/08/2003
09/03/2003
12/31/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
06/16/2005
05/05/2007
07/21/2006
02/05/2002
02/05/2002
02/05/2002
01/01/2002
09/08/2003
01/01/2006
01/01/2006
04/03/2007
04/03/2007
02/08/2005
03/30/2005
10/05/2004
12/08/2004
05/05/2007
09/14/2007
09/14/2007
01/01/2002
01/01/2002
01/01/2002
03/07/2002
03/07/2002
03/07/2002
09/01/2003
09/08/2003
10/24/2007
10/24/2007
09/15/2003
09/15/2003
09/15/2003
07/08/2003
07/08/2003
07/08/2003
07/08/2003
01/01/2002
11/05/2002
11/14/2002
12/11/2002
12/19/2002
12/19/2002
02/10/2003
12/19/2002
11/14/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/30/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/31/2013
08/31/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/31/2011
04/30/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/01/2003
05/01/2011
05/01/2011
03/01/2011
04/01/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
00074245351
00074245531
00406324552
00409128305
00409128310
00409128331
00409130431
00409131210
00409131230
00409217201
00409217205
00409254001
00409255201
00409335601
00409336501
00555111705
00555111706
00555111707
00574201701
00641012121
00641012125
00641234139
00641234141
38779073101
38779073103
38779073104
38779073105
38779073106
49452002901
49452002902
49452002903
49452002904
51552068201
51552068202
51552068203
51552068204
51927100300
54868513700
54868531900
58298053402
58298053403
59011044110
59011044225
59011044410
59011044505
61553016141
61553016267
61553016375
61553016541
61553016667
61553016775
61553062448
61553068176
61553070168
61553070268
61553070468
61553070568
61553070668
61553071068
61553071268
61553078068
61703024345
61703024350
61703024353
61703024615
12/19/2013
HCPCS Description
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
HYDROMORPHONE INJ, 4 MG
HYDROMORPHONE INJ, 4 MG
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
INJECTION, HYDROMORPHONE,
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
4MG
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
UP TO
4MG
4MG
4
4
4
4
4
4
MG
MG
MG
MG
MG
MG
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
Earliest Start
Date
11/26/2002
12/11/2002
01/01/2002
10/22/2012
05/15/2009
06/14/2005
07/01/1997
10/01/2010
07/07/2005
04/19/2005
04/19/2005
09/21/2005
09/21/2005
09/21/2005
09/21/2005
05/08/2007
05/08/2007
05/08/2007
01/01/2002
12/08/2004
01/01/2002
05/05/2007
01/01/2002
04/23/2002
01/01/2002
01/01/2002
09/27/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
11/15/2004
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/08/2003
08/13/2004
05/31/2005
04/03/2006
04/03/2006
01/01/2009
01/01/2009
09/30/1990
02/18/2009
02/02/2004
02/02/2004
02/02/2004
02/02/2004
02/02/2004
02/02/2004
02/02/2004
11/21/2007
12/01/2006
12/01/2006
12/01/2006
12/01/2006
12/01/2006
12/01/2006
12/01/2006
12/01/2006
05/15/2003
05/15/2003
05/15/2003
10/08/2003
Latest End
Date
12/31/2078
07/31/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/01/2011
10/01/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/31/2011
09/30/2011
06/30/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1170
J1180
J1190
J1190
J1190
J1190
J1190
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1200
J1205
J1212
J1212
J1212
J1212
J1212
J1212
J1212
61703042594
61703042595
63275200101
63275200502
63275201003
63275210005
63275210009
63370093010
63370093015
63370093020
63370093025
63370093035
51927165900
00013871562
00013872589
38423011001
55390001402
55390006002
00071425945
00409229011
00409229031
00463108030
00463108910
00548139000
00641037621
12280022710
17317014603
17317014605
17317014606
38779028204
38779028205
38779028208
38779028209
49452264001
49452264002
49999052510
51552012402
51552012404
51552012405
51552012406
51927107900
54569581500
54868000700
54868055400
54868204800
54868204801
54868305300
54868364400
55045329801
55553082710
62991104702
63323066401
63370007125
63370007135
63370007145
63370007150
67457012410
67386071155
00433043305
10106922401
17317082801
49452258801
49452258802
49452258804
51552105306
12/19/2013
HCPCS Description
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
HYDROMORPHONE, UP TO 4 MG
HYDROMORPHONE, UP TO 4 MG
HYDROMORPHONE, UP TO 4 MG
HYDROMORPHONE, UP TO 4 MG
HYDROMORPHONE, UP TO 4 MG
HYDROMORPHONE, UP TO 4 MG
HYDROMORPHONE, UP TO 4 MG
HYDROMORPHONE, UP TO 4 MG
HYDROMORPHONE, UP TO 4 MG
HYDROMORPHONE, UP TO 4 MG
HYDROMORPHONE, UP TO 4 MG
HYDROMORPHONE, UP TO 4 MG
DYPHYLLINE, UP TO 500 MG
DEXRAZOXANE HYDROCHLORIDE, PER 250 MG
DEXRAZOXANE HYDROCHLORIDE, PER 250 MG
DEXRAZOXANE HYDROCHLORIDE, PER 250 MG
DEXRAZOXANE HYDROCHLORIDE, PER 250 MG
DEXRAZOXANE HYDROCHLORIDE, PER 250 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
DIPHENHYDRAMINE HCL, UP TO 50 MG
CHLOROTHIAZIDE SODIUM, PER 500 MG
DMSO, DIMETHYL SULFOXIDE, 50%, 50 ML
DMSO, DIMETHYL SULFOXIDE, 50%, 50 ML
DMSO, DIMETHYL SULFOXIDE, 50%, 50 ML
DMSO, DIMETHYL SULFOXIDE, 50%, 50 ML
DMSO, DIMETHYL SULFOXIDE, 50%, 50 ML
DMSO, DIMETHYL SULFOXIDE, 50%, 50 ML
DMSO, DIMETHYL SULFOXIDE, 50%, 50 ML
Earliest Start
Date
03/07/2006
03/07/2006
12/03/2002
12/03/2002
12/03/2002
12/03/2002
09/01/2003
07/08/2003
07/08/2003
07/08/2003
07/08/2003
07/08/2003
09/08/2003
01/01/2002
01/01/2002
09/06/2007
04/08/2005
04/08/2005
01/01/2002
07/31/2008
04/25/2005
01/01/2002
01/01/2002
01/01/2002
12/08/2004
08/08/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
04/22/2002
01/01/2002
01/01/2002
01/25/2008
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/08/2003
08/03/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/13/2006
01/01/2002
01/01/2005
01/01/2002
01/01/2002
06/12/2002
07/08/2003
07/08/2003
07/08/2003
07/08/2003
05/01/2007
01/21/2006
01/01/2002
01/01/2002
01/01/2002
01/31/2002
01/31/2002
01/31/2002
09/01/2003
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
11/30/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J1212
J1212
J1212
J1212
J1212
J1230
J1230
J1230
J1230
J1230
J1230
J1230
J1230
J1230
J1230
J1230
J1230
J1230
J1230
J1230
J1230
J1230
J1230
J1230
J1230
J1230
J1230
J1230
J1240
J1240
J1240
J1240
J1240
J1240
J1240
J1240
J1245
J1245
J1245
J1245
J1245
J1245
J1245
J1245
J1245
J1245
J1245
J1245
J1245
J1250
J1250
J1250
J1250
J1250
J1250
J1250
J1250
J1250
J1250
J1250
J1250
J1250
J1250
J1250
J1250
51927161200
51927328700
62991153601
62991153602
67457017750
00406151056
00406151057
00406151059
38779010403
38779010404
38779010405
49452455301
49452455302
49452455303
51552072801
51552072802
51552072804
51927101700
63275910004
63275910005
63370093915
63370093925
63370093935
64019075085
64019075088
66479053002
66591081551
66689068155
00463108610
38779028104
38779028105
38779028108
51552067604
51552067605
51927108000
63323036601
00409204302
00641256941
00703165202
00703165401
00703165402
49452264103
49452264104
49452264105
51927157100
55390055510
55390055590
60505071500
60505071501
00074472901
00338107302
00338107303
00338107502
00338107702
00409202520
00409202554
00409234401
00409234402
00409234488
00409234632
00409234634
00409234732
00409234733
00409372432
51927277500
12/19/2013
HCPCS Description
INJECTION, DMSO, DIMETHYL SULFOXIDE, 50%, 50 ML
INJECTION, DMSO, DIMETHYL SULFOXIDE, 50%, 50 ML
INJECTION, DMSO, DIMETHYL SULFOXIDE, 50%, 50 ML
INJECTION, DMSO, DIMETHYL SULFOXIDE, 50%, 50 ML
INJECTION, DMSO, DIMETHYL SULFOXIDE, 50%, 50 ML
INJECTION, METHADONE HCL, UP TO 10 MG
INJECTION, METHADONE HCL, UP TO 10 MG
INJECTION, METHADONE HCL, UP TO 10 MG
INJECTION, METHADONE HCL, UP TO 10 MG
INJECTION, METHADONE HCL, UP TO 10 MG
INJECTION, METHADONE HCL, UP TO 10 MG
INJECTION, METHADONE HCL, UP TO 10 MG
INJECTION, METHADONE HCL, UP TO 10 MG
INJECTION, METHADONE HCL, UP TO 10 MG
INJECTION, METHADONE HCL, UP TO 10 MG
INJECTION, METHADONE HCL, UP TO 10 MG
INJECTION, METHADONE HCL, UP TO 10 MG
INJECTION, METHADONE HCL, UP TO 10 MG
INJECTION, METHADONE HCL, UP TO 10 MG
INJECTION, METHADONE HCL, UP TO 10 MG
INJECTION, METHADONE HCL, UP TO 10 MG
INJECTION, METHADONE HCL, UP TO 10 MG
INJECTION, METHADONE HCL, UP TO 10 MG
INJECTION, METHADONE HCL, UP TO 10 MG
INJECTION, METHADONE HCL, UP TO 10 MG
INJECTION, METHADONE HCL, UP TO 10 MG
INJECTION, METHADONE HCL, UP TO 10 MG
INJECTION, METHADONE HCL, UP TO 10 MG
INJECTION, DIMENHYDRINATE, UP TO 50 MG
INJECTION, DIMENHYDRINATE, UP TO 50 MG
INJECTION, DIMENHYDRINATE, UP TO 50 MG
INJECTION, DIMENHYDRINATE, UP TO 50 MG
INJECTION, DIMENHYDRINATE, UP TO 50 MG
INJECTION, DIMENHYDRINATE, UP TO 50 MG
INJECTION, DIMENHYDRINATE, UP TO 50 MG
INJECTION, DIMENHYDRINATE, UP TO 50 MG
INJECTION, DIPYRIDAMOLE, PER 10 MG
INJECTION, DIPYRIDAMOLE, PER 10 MG
INJECTION, DIPYRIDAMOLE, PER 10 MG
DIPYRIDAMOLE 10MG IV
INJECTION, DIPYRIDAMOLE, PER 10 MG
INJECTION, DIPYRIDAMOLE, PER 10 MG
INJECTION, DIPYRIDAMOLE, PER 10 MG
INJECTION, DIPYRIDAMOLE, PER 10 MG
INJECTION, DIPYRIDAMOLE, PER 10 MG
INJECTION, DIPYRIDAMOLE, PER 10 MG
INJECTION, DIPYRIDAMOLE, PER 10 MG
INJECTION, DIPYRIDAMOLE, PER 10 MG
INJECTION, DIPYRIDAMOLE, PER 10 MG
INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG
INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG
INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG
INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG
INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG
INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG
INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG
INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG
INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG
INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG
INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG
INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG
INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG
INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG
INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG
INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG
Earliest Start
Date
12/04/2003
12/04/2003
09/15/2003
09/15/2003
06/22/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/31/2002
01/31/2002
11/15/2004
09/01/2003
09/01/2003
09/01/2004
09/08/2003
12/03/2002
12/03/2002
07/08/2003
07/08/2003
07/08/2003
01/01/2002
01/01/2002
01/09/2007
12/12/2003
02/01/2002
01/01/2002
02/05/2002
02/05/2002
02/05/2002
09/01/2003
09/01/2003
09/08/2003
07/01/2004
03/31/2005
05/05/2007
01/01/2002
01/01/2007
01/01/2002
01/01/2003
01/01/2003
01/01/2003
09/08/2003
01/01/2002
04/08/2005
08/01/2004
08/01/2004
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
02/20/2006
11/10/2005
07/27/2005
06/29/2005
03/21/2005
08/11/2005
02/07/2006
01/11/2006
03/21/2005
10/07/2005
09/08/2003
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
04/30/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2010
12/31/2078
12/31/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
05/01/2006
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J1250
J1250
J1250
J1250
J1260
J1260
J1260
J1260
J1265
J1265
J1265
J1265
J1265
J1265
J1265
J1265
J1265
J1265
J1265
J1265
J1265
J1265
J1265
J1265
J1265
J1265
J1265
J1265
J1265
J1265
J1265
J1265
J1265
J1265
J1267
J1267
J1270
J1270
J1270
J1290
J1300
J1320
J1320
J1320
J1320
J1320
J1320
J1320
J1320
J1320
J1320
J1320
J1320
J1320
J1320
J1320
J1320
J1320
J1320
J1320
J1320
J1320
J1324
J1324
J1324
54868571700
54868571701
54868571702
55390056090
00088120632
00088120806
00088120876
00088120926
00074414103
00074414203
00264144155
00264144255
00264148155
00264148255
00264149255
00338100502
00338100503
00338100702
00338100703
00338100902
00409414202
00409426501
00409582001
00409780822
00409780824
00409780922
00409780924
00409781022
00409910420
00517130525
00517180525
00517190525
51927231900
54868001500
50458040102
50458040202
58468012201
58468012301
58468012601
47783010101
25682000101
38779018903
38779018904
38779018905
49452046001
49452046002
49452046003
51552046402
51552046404
51552046405
51552046406
51927160300
62991200401
62991200402
62991200403
63275993602
63275993604
63275993605
63275993608
63370001815
63370001825
63370001835
00004038039
35356020660
54569578100
12/19/2013
HCPCS Description
INJECTION, DOBUTAMINE HYDROCHLORIDE, PER
INJECTION, DOBUTAMINE HYDROCHLORIDE, PER
INJECTION, DOBUTAMINE HYDROCHLORIDE, PER
INJECTION, DOBUTAMINE HYDROCHLORIDE, PER
INJECTION, DOLASETRON MESYLATE, 10 MG
INJECTION, DOLASETRON MESYLATE, 10 MG
INJECTION, DOLASETRON MESYLATE, 10 MG
INJECTION, DOLASETRON MESYLATE, 10 MG
INJECTION, DOPAMINE HCL, 40 MG
INJECTION, DOPAMINE HCL, 40 MG
INJECTION, DOPAMINE HCL, 40 MG
INJECTION, DOPAMINE HCL, 40 MG
INJECTION, DOPAMINE HCL, 40 MG
INJECTION, DOPAMINE HCL, 40 MG
INJECTION, DOPAMINE HCL, 40 MG
INJECTION, DOPAMINE HCL, 40 MG
INJECTION, DOPAMINE HCL, 40 MG
INJECTION, DOPAMINE HCL, 40 MG
INJECTION, DOPAMINE HCL, 40 MG
INJECTION, DOPAMINE HCL, 40 MG
INJECTION, DOPAMINE HCL, 40 MG
INJECTION, DOPAMINE HCL, 40 MG
INJECTION, DOPAMINE HCL, 40 MG
INJECTION, DOPAMINE HCL, 40 MG
INJECTION, DOPAMINE HCL, 40 MG
INJECTION, DOPAMINE HCL, 40 MG
INJECTION, DOPAMINE HCL, 40 MG
INJECTION, DOPAMINE HCL, 40 MG
INJECTION, DOPAMINE HCL, 40 MG
INJECTION, DOPAMINE HCL, 40 MG
INJECTION, DOPAMINE HCL, 40 MG
INJECTION, DOPAMINE HCL, 40 MG
INJECTION, DOPAMINE HCL, 40 MG
INJECTION, DOPAMINE HCL, 40 MG
INJECTION, DORIPENEM, 10 MG
INJECTION, DORIPENEM, 10 MG
INJECTION, DOXERCALCIFEROL, 1 MCG
INJECTION, DOXERCALCIFEROL, 1 MCG
DOXERCALCIFEROL, PER 1 MCG
INJECTION, ECALLANTIDE, 1 MG
INJECTION, ECULIZUMAB, 10 MG
INJECTION, AMITRIPTYLINE HCL, UP TO 20 MG
INJECTION, AMITRIPTYLINE HCL, UP TO 20 MG
INJECTION, AMITRIPTYLINE HCL, UP TO 20 MG
INJECTION, AMITRIPTYLINE HCL, UP TO 20 MG
INJECTION, AMITRIPTYLINE HCL, UP TO 20 MG
INJECTION, AMITRIPTYLINE HCL, UP TO 20 MG
INJECTION, AMITRIPTYLINE HCL, UP TO 20 MG
INJECTION, AMITRIPTYLINE HCL, UP TO 20 MG
INJECTION, AMITRIPTYLINE HCL, UP TO 20 MG
INJECTION, AMITRIPTYLINE HCL, UP TO 20 MG
INJECTION, AMITRIPTYLINE HCL, UP TO 20 MG
INJECTION, AMITRIPTYLINE HCL, UP TO 20 MG
INJECTION, AMITRIPTYLINE HCL, UP TO 20 MG
INJECTION, AMITRIPTYLINE HCL, UP TO 20 MG
INJECTION, AMITRIPTYLINE HCL, UP TO 20 MG
INJECTION, AMITRIPTYLINE HCL, UP TO 20 MG
INJECTION, AMITRIPTYLINE HCL, UP TO 20 MG
INJECTION, AMITRIPTYLINE HCL, UP TO 20 MG
INJECTION, AMITRIPTYLINE HCL, UP TO 20 MG
INJECTION, AMITRIPTYLINE HCL, UP TO 20 MG
INJECTION, AMITRIPTYLINE HCL, UP TO 20 MG
INJECTION, ENFUVIRTIDE, 1 MG
INJECTION, ENFUVIRTIDE, 1 MG
INJECTION, ENFUVIRTIDE, 1 MG
250
250
250
250
MG
MG
MG
MG
Earliest Start
Date
12/11/2006
01/02/2007
06/28/2007
01/01/2002
01/01/2002
12/15/2003
02/20/2002
07/21/2003
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
12/11/2006
01/01/2012
01/01/2012
06/01/2006
01/01/2009
01/10/2011
01/01/2012
01/01/2008
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/08/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2007
01/01/2007
01/01/2007
01/01/2007
07/08/2003
07/08/2003
07/08/2003
01/01/2007
05/30/2008
01/01/2007
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/01/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/31/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/31/2014
09/30/2014
09/30/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
06/30/2013
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J1325
J1325
J1325
J1325
J1325
J1325
J1325
J1327
J1327
J1327
J1330
J1330
J1330
J1330
J1330
J1330
J1330
J1335
J1335
J1364
J1364
J1364
J1364
J1364
J1380
J1380
J1380
J1380
J1390
J1390
J1390
J1390
J1410
J1430
J1435
J1435
J1435
J1435
J1435
J1435
J1435
J1435
J1435
J1435
J1435
J1435
J1435
J1435
J1435
J1435
J1435
J1435
J1435
J1435
J1435
J1435
J1435
J1435
J1435
J1438
J1438
J1438
J1438
J1438
J1438
00173051700
00173051900
00703198501
00703199501
66215040101
66215040201
66215040301
00085113601
00085117701
00085117702
49452276202
49452276203
51552018801
51552018805
51552018807
51927209900
63704000201
00006384371
00006384571
00074647644
00074647844
00409647644
00409647844
00409648201
00781303075
42023011001
42023011101
61570018001
00781302975
42023011101
61570018101
61570018201
00046074905
67871479006
00463102930
38779089103
38779089104
38779089105
38779089106
49452279501
49452279502
49452279504
51552044501
51552044502
51552044504
51927170900
52637031310
55553004110
62991105101
62991105102
62991105103
62991105104
63275998601
63275998602
63275998604
63370009010
63370009015
63370009025
63370009035
54868478200
54868544400
58406042534
58406042541
58406043501
58406043504
12/19/2013
Earliest Start
Date
HCPCS Description
INJECTION, EPOPROSTENOL, 0.5 MG
INJECTION, EPOPROSTENOL, 0.5 MG
INJECTION, EPOPROSTENOL, 0.5 MG
INJECTION, EPOPROSTENOL, 0.5 MG
INJECTION, EPOPROSTENOL, 0.5 MG
INJECTION, EPOPROSTENOL, 0.5 MG
INJECTION, EPOPROSTENOL, 0.5 MG
INJECTION, EPTIFIBATIDE, 5 MG
INJECTION, EPTIFIBATIDE, 5 MG
INJECTION, EPTIFIBATIDE, 5 MG
INJECTION, ERGONOVINE MALEATE, UP TO 0.2 MG
INJECTION, ERGONOVINE MALEATE, UP TO 0.2 MG
INJECTION, ERGONOVINE MALEATE, UP TO 0.2 MG
INJECTION, ERGONOVINE MALEATE, UP TO 0.2 MG
INJECTION, ERGONOVINE MALEATE, UP TO 0.2 MG
INJECTION, ERGONOVINE MALEATE, UP TO 0.2 MG
INJECTION, ERGONOVINE MALEATE, UP TO 0.2 MG
INJECTION, ERTAPENEM SODIUM, 500 MG
INJECTION, ERTAPENEM SODIUM, 500 MG
INJECTION, ERYTHROMYCIN LACTOBIONATE, PER 500 MG
INJECTION, ERYTHROMYCIN LACTOBIONATE, PER 500 MG
INJECTION, ERYTHROMYCIN LACTOBIONATE, PER 500 MG
INJECTION, ERYTHROMYCIN LACTOBIONATE, PER 500 MG
INJECTION, ERYTHROMYCIN LACTOBIONATE, PER 500 MG
INJECTION, ESTRADIOL VALERATE, UP TO 10 MG
INJECTION, ESTRADIOL VALERATE, UP TO 10 MG
ESTRADIOL VALERATE INJ, UP TO 10MG
INJECTION, ESTRADIOL VALERATE, UP TO 10 MG
INJECTION, ESTRADIOL VALERATE, UP TO 20 MG
INJECTION, ESTRADIOL VALERATE, UP TO 20 MG
INJECTION, ESTRADIOL VALERATE, UP TO 20 MG
ESTRADIOL VALERATE INJ, UP TO 20MG
INJECTION, ESTROGEN CONJUGATED, PER 25 MG
INJECTION, ETHANOLAMINE OLEATE, 100 MG
INJECTION, ESTRONE, PER 1 MG
INJECTION, ESTRONE, PER 1 MG
INJECTION, ESTRONE, PER 1 MG
INJECTION, ESTRONE, PER 1 MG
INJECTION, ESTRONE, PER 1 MG
INJECTION, ESTRONE, PER 1 MG
INJECTION, ESTRONE, PER 1 MG
INJECTION, ESTRONE, PER 1 MG
INJECTION, ESTRONE, PER 1 MG
INJECTION, ESTRONE, PER 1 MG
INJECTION, ESTRONE, PER 1 MG
INJECTION, ESTRONE, PER 1 MG
INJECTION, ESTRONE, PER 1 MG
INJECTION, ESTRONE, PER 1 MG
INJECTION, ESTRONE, PER 1 MG
INJECTION, ESTRONE, PER 1 MG
INJECTION, ESTRONE, PER 1 MG
INJECTION, ESTRONE, PER 1 MG
INJECTION, ESTRONE, PER 1 MG
INJECTION, ESTRONE, PER 1 MG
INJECTION, ESTRONE, PER 1 MG
INJECTION, ESTRONE, PER 1 MG
INJECTION, ESTRONE, PER 1 MG
INJECTION, ESTRONE, PER 1 MG
INJECTION, ESTRONE, PER 1 MG
INJECTION, ETANERCEPT, 25 MG (CODE MAY BE USED FOR
INJECTION, ETANERCEPT, 25 MG (CODE MAY BE USED FOR
INJECTION, ETANERCEPT, 25 MG (CODE MAY BE USED FOR
INJECTION, ETANERCEPT, 25 MG (CODE MAY BE USED FOR
INJECTION, ETANERCEPT, 25 MG (CODE MAY BE USED FOR
INJECTION, ETANERCEPT, 25 MG (CODE MAY BE USED FOR
MEDICARE
MEDICARE
MEDICARE
MEDICARE
MEDICARE
MEDICARE
01/01/2002
01/01/2002
04/23/2008
04/23/2008
08/27/2007
10/01/2012
10/01/2012
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
09/08/2003
01/01/2006
01/01/2004
04/16/2007
01/01/2002
01/01/2002
03/10/2006
01/10/2007
05/23/2005
10/04/2007
12/10/2007
09/03/1990
10/24/2002
10/04/2007
12/18/2007
08/29/2002
01/01/2006
01/01/2002
01/01/2006
01/01/2002
01/01/2002
01/01/2002
08/21/2002
01/01/2002
01/01/2002
01/01/2002
11/15/2004
01/01/2002
09/01/2003
09/01/2003
09/08/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/15/2003
09/15/2003
12/04/2002
12/04/2002
12/04/2002
07/08/2003
07/08/2003
07/08/2003
07/08/2003
04/30/2003
03/18/2008
01/01/2002
01/01/2002
11/17/2004
11/17/2004
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/31/2015
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/01/2008
11/01/2007
12/31/2078
10/01/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/31/2008
12/31/2078
12/31/2078
07/31/2008
03/31/2009
12/31/2078
12/31/2078
12/17/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J1438
J1438
J1438
J1438
J1440
J1440
J1440
J1440
J1440
J1440
J1441
J1441
J1441
J1441
J1441
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
J1450
58406044501
58406044504
58406045501
58406045504
54868252200
54868502000
55513053001
55513053010
55513092401
55513092410
54868305000
55513020901
55513020910
55513054601
55513054610
00049337126
00049337226
00049343526
00049343626
00049343726
00049343826
00074468402
00074468833
00143989906
00143989991
00338604537
00338604648
00409468402
00409468423
00409468802
00409468823
00409468827
00409468828
00409468833
00409468834
00703101009
00703101909
00703102030
00703102930
25021011382
25021011387
49452315101
49452315102
49452315103
51552103101
51552103102
51552103104
55390001201
55390004601
55390019401
59762503402
59762503502
59762503602
59762503702
60505073301
60505073302
60505073401
60505073402
61703041463
61703041464
63275996001
63275996002
63275996004
63275996005
63275996009
12/19/2013
HCPCS Description
INJECTION, ETANERCEPT, 25 MG (CODE MAY
INJECTION, ETANERCEPT, 25 MG (CODE MAY
INJECTION, ETANERCEPT, 25 MG (CODE MAY
INJECTION, ETANERCEPT, 25 MG (CODE MAY
INJECTION, FILGRASTIM (G-CSF), 300 MCG
INJECTION, FILGRASTIM (G-CSF), 300 MCG
INJECTION, FILGRASTIM (G-CSF), 300 MCG
INJECTION, FILGRASTIM (G-CSF), 300 MCG
INJECTION, FILGRASTIM (G-CSF), 300 MCG
INJECTION, FILGRASTIM (G-CSF), 300 MCG
INJECTION, FILGRASTIM (G-CSF), 480 MCG
INJECTION, FILGRASTIM (G-CSF), 480 MCG
INJECTION, FILGRASTIM (G-CSF), 480 MCG
INJECTION, FILGRASTIM (G-CSF), 480 MCG
INJECTION, FILGRASTIM (G-CSF), 480 MCG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
FLUCONAZOLE INJ PER 200MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
FLUCONAZOLE 200MG/100ML
FLUCONAZOLE INJ PER 200MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
FLUCONAZOLE INJ PER 200MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
BE
BE
BE
BE
USED
USED
USED
USED
FOR
FOR
FOR
FOR
MEDICARE
MEDICARE
MEDICARE
MEDICARE
Earliest Start
Date
07/17/2006
07/17/2006
04/30/2007
04/30/2007
01/01/2002
03/11/2004
01/01/2002
01/01/2002
01/01/2002
01/01/2002
08/14/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
04/01/2006
04/01/2006
04/03/2007
07/14/2006
07/29/2004
07/29/2004
03/06/2007
04/14/2006
07/27/2006
06/16/2006
05/27/2006
06/01/2005
10/25/2006
03/02/2006
08/02/2004
08/02/2004
03/14/2005
03/16/2005
08/27/2009
08/27/2009
01/01/2003
01/01/2003
11/15/2004
09/01/2003
09/01/2003
09/01/2003
07/29/2004
07/29/2004
01/14/2010
09/09/2004
09/09/2004
09/09/2004
09/09/2004
05/25/2005
05/25/2005
05/25/2005
05/25/2005
06/09/2004
06/09/2004
05/01/2004
05/01/2004
05/01/2004
05/01/2004
05/01/2004
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
05/01/2011
11/01/2014
07/31/2011
07/31/2011
05/31/2010
07/31/2011
08/01/2007
01/01/2007
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/05/2013
09/05/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
11/30/2007
11/30/2007
11/30/2007
11/30/2007
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J1450
J1450
J1450
J1450
J1450
J1450
J1451
J1451
J1451
J1451
J1451
J1453
J1453
J1455
J1455
J1455
J1457
J1457
J1458
J1459
J1459
J1459
J1459
J1460
J1460
J1460
J1460
J1460
J1460
J1470
J1470
J1470
J1470
J1470
J1470
J1470
J1470
J1480
J1480
J1480
J1480
J1480
J1480
J1480
J1480
J1490
J1490
J1490
J1490
J1490
J1490
J1490
J1490
J1500
J1500
J1500
J1500
J1500
J1500
J1500
J1500
J1510
J1510
J1510
J1510
63323030861
63323030863
63370008925
63370008935
63370008945
63370008950
00781318273
00781318284
39822071001
62161000334
68727020002
00006388432
00006394132
00186190601
00409386302
00409386305
51927325600
66657030105
68135002001
44206043605
44206043710
44206043820
44206043940
13533063503
13533063504
13533063512
54569527500
54569582800
54868419300
00026063504
00026063512
13533063504
13533063512
54569527500
54569527600
54569582800
54868419300
00026063504
00026063512
13533063504
13533063512
54569527500
54569527600
54569582800
54868419300
00026063504
00026063512
13533063504
13533063512
54569527500
54569527600
54569582800
54868419300
00026063504
00026063512
13533063504
13533063512
54569527500
54569527600
54569582800
54868419300
00026063504
00026063512
13533063504
13533063512
12/19/2013
Earliest Start
Date
HCPCS Description
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION FLUCONAZOLE, 200 MG
INJECTION, FOMEPIZOLE, 15 MG
INJECTION, FOMEPIZOLE, 15 MG
INJECTION, FOMEPIZOLE, 15 MG
INJECTION, FOMEPIZOLE, 15 MG
INJECTION, FOMEPIZOLE, 15 MG
INJECTION, FOSAPREPITANT, 1 MG
FOSAPREPITANT, 1MG
INJECTION, FOSCARNET SODIUM, PER 1000 MG
INJECTION, FOSCARNET SODIUM, PER 1000 MG
INJECTION, FOSCARNET SODIUM, PER 1000 MG
INJECTION, GALLIUM NITRATE, 1 MG
INJECTION, GALLIUM NITRATE, 1 MG
INJECTION, GALSULFASE, 1 MG
INJECTION, IMMUNE GLOBULIN (PRIVIGEN), INTRAVENOUS,
INJECTION, IMMUNE GLOBULIN (PRIVIGEN), INTRAVENOUS,
INJECTION, IMMUNE GLOBULIN (PRIVIGEN), INTRAVENOUS,
INJECTION, IMMUNE GLOBULIN (PRIVIGEN), INTRAVENOUS,
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 1 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 1 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 1 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 1 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 1 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 1 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 2 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 2 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 2 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 2 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 2 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 2 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 2 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 2 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 3 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 3 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 3 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 3 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 3 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 3 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 3 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 3 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 4 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 4 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 4 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 4 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 4 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 4 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 4 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 4 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 5 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 5 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 5 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 5 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 5 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 5 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 5 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 5 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 6 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 6 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 6 CC
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 6 CC
NON-LYOP
NON-LYOP
NON-LYOP
NON-LYOP
07/08/2004
07/08/2004
07/12/2004
07/12/2004
07/12/2004
07/12/2004
04/02/2008
04/02/2008
12/14/2007
01/01/2006
11/09/2006
01/30/2008
11/15/2010
01/01/2002
02/01/2006
02/01/2006
01/01/2005
01/01/2005
01/01/2007
01/01/2009
01/01/2009
01/01/2009
06/01/2013
01/17/2008
10/04/2005
10/04/2005
01/01/2002
09/26/2006
01/01/2002
01/01/2002
01/01/2002
10/04/2005
10/04/2005
01/01/2002
01/01/2002
09/26/2006
01/01/2002
01/01/2002
01/01/2002
10/04/2005
10/04/2005
01/01/2002
01/01/2002
09/26/2006
01/01/2002
01/01/2002
01/01/2002
10/04/2005
10/04/2005
01/01/2002
01/01/2002
09/26/2006
01/01/2002
01/01/2002
01/01/2002
10/04/2005
10/04/2005
01/01/2002
01/01/2002
09/26/2006
01/01/2002
01/01/2002
01/01/2002
10/04/2005
10/04/2005
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/28/2011
06/30/2012
07/31/2012
12/31/2078
04/30/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/13/2006
03/06/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/13/2006
03/06/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/13/2006
03/06/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/13/2006
03/06/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/13/2006
03/06/2008
12/31/2078
12/31/2078
Page 1 of 1
Earliest Start
Date
(GAMUNEX-C/GAMMAKED), NON-LYOPHI
(GAMUNEX-C/GAMMAKED), NON-LYOPHI
(GAMUNEX-C/GAMMAKED), NON-LYOPHI
(GAMUNEX-C/GAMMAKED), NON-LYOPHI
(GAMUNEX-C/GAMMAKED), NON-LYOPHI
(GAMUNEX-C/GAMMAKED), NON-LYOPHI
(GAMUNEX-C/GAMMAKED), NON-LYOPHI
(GAMUNEX-C/GAMMAKED), NON-LYOPHI
(GAMUNEX-C/GAMMAKED), NON-LYOPHI
(GAMUNEX-C/GAMMAKED), NON-LYOPHI
(GAMUNEX/GAMUNEX-C/GAMMAKED), NO
01/01/2002
01/01/2002
09/26/2006
01/01/2002
01/01/2002
01/01/2002
10/04/2005
10/04/2005
01/01/2002
01/01/2002
09/26/2006
01/01/2002
01/01/2002
01/01/2002
10/04/2005
10/04/2005
01/01/2002
01/01/2002
09/26/2006
01/01/2002
01/01/2002
01/01/2002
10/04/2005
10/04/2005
01/01/2002
01/01/2002
09/26/2006
01/01/2002
01/01/2002
01/01/2002
10/04/2005
10/04/2005
01/01/2002
09/26/2006
01/01/2002
01/01/2012
01/01/2012
01/01/2012
01/01/2011
01/01/2011
01/01/2011
01/01/2006
01/01/2006
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
12/07/2010
12/07/2010
12/07/2010
12/07/2010
12/07/2010
12/29/2010
Latest End
Date
J1561
76125090050 INJECTION, IMMUNE GLOBULIN, (GAMUNEX/GAMUNEX-C/GAMMAKED), NO
12/29/2010
12/31/2078
J1562
J1562
J1562
J1562
J1562
J1566
J1566
J1566
00053759603
00053759610
00053759615
00053759620
00053759625
00053748605
00053748610
00944047169
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2006
01/01/2006
01/01/2006
12/31/2078
05/06/2013
12/31/2078
06/08/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
HCPCS
NDC
J1510
J1510
J1510
J1510
J1520
J1520
J1520
J1520
J1520
J1520
J1520
J1520
J1530
J1530
J1530
J1530
J1530
J1530
J1530
J1530
J1540
J1540
J1540
J1540
J1540
J1540
J1540
J1540
J1550
J1550
J1550
J1550
J1550
J1550
J1550
J1557
J1557
J1557
J1559
J1559
J1559
J1560
J1560
J1561
J1561
J1561
J1561
J1561
J1561
J1561
J1561
J1561
J1561
J1561
54569527500
54569527600
54569582800
54868419300
00026063504
00026063512
13533063504
13533063512
54569527500
54569527600
54569582800
54868419300
00026063504
00026063512
13533063504
13533063512
54569527500
54569527600
54569582800
54868419300
00026063504
00026063512
13533063504
13533063512
54569527500
54569527600
54569582800
54868419300
00026063504
00026063512
13533063504
13533063512
54569527500
54569582800
54868419300
64208823401
64208823402
64208823403
44206045101
44206045202
44206045404
13533063504
13533063512
13533064512
13533064515
13533064520
13533064524
13533064571
13533080012
13533080015
13533080020
13533080024
13533080071
76125090010
12/19/2013
HCPCS Description
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
10 CC
10 CC
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
GAMMA GLOBULIN, INTRAMUSCULAR, 6 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 6 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 6 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 6 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 7 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 7 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 7 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 7 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 7 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 7 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 7 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 7 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 8 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 8 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 8 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 8 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 8 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 8 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 8 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 8 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 9 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 9 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 9 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 9 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 9 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 9 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 9 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 9 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 10 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 10 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 10 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 10 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 10 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 10 CC
GAMMA GLOBULIN, INTRAMUSCULAR, 10 CC
IMMUNE GLOBULIN (GAMMAPLEX), INTRAVENOUS, NONLYOP
IMMUNE GLOBULIN (GAMMAPLEX), INTRAVENOUS, NONLYOP
IMMUNE GLOBULIN (GAMMAPLEX), INTRAVENOUS, NONLYOP
IMMUNE GLOBULIN (HIZENTRA), 100 MG
IMMUNE GLOBULIN (HIZENTRA), 100 MG
IMMUNE GLOBULIN (HIZENTRA), 100 MG
IMMUNE
IMMUNE
IMMUNE
IMMUNE
IMMUNE
IMMUNE
IMMUNE
IMMUNE
IMMUNE
IMMUNE
IMMUNE
IMMUNE
IMMUNE
IMMUNE
IMMUNE
IMMUNE
IMMUNE
IMMUNE
IMMUNE
GLOBULIN,
GLOBULIN,
GLOBULIN,
GLOBULIN,
GLOBULIN,
GLOBULIN,
GLOBULIN,
GLOBULIN,
GLOBULIN,
GLOBULIN,
GLOBULIN,
GLOBULIN (VIVAGLOBIN), 100 MG
GLOBULIN (VIVAGLOBIN), 100 MG
GLOBULIN (VIVAGLOBIN), 100 MG
GLOBULIN (VIVAGLOBIN), 100 MG
GLOBULIN (VIVAGLOBIN), 100 MG
GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. P
GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. P
GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. P
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/13/2006
03/06/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/13/2006
03/06/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/13/2006
03/06/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/13/2006
03/06/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/24/2013
04/19/2013
06/26/2014
10/17/2013
10/22/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J1566
J1566
J1566
J1566
J1566
J1566
J1566
J1566
J1566
J1566
J1566
J1566
J1566
J1566
J1566
J1566
J1566
J1566
J1567
J1567
J1567
J1567
J1567
J1567
J1568
J1568
J1568
J1568
J1568
J1568
J1568
J1568
J1568
J1569
J1569
J1569
J1569
J1569
J1569
J1570
J1571
J1571
J1572
J1572
J1572
J1572
J1572
J1572
J1572
J1572
J1572
J1573
J1573
J1573
J1573
J1573
J1573
J1580
J1580
J1580
J1580
J1580
J1580
J1580
J1580
00944047172
00944047175
00944047180
00944262001
00944262002
00944262003
00944262004
00944265503
00944265504
00944265603
00944265804
44206041501
44206041603
44206041706
44206041812
52769041706
52769041812
52769047072
68516161201
68516161301
68516161401
68516162201
68516162301
68516162401
67467084301
67467084302
67467084303
67467084304
67467084305
68209084301
68209084302
68209084303
68209084304
00944270002
00944270003
00944270004
00944270005
00944270006
00944270007
00004694003
60492005101
60492005201
61953000301
61953000302
61953000303
61953000304
61953000401
61953000402
61953000403
61953000404
61953000405
53270005101
53270005201
53270005301
53270005401
60492005102
60492005202
00264580632
00264580832
00264581032
00264581238
00264581638
00338050148
00338050348
00338050548
12/19/2013
HCPCS Description
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. P
IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. P
IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. P
IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. P
IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. P
IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. P
IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. P
IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. P
IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. P
IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. P
IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. P
IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. P
IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. P
IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. P
IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. P
IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. P
IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. P
IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. P
IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.
IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.
IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.
IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.
IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.
IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.
IMMUNE GLOBULIN, (OCTAGAM), INTRAVENOUS, NON-LYOP
IMMUNE GLOBULIN, (OCTAGAM), INTRAVENOUS, NON-LYOP
IMMUNE GLOBULIN, (OCTAGAM), INTRAVENOUS, NON-LYOP
IMMUNE GLOBULIN, (OCTAGAM), INTRAVENOUS, NON-LYOP
IMMUNE GLOBULIN, (OCTAGAM), INTRAVENOUS, NON-LYOP
IMMUNE GLOBULIN, (OCTAGAM), INTRAVENOUS, NON-LYOP
IMMUNE GLOBULIN, (OCTAGAM), INTRAVENOUS, NON-LYOP
IMMUNE GLOBULIN, (OCTAGAM), INTRAVENOUS, NON-LYOP
IMMUNE GLOBULIN, (OCTAGAM), INTRAVENOUS, NON-LYOP
IMMUNE GLOBULIN, (GAMMAGARD LIQUID), NON-LYOPHILI
IMMUNE GLOBULIN, (GAMMAGARD LIQUID), NON-LYOPHILI
IMMUNE GLOBULIN, (GAMMAGARD LIQUID), NON-LYOPHILI
IMMUNE GLOBULIN, (GAMMAGARD LIQUID), NON-LYOPHILI
IMMUNE GLOBULIN, (GAMMAGARD LIQUID), NON-LYOPHILI
IMMUNE GLOBULIN, (GAMMAGARD LIQUID), NON-LYOPHILI
GANCICLOVIR SODIUM, 500 MG
HEPATITIS B IMMUNE GLOBULIN (HEPAGAM B), INTRAMUS
HEPATITIS B IMMUNE GLOBULIN (HEPAGAM B), INTRAMUS
IMMUNE GLOBULIN, (FLEBOGAMMA/FLEBOGAMMA DIF), INT
IMMUNE GLOBULIN, (FLEBOGAMMA/FLEBOGAMMA DIF), INT
IMMUNE GLOBULIN, (FLEBOGAMMA/FLEBOGAMMA DIF), INT
IMMUNE GLOBULIN, (FLEBOGAMMA/FLEBOGAMMA DIF), INT
IMMUNE GLOBULIN, (FLEBOGAMMA/FLEBOGAMMA DIF), INT
IMMUNE GLOBULIN, (FLEBOGAMMA/FLEBOGAMMA DIF), INT
IMMUNE GLOBULIN, (FLEBOGAMMA/FLEBOGAMMA DIF), INT
IMMUNE GLOBULIN, (FLEBOGAMMA/FLEBOGAMMA DIF), INT
IMMUNE GLOBULIN, (FLEBOGAMMA/FLEBOGAMMA DIF), INT
HEPATITIS B IMMUNE GLOBULIN (HEPAGAM B), INTRAVEN
HEPATITIS B IMMUNE GLOBULIN (HEPAGAM B), INTRAVEN
HEPATITIS B IMMUNE GLOBULIN (HEPAGAM B), INTRAVEN
HEPATITIS B IMMUNE GLOBULIN (HEPAGAM B), INTRAVEN
HEPATITIS B IMMUNE GLOBULIN (HEPAGAM B), INTRAVEN
HEPATITIS B IMMUNE GLOBULIN (HEPAGAM B), INTRAVEN
GARAMYCIN, GENTAMICIN, UP TO 80 MG
GARAMYCIN, GENTAMICIN, UP TO 80 MG
GARAMYCIN, GENTAMICIN, UP TO 80 MG
GARAMYCIN, GENTAMICIN, UP TO 80 MG
GARAMYCIN, GENTAMICIN, UP TO 80 MG
GARAMYCIN, GENTAMICIN, UP TO 80 MG
GARAMYCIN, GENTAMICIN, UP TO 80 MG
GARAMYCIN, GENTAMICIN, UP TO 80 MG
Earliest Start
Date
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
06/01/2007
06/01/2007
01/24/2013
01/24/2013
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
03/18/2011
01/01/2002
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
08/01/2010
08/01/2010
08/01/2010
08/01/2010
01/01/2008
01/01/2008
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
05/25/2013
04/11/2014
06/21/2014
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
06/03/2014
12/31/2078
12/31/2078
04/08/2009
03/27/2009
02/21/1994
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/31/2013
04/30/2013
08/31/2012
04/30/2013
11/30/2010
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J1580
J1580
J1580
J1580
J1580
J1580
J1580
J1580
J1580
J1580
J1580
J1580
J1580
J1580
J1580
J1580
J1580
J1580
J1580
J1595
J1595
J1595
J1599
J1599
J1599
J1600
J1600
J1600
J1600
J1600
J1610
J1610
J1610
J1610
J1610
J1610
J1626
J1626
J1626
J1626
J1626
J1626
J1626
J1626
J1626
J1626
J1626
J1626
J1626
J1626
J1626
J1626
J1626
J1626
J1626
J1626
J1626
J1626
J1626
J1626
J1630
J1630
J1630
J1630
J1630
00338050741
00338050748
00338050941
00338051141
00409120703
00409340001
00409340101
00409340201
00409787913
00409788113
00409788313
00409788423
00409788623
00409788923
54868410300
63323001002
63323001020
63323017302
63323051302
00088115330
68115075030
68546031730
64208823401
64208823402
64208823403
11098053301
11098053310
51927289500
54643100600
54643100700
00002803101
00169706515
54569473400
54868507000
55390000401
55390000410
00004023909
00004024009
00703787103
00703789102
00703797103
00703797301
10019005303
10019005314
17478054601
17478054605
25021078104
55390025010
60505069200
60505069300
60505076402
63323031701
63323031801
63323031904
64679066102
64679066103
64679066201
66758003501
66758003601
66758003702
00045025501
00703704103
00703704501
10147091101
25021080601
12/19/2013
HCPCS Description
INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG
INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG
INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG
INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG
INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG
INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG
INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG
INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG
INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG
INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG
INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG
INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG
INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG
INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG
INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG
INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG
INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG
INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG
INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG
INJECTION, GLATIRAMER ACETATE, 20 MG
INJECTION, GLATIRAMER ACETATE, 20 MG
INJECTION, GLATIRAMER ACETATE, 20 MG
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.
INJECTION, GOLD SODIUM THIOMALATE, UP TO 50 MG
INJECTION, GOLD SODIUM THIOMALATE, UP TO 50 MG
INJECTION, GOLD SODIUM THIOMALATE, UP TO 50 MG
INJECTION, GOLD SODIUM THIOMALATE, UP TO 50 MG
INJECTION, GOLD SODIUM THIOMALATE, UP TO 50 MG
INJECTION, GLUCAGON HYDROCHLORIDE, PER 1 MG
INJECTION, GLUCAGON HYDROCHLORIDE, PER 1 MG
INJECTION, GLUCAGON HYDROCHLORIDE, PER 1 MG
INJECTION, GLUCAGON HYDROCHLORIDE, PER 1 MG
INJECTION, GLUCAGON HYDROCHLORIDE, PER 1 MG
INJECTION, GLUCAGON HYDROCHLORIDE, PER 1 MG
INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG
INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG
INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG
INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG
INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG
INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG
INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG
INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG
GRANISETRON INJ PER 100 MCG
GRANISETRON INJ PER 100 MCG
GRANISETRON INJ PER 100 MCG
INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG
INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG
INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG
INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG
INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG
INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG
INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG
INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG
INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG
INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG
INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG
INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG
INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL, UP TO 5 MG
HALOPERIDOL LACTATE PER 5MG
HALOPERIDOL INJ 5MG
Earliest Start
Date
01/01/2002
01/01/2002
01/01/2002
01/01/2002
08/30/2005
03/24/2006
01/09/2006
06/05/2006
03/31/2006
01/23/2006
01/09/2006
07/06/2005
01/27/2006
09/20/2005
02/12/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2004
03/29/2004
04/28/2008
01/01/2011
01/01/2011
01/01/2011
06/21/2002
06/21/2002
09/08/2003
10/01/2003
10/01/2003
01/01/2002
06/01/2005
01/01/2002
05/24/2004
01/01/2002
01/01/2002
01/03/2002
06/09/1997
01/03/2008
01/03/2008
01/03/2008
06/30/2008
12/31/2007
12/31/2007
03/01/2010
03/01/2010
01/03/2011
07/29/2008
08/14/2008
08/14/2008
12/31/2007
12/14/2007
06/25/2008
06/25/2008
07/01/2008
07/01/2008
04/25/2008
06/30/2008
06/30/2008
06/30/2008
01/01/2002
01/18/2002
01/18/2002
07/11/2011
12/02/2011
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
11/30/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
04/30/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/31/2010
11/30/2011
08/31/2010
12/31/2010
12/31/2078
12/31/2078
06/28/2010
06/28/2010
03/31/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/31/2011
10/31/2012
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J1630
J1630
J1630
J1630
J1630
J1630
J1630
J1630
J1630
J1630
J1630
J1630
J1630
J1630
J1630
J1630
J1630
J1630
J1630
J1630
J1630
J1630
J1630
J1630
J1630
J1630
J1630
J1631
J1631
J1631
J1631
J1631
J1631
J1631
J1631
J1631
J1631
J1631
J1631
J1631
J1631
J1631
J1631
J1631
J1631
J1631
J1631
J1631
J1631
J1631
J1631
J1640
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
38779033001
38779033003
38779033004
38779033005
38779033006
49452344601
49452344602
50458025501
51552051901
51552051902
51927143300
54868345900
55390014701
55390014710
55390044701
55390044710
60505072703
62991203101
62991203102
62991203103
62991203104
63323047401
63323047410
63323047491
63370010215
63370010225
63370010235
00045025301
00045025303
00045025414
00703701103
00703701301
00703702103
00703702301
54868288900
54868288901
55390041201
55390041205
55390041301
55390041305
60505070201
60505070301
60505602002
60505602102
63323046901
63323046905
63323046951
63323047101
63323047105
63323047151
63323047155
67386070154
00074345425
00409115112
00409115170
00409115178
00409115212
00409115270
00409115278
00409128031
00409128032
00409128033
00409128035
00409128131
00409128132
12/19/2013
Earliest Start
Date
HCPCS Description
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL, UP TO 5 MG
HALOPERIDOL INJ 5MG
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL, UP TO 5 MG
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
INJECTION, HEMIN, 1 MG
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
10
10
10
10
10
10
10
10
10
10
10
10
10
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
11/10/2010
01/01/2002
09/01/2003
09/08/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/24/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
07/08/2003
07/08/2003
07/08/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/30/2008
12/14/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2006
02/20/2002
07/14/2005
07/20/2005
09/19/2005
03/15/2005
09/07/2005
02/25/2005
03/28/2005
04/08/2005
04/05/2005
04/01/2005
07/22/2005
04/25/2005
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/31/2011
04/30/2011
05/31/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/30/2004
12/31/2078
12/31/2078
01/30/2004
11/30/2003
12/31/2078
11/01/2006
12/31/2078
12/31/2078
12/31/2078
07/01/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
00409128133
00409128135
00641027221
00641027225
00641027321
00641027325
00641038721
00641038725
00641038921
00641038925
00641039221
00641039225
00641039321
00641039325
00641041121
00641041125
00641041421
00641041425
00641243641
00641243645
00641243841
00641243845
00641244241
00641244245
00641244341
00641244345
08166110003
08166110005
08166111003
08166111005
08290034002
08290034003
08290035005
08290036003
08290036005
08290036006
08290036105
08290037002
08290037003
08290038003
08290038005
08290039003
08290039005
08290039105
08450602603
08450603005
08450603403
08450603705
08450604603
08450604903
08450605005
08450605503
08450605805
08881012502
08881580121
08881580123
08881580125
08881590121
08881590123
08881590125
17474012302
54868252600
54868361500
63323001710
63323054401
12/19/2013
HCPCS Description
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
HEPARIN
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
SODIUM,
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
(HEPARIN
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
LOCK
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
FLUSH),
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
Earliest Start
Date
07/15/2005
04/25/2005
05/05/2007
10/17/2005
05/05/2007
10/17/2005
12/08/2004
01/01/2002
12/08/2004
01/01/2002
12/08/2004
01/01/2002
12/08/2004
01/01/2002
12/08/2004
01/01/2002
12/08/2004
01/01/2002
05/05/2007
01/01/2002
05/05/2007
01/01/2002
05/05/2007
01/01/2002
05/05/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
08/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
08/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
11/01/2003
11/01/2003
11/01/2003
11/01/2003
11/01/2003
11/01/2003
11/01/2003
11/01/2003
11/01/2003
08/23/2006
03/14/2002
03/14/2002
08/23/2006
03/14/2002
03/14/2002
08/23/2006
03/14/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
11/28/2009
11/28/2009
12/31/2078
12/31/2078
07/28/2009
07/28/2009
12/28/2009
12/28/2009
09/28/2008
09/28/2008
07/28/2009
07/28/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/28/2010
02/28/2010
06/28/2009
06/28/2009
07/28/2009
07/28/2009
12/28/2009
12/28/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1642
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
63323054411
63323054501
63323054505
63807030031
63807030035
63807040031
63807040035
63807050031
63807050051
63807060031
63807060051
63807060055
64054100301
64054100302
64054300302
64054300502
64253022221
64253022222
64253022223
64253022225
64253022230
64253022233
64253022235
64253033321
64253033322
64253033323
64253033325
64253033330
64253033333
64253033335
64253044421
64253044422
64253044423
64253044425
64253044430
64253044433
64253044435
68883001003
68883001005
68883001006
68883010003
68883010004
68883010005
68883010006
00264956710
00264957710
00264958720
00264987210
00338043103
00338043304
00338054903
00338055002
00338055003
00409131625
00409131632
00409131666
00409140231
00409258102
00409258402
00409272002
00409272101
00409272301
00409762003
00409762059
00409765062
12/19/2013
HCPCS Description
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH),
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
HEPARIN PER 1000 UNITS
HEPARIN SODIUM PER 1,000 UNITS
HEPARIN PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
UNIT
Earliest Start
Date
01/01/2002
01/01/2002
01/01/2002
01/01/2007
04/12/2007
01/01/2007
04/12/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
05/10/2005
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
10/10/2003
10/10/2003
10/10/2003
10/10/2003
10/10/2003
10/10/2003
10/10/2003
01/05/2006
01/05/2006
01/05/2006
01/05/2006
01/05/2006
01/05/2006
01/05/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
12/08/2004
01/01/2002
10/29/2007
03/23/2005
02/11/2005
03/21/2005
03/24/2006
07/01/2005
08/31/2009
08/13/2009
08/31/2009
04/05/2005
04/13/2005
07/06/2005
Latest End
Date
12/31/2078
12/31/2078
01/14/1999
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
10/01/2012
12/31/2078
12/31/2078
07/01/2012
07/01/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1644
J1645
J1645
J1645
J1645
J1645
J1645
J1645
J1645
J1645
J1645
J1645
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1650
00409765103
00409765162
00409776003
00409776103
00409779323
00409779362
00409779462
00641039102
00641039121
00641039125
00641039164
00641040002
00641040021
00641040025
00641040064
00641041002
00641041021
00641041025
00641041064
00641244041
00641244045
00641245041
00641245045
00641246041
00641246045
00641247041
00641247045
11743021002
25021040010
25021040030
25021040201
25021040301
49452345001
49452345002
49452345003
51927328600
63323004710
63323026201
63323027602
63323054001
63323054011
63323054031
63323054201
63323054207
63323091501
00013240691
00013242601
62856010110
62856010201
62856012510
62856015010
62856018010
62856025010
62856025101
62856050010
62856075010
00075062040
00075062041
00075062160
00075062161
00075062280
00075062281
00075062300
00075062301
00075062430
12/19/2013
HCPCS Description
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
HEPARIN SODIUM PER 1,000 UNITS
HEPARIN SODIUM PER 1,000 UNITS
HEPARIN SODIUM PER 1,000 UNITS
HEPARIN NA 10000U/ML
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
INJECTION, DALTEPARIN SODIUM, PER 2500 IU
INJECTION, DALTEPARIN SODIUM, PER 2500 IU
INJECTION, DALTEPARIN SODIUM, PER 2500 IU
INJECTION, DALTEPARIN SODIUM, PER 2500 IU
INJECTION, DALTEPARIN SODIUM, PER 2500 IU
INJECTION, DALTEPARIN SODIUM, PER 2500 IU
INJECTION, DALTEPARIN SODIUM, PER 2500 IU
INJECTION, DALTEPARIN SODIUM, PER 2500 IU
INJECTION, DALTEPARIN SODIUM, PER 2500 IU
INJECTION, DALTEPARIN SODIUM, PER 2500 IU
INJECTION, DALTEPARIN SODIUM, PER 2500 IU
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
Earliest Start
Date
06/28/2005
07/28/2005
08/30/2005
07/22/2005
01/25/2006
10/14/2005
06/12/2006
10/01/2007
12/08/2004
01/01/2002
10/01/2007
10/01/2007
12/08/2004
01/01/2002
10/01/2007
10/01/2007
12/08/2004
01/01/2002
10/01/2007
12/08/2004
01/01/2002
12/08/2004
01/01/2002
12/08/2004
01/01/2002
12/08/2004
01/01/2002
01/01/2002
07/01/2010
07/16/2010
07/06/2010
07/06/2010
01/01/2002
01/01/2002
01/01/2002
09/08/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
06/14/2002
11/20/2006
07/10/2006
08/25/2007
08/25/2007
08/25/2007
06/26/2007
11/20/2006
10/10/2006
02/06/2007
01/01/2002
03/17/2008
01/01/2002
03/11/2008
01/01/2002
03/11/2008
01/01/2002
03/11/2008
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/28/2009
08/28/2009
08/28/2009
12/31/2078
02/28/2010
09/28/2009
09/28/2009
12/31/2078
01/28/2010
08/29/2008
08/29/2008
12/31/2078
12/28/2009
12/28/2009
12/28/2009
12/28/2009
02/28/2010
02/28/2010
01/28/2010
01/28/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/31/2010
10/31/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1650
J1652
J1652
J1652
J1652
J1652
J1652
J1652
J1652
J1652
J1652
J1652
J1652
J1652
J1652
J1652
J1652
J1652
J1652
J1652
J1652
J1652
J1655
J1655
J1670
J1675
J1675
J1680
J1700
J1700
J1700
J1700
J1700
J1700
00075062431
00075062603
00075062604
00075291201
00075291501
00781311902
00781311963
00781311964
00781311966
00781311968
00781311969
00781312168
00781313363
00781322464
00781342868
00781350069
35356001810
35356001910
35356002010
54569574200
54569574201
54868511200
54868511201
54868544000
54868544001
54868558700
54868558701
54868583500
54868583700
58016487201
68115074910
68115077410
00007323002
00007323011
00007323202
00007323211
00007323402
00007323411
00007323602
00007323611
35356007802
35356007810
35356007902
35356007910
35356008002
35356008010
35356008102
35356008110
54868550100
54868550101
54868550102
54868565200
66203230001
67211034208
67211034253
13533063402
67979000201
67979050001
63833089151
00463103610
00574042101
00574042125
17317019901
17317019902
17317019903
12/19/2013
HCPCS Description
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
ENOXAPARIN 10MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
ENOXAPARIN 10MG
ENOXAPARIN 10MG
ENOXAPARIN 10MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, ENOXAPARIN SODIUM, 10 MG
INJECTION, FONDAPARINUX SODIUM, 0.5 MG
INJECTION, FONDAPARINUX SODIUM, 0.5 MG
INJECTION, FONDAPARINUX SODIUM, 0.5 MG
INJECTION, FONDAPARINUX SODIUM, 0.5 MG
INJECTION, FONDAPARINUX SODIUM, 0.5 MG
INJECTION, FONDAPARINUX SODIUM, 0.5 MG
INJECTION, FONDAPARINUX SODIUM, 0.5 MG
INJECTION, FONDAPARINUX SODIUM, 0.5 MG
INJECTION, FONDAPARINUX SODIUM, 0.5 MG
INJECTION, FONDAPARINUX SODIUM, 0.5 MG
INJECTION, FONDAPARINUX SODIUM, 0.5 MG
INJECTION, FONDAPARINUX SODIUM, 0.5 MG
INJECTION, FONDAPARINUX SODIUM, 0.5 MG
INJECTION, FONDAPARINUX SODIUM, 0.5 MG
INJECTION, FONDAPARINUX SODIUM, 0.5 MG
INJECTION, FONDAPARINUX SODIUM, 0.5 MG
INJECTION, FONDAPARINUX SODIUM, 0.5 MG
INJECTION, FONDAPARINUX SODIUM, 0.5 MG
INJECTION, FONDAPARINUX SODIUM, 0.5 MG
INJECTION, FONDAPARINUX SODIUM, 0.5 MG
INJECTION, FONDAPARINUX SODIUM, 0.5 MG
INJECTION, TINZAPARIN SODIUM, 1000 IU
INJECTION, TINZAPARIN SODIUM, 1000 IU
INJECTION, TETANUS IMMUNE GLOBULIN, HUMAN, UP TO 250 UNITS
INJECTION, HISTRELIN ACETATE, 10 MICROGRAMS
INJECTION, HISTRELIN ACETATE, 10 MICROGRAMS
INJECTION, HUMAN FIBRINOGEN CONCENTRATE, 100 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
Earliest Start
Date
03/17/2008
03/07/2003
03/11/2008
01/01/2002
01/01/2002
07/01/2010
07/23/2010
07/23/2010
07/23/2010
07/23/2010
07/23/2010
07/23/2010
09/30/2011
09/30/2011
09/30/2011
09/30/2011
09/14/2007
09/14/2007
09/14/2007
10/24/2005
12/08/2005
07/28/2004
09/08/2004
09/29/2005
11/01/2005
05/17/2006
09/25/2007
11/29/2007
12/04/2007
04/01/2006
03/17/2004
02/06/2004
02/06/2006
06/03/2005
02/06/2006
11/16/2004
02/06/2006
11/16/2004
02/06/2006
11/16/2004
01/25/2008
01/25/2008
01/25/2008
01/25/2008
01/25/2008
01/25/2008
01/25/2008
01/25/2008
01/11/2006
01/11/2006
11/13/2006
08/04/2006
01/01/2003
01/01/2002
01/01/2002
10/14/2006
01/01/2012
01/01/2012
01/01/2012
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/31/2013
06/30/2013
07/31/2013
07/31/2013
06/30/2013
07/31/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/31/2013
12/31/2078
03/31/2014
12/31/2078
04/30/2014
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
06/30/2007
07/31/2011
09/30/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J1700
J1700
J1700
J1700
J1700
J1700
J1700
J1700
J1700
J1700
J1700
J1700
J1700
J1700
J1700
J1700
J1700
J1700
J1700
J1700
J1700
J1700
J1700
J1700
J1700
J1700
J1700
J1700
J1700
J1700
J1720
J1720
J1720
J1720
J1720
J1720
J1720
J1720
J1720
J1720
J1720
J1720
J1730
J1730
J1730
J1730
J1730
J1730
J1740
J1740
J1742
J1743
J1744
J1744
J1745
J1750
J1750
J1750
J1750
J1751
J1751
J1752
J1752
J1752
J1752
17317019908
38779000801
38779000804
38779000805
38779000808
38779000809
39822509001
39822509003
39822509005
49452359001
49452359002
49452359003
49452359004
49452359006
51552002101
51552002102
51552002103
51552002104
51552002105
51927111000
62991107801
62991107802
62991107803
62991107804
62991107805
63370010815
63370010825
63370010835
63370010845
63370010850
00009001104
00009001306
00009082501
00009090013
00009090020
00009090908
00009090916
00009091205
00009092003
00409485605
54868060500
54868450800
38779032403
38779032404
38779032406
49452254102
49452254103
51927274200
00004018809
54868582300
00009379401
54092070001
54092070202
54092070203
57894003001
00517023410
52544093102
54868431900
54868471500
00517023410
52544093102
00517013410
00517023410
52544093102
54868431900
12/19/2013
Earliest Start
Date
HCPCS Description
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
HYDROCORTISONE NA SUCCINATE, UP TO 100MG
HYDROCORTISONE NA SUCCINATE, UP TO 100MG
INJECTION, HYDROCORTISONE SODIUM SUCCINATE, UP
INJECTION, HYDROCORTISONE SODIUM SUCCINATE, UP
INJECTION, HYDROCORTISONE SODIUM SUCCINATE, UP
INJECTION, HYDROCORTISONE SODIUM SUCCINATE, UP
INJECTION, HYDROCORTISONE SODIUM SUCCINATE, UP
INJECTION, HYDROCORTISONE SODIUM SUCCINATE, UP
INJECTION, HYDROCORTISONE SODIUM SUCCINATE, UP
INJECTION, HYDROCORTISONE SODIUM SUCCINATE, UP
INJECTION, HYDROCORTISONE SODIUM SUCCINATE, UP
INJECTION, HYDROCORTISONE SODIUM SUCCINATE, UP
INJECTION, DIAZOXIDE, UP TO 300 MG
INJECTION, DIAZOXIDE, UP TO 300 MG
INJECTION, DIAZOXIDE, UP TO 300 MG
INJECTION, DIAZOXIDE, UP TO 300 MG
INJECTION, DIAZOXIDE, UP TO 300 MG
INJECTION, DIAZOXIDE, UP TO 300 MG
INJECTION, IBANDRONATE SODIUM, 1 MG
INJECTION, IBANDRONATE SODIUM, 1 MG
INJECTION, IBUTILIDE FUMARATE, 1 MG
INJECTION, IDURSULFASE, 1 MG
ICATIBANT, 1 MG INJ
ICATIBANT, 1 MG INJ
INJECTION INFLIXIMAB, 10 MG
INJECTION, IRON DEXTRAN, 50MG
INJECTION IRON DEXTRAN, 50MG
INJECTION, IRON DEXTRAN, 50 MG
INJECTION, IRON DEXTRAN, 50 MG
INJECTION, IRON DEXTRAN 165, 50 MG
INJECTION, IRON DEXTRAN 165, 50 MG
INJECTION, IRON DEXTRAN 267, 50 MG
INJECTION, IRON DEXTRAN 267, 50 MG
INJECTION, IRON DEXTRAN 165, 50 MG
INJECTION, IRON DEXTRAN 267, 50 MG
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
100
100
100
100
100
100
100
100
100
100
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/08/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
07/12/2004
07/12/2004
07/12/2004
07/12/2004
07/12/2004
08/11/2010
09/30/1990
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
06/27/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/08/2003
01/01/2007
10/16/2007
01/01/2002
01/01/2008
01/01/2013
01/01/2013
01/01/2002
01/01/2010
01/01/2009
01/01/2009
01/01/2009
01/01/2008
01/01/2006
01/01/2006
01/01/2006
01/01/2007
03/20/2006
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
05/31/2012
05/31/2012
05/31/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
11/01/2014
02/01/2015
07/01/2014
12/31/2078
07/01/2014
05/01/2014
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/30/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J1752
J1756
J1756
J1756
J1756
J1756
J1756
J1785
J1785
J1790
J1790
J1790
J1790
J1790
J1790
J1790
J1790
J1790
J1790
J1800
J1800
J1800
J1800
J1800
J1800
J1800
J1800
J1800
J1800
J1800
J1800
J1800
J1800
J1800
J1800
J1800
J1800
J1800
J1800
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
54868471500
00517231005
00517234010
00517234025
49230053010
49230053410
49230053425
58468198301
58468466301
00409118701
00517970225
11098001001
11098001002
38779050100
38779050106
49452269601
49452269602
51927218200
54868389000
00781377795
10019014501
10019014543
38779018303
38779018304
38779018305
38779018308
49452608902
49452608903
49452608904
51552091004
51552091005
51927160600
54868387300
55390000310
63323060401
63370020525
63370020535
63370020545
66860009002
00002751001
00002751101
00002751201
00002751659
00002821501
00002821517
00002831501
00002861501
00002871501
00002872559
00002873059
00002877059
00002879359
00002879459
00002879759
00002879859
00002879959
00002951501
00088222033
00088222052
00088222060
00088250033
00088250052
00169183311
00169183411
00169183711
12/19/2013
HCPCS Description
INJECTION, IRON DEXTRAN 267, 50 MG
INJECTION, IRON SUCROSE, 1 MG
INJECTION, IRON SUCROSE, 1 MG
INJECTION, IRON SUCROSE, 1 MG
INJECTION, IRON SUCROSE, 1 MG
INJECTION, IRON SUCROSE, 1 MG
INJECTION, IRON SUCROSE, 1 MG
INJECTION, IMIGLUCERASE, PER UNIT
INJECTION, IMIGLUCERASE, PER UNIT
INJECTION, DROPERIDOL, UP TO 5 MG
INJECTION, DROPERIDOL, UP TO 5 MG
INJECTION, DROPERIDOL, UP TO 5 MG
INJECTION, DROPERIDOL, UP TO 5 MG
INJECTION, DROPERIDOL, UP TO 5 MG
INJECTION, DROPERIDOL, UP TO 5 MG
INJECTION, DROPERIDOL, UP TO 5 MG
INJECTION, DROPERIDOL, UP TO 5 MG
INJECTION, DROPERIDOL, UP TO 5 MG
INJECTION, DROPERIDOL, UP TO 5 MG
INJECTION, PROPRANOLOL HCL, UP TO 1
INJECTION, PROPRANOLOL HCL, UP TO 1
INJECTION, PROPRANOLOL HCL, UP TO 1
INJECTION, PROPRANOLOL HCL, UP TO 1
INJECTION, PROPRANOLOL HCL, UP TO 1
INJECTION, PROPRANOLOL HCL, UP TO 1
INJECTION, PROPRANOLOL HCL, UP TO 1
INJECTION, PROPRANOLOL HCL, UP TO 1
INJECTION, PROPRANOLOL HCL, UP TO 1
INJECTION, PROPRANOLOL HCL, UP TO 1
INJECTION, PROPRANOLOL HCL, UP TO 1
INJECTION, PROPRANOLOL HCL, UP TO 1
INJECTION, PROPRANOLOL HCL, UP TO 1
INJECTION, PROPRANOLOL HCL, UP TO 1
INJECTION, PROPRANOLOL HCL, UP TO 1
INJECTION, PROPRANOLOL HCL, UP TO 1
INJECTION, PROPRANOLOL HCL, UP TO 1
INJECTION, PROPRANOLOL HCL, UP TO 1
INJECTION, PROPRANOLOL HCL, UP TO 1
INJECTION, PROPRANOLOL HCL, UP TO 1
INSULIN 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INSULIN 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
Earliest Start
Date
01/01/2006
05/01/2007
01/01/2003
10/01/2006
12/23/2010
10/01/2008
10/01/2008
01/01/2002
01/01/2002
08/23/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/08/2003
01/01/2002
02/15/2007
01/15/2004
05/05/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
11/15/2004
11/15/2004
11/15/2004
09/01/2003
09/01/2003
09/08/2003
12/11/2006
01/01/2002
01/01/2002
07/08/2003
07/08/2003
07/08/2003
01/01/2003
01/01/2006
01/01/2003
11/01/2006
01/01/2003
01/01/2003
01/01/2010
01/01/2003
01/01/2003
01/01/2003
01/01/2003
01/01/2003
01/01/2003
01/20/2006
01/01/2003
12/10/2007
12/10/2007
12/10/2007
01/01/2003
01/01/2003
01/10/2005
07/09/2007
01/01/2006
01/24/2006
01/01/2003
01/01/2003
01/01/2003
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/01/2007
12/31/2078
08/01/2013
12/31/2078
12/31/2078
11/01/2011
07/01/2012
12/31/2078
12/31/2078
12/31/2078
05/31/2010
12/31/2078
06/30/2013
12/31/2078
12/31/2078
09/30/2011
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1815
J1817
J1817
J1817
J1817
J1817
J1817
J1817
J1817
J1817
J1817
J1830
J1835
J1835
J1835
J1835
J1835
J1835
J1835
00169231321
00169231421
00169231721
00169330312
00169347318
00169347418
00169347718
00169368213
00169368512
00169369619
00169633910
00169643910
00169750111
23490668700
49999099310
49999099410
54569231800
54569231900
54569291800
54569291802
54569346700
54569383300
54569383302
54569383500
54569383502
54569560500
54868142901
54868238001
54868274600
54868347400
54868359800
54868361900
54868438100
54868462600
54868520100
54868532700
54868576500
54868582400
54868589900
55045350601
55045350801
55045368501
58016478801
68115070905
68115072810
68115072905
68115083910
00002751001
00002850101
00088250033
00088250205
00169750111
35356010200
54868277700
54868510800
54868583600
68115074610
50419052325
38779193101
49452384501
49452384502
49452384503
49452384504
50458029801
51552092002
12/19/2013
HCPCS Description
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INSULIN 5 UNITS
INSULIN 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INJECTION, INSULIN, PER 5 UNITS
INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP)
INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP)
INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP)
INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP)
INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP)
INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP)
INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP)
INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP)
INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP)
INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP)
INJECTION INTERFERON BETA-1B, 0.25 MG (CODE MAY BE USED FOR
INJECTION, ITRACONAZOLE, 50 MG
INJECTION, ITRACONAZOLE, 50 MG
INJECTION, ITRACONAZOLE, 50 MG
INJECTION, ITRACONAZOLE, 50 MG
INJECTION, ITRACONAZOLE, 50 MG
INJECTION, ITRACONAZOLE, 50 MG
INJECTION, ITRACONAZOLE, 50 MG
Earliest Start
Date
01/01/2003
01/01/2003
01/01/2003
01/01/2003
01/01/2003
01/01/2003
01/01/2003
01/01/2003
02/10/2003
01/01/2003
02/10/2003
03/27/2006
07/01/2003
04/30/2007
06/14/2007
06/14/2007
01/01/2003
01/01/2003
01/01/2003
09/22/2003
01/01/2003
01/01/2003
09/22/2003
01/01/2003
09/22/2003
02/16/2006
01/01/2003
07/16/2007
01/01/2003
01/01/2003
06/30/2005
01/01/2003
01/01/2003
01/01/2003
12/28/2004
06/09/2005
04/04/2007
10/16/2007
05/12/2008
06/28/2006
06/30/2006
11/15/2006
02/01/2006
03/17/2004
03/17/2004
03/17/2004
01/20/2004
01/01/2003
01/01/2003
01/24/2006
03/04/2009
01/01/2003
03/07/2008
05/07/2007
07/15/2004
12/03/2007
02/12/2004
01/02/2004
04/25/2002
01/01/2003
01/01/2003
01/01/2003
01/01/2003
01/01/2002
09/01/2003
Latest End
Date
07/31/2011
11/30/2011
01/31/2012
12/31/2078
07/31/2011
10/31/2011
07/31/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/29/2008
12/31/2078
Page 1 of 1
HCPCS
NDC
J1835
J1835
J1835
J1835
J1835
J1835
J1835
J1835
J1835
J1835
J1835
J1835
J1835
J1835
J1840
J1840
J1840
J1840
J1840
J1840
J1840
J1840
J1840
J1840
J1840
J1840
J1840
J1840
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
51552092004
51552092005
51552092006
51927330600
62991256201
62991256202
62991256203
63275996302
63275996304
63275996305
63275996309
63370012215
63370012225
63370012235
38779198101
38779198104
38779198105
38779198108
49452388501
49452388502
49452388503
51552091301
51552091302
51927315800
63323035903
63370012420
63370012425
63370012435
00074228754
00074379601
00409228721
00409228722
00409228731
00409228761
00409228821
00409228831
00409379301
00409379349
00409379501
00409379549
00409379561
00409379601
00409379649
00409379661
00517060125
00517080125
00517090225
10019002109
10019002209
10019002232
10019002902
10019002912
10019003003
10019003004
10019003012
10019003017
12280045610
21695058825
23490579204
49452391901
49452391902
49452391903
49452391905
49999041602
54868384300
12/19/2013
Earliest Start
Date
HCPCS Description
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
ITRACONAZOLE, 50 MG
ITRACONAZOLE, 50 MG
ITRACONAZOLE, 50 MG
ITRACONAZOLE, 50 MG
ITRACONAZOLE, 50 MG
ITRACONAZOLE, 50 MG
ITRACONAZOLE, 50 MG
ITRACONAZOLE, 50 MG
ITRACONAZOLE, 50 MG
ITRACONAZOLE, 50 MG
ITRACONAZOLE, 50 MG
ITRACONAZOLE, 50 MG
ITRACONAZOLE, 50 MG
ITRACONAZOLE, 50 MG
KANAMYCIN SULFATE, UP TO 500 MG
KANAMYCIN SULFATE, UP TO 500 MG
KANAMYCIN SULFATE, UP TO 500 MG
KANAMYCIN SULFATE, UP TO 500 MG
KANAMYCIN SULFATE, UP TO 500 MG
KANAMYCIN SULFATE, UP TO 500 MG
KANAMYCIN SULFATE, UP TO 500 MG
KANAMYCIN SULFATE, UP TO 500 MG
KANAMYCIN SULFATE, UP TO 500 MG
KANAMYCIN SULFATE, UP TO 500 MG
KANAMYCIN SULFATE, UP TO 500 MG
KANAMYCIN SULFATE, UP TO 500 MG
KANAMYCIN SULFATE, UP TO 500 MG
KANAMYCIN SULFATE, UP TO 500 MG
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
KETOROLAC TROMETHAMINE, PER 15
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
09/01/2003
09/01/2003
09/01/2003
09/08/2003
11/01/2005
11/01/2005
11/01/2005
06/04/2004
06/04/2004
06/04/2004
06/04/2004
07/08/2003
07/08/2003
07/08/2003
04/25/2002
04/25/2002
04/25/2002
04/25/2002
01/29/2002
01/29/2002
01/29/2002
09/01/2003
09/01/2003
09/08/2003
01/03/2003
07/08/2003
07/08/2003
07/08/2003
01/01/2002
01/01/2002
06/22/2007
06/22/2007
04/25/2005
06/20/2005
06/22/2007
08/29/2005
05/31/2005
04/19/2005
01/06/2006
09/21/2005
10/31/2005
12/21/2005
11/07/2005
08/05/2005
04/01/2008
04/01/2008
04/01/2008
01/01/2002
01/01/2002
01/01/2002
07/21/2004
05/05/2007
07/21/2004
07/21/2004
05/05/2007
05/05/2007
10/04/2005
08/09/2007
04/09/2007
01/01/2003
01/01/2003
01/01/2003
01/01/2003
07/06/2004
06/21/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/01/2007
04/01/2012
10/01/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/01/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
10/31/2013
12/31/2078
05/31/2013
08/31/2013
05/31/2013
08/31/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1885
J1930
J1930
J1930
J1930
J1931
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
J1940
54868441900
54868441901
55390048001
55390048101
55390048102
55390048110
58016941301
60505070500
60505070600
60505070601
60505072501
60505072601
60505072602
63323016101
63323016201
63323016202
64679075701
64679075702
64679075801
64679075802
64679075804
64679075805
64679075806
66860008503
15054006001
15054009001
15054012001
15054012002
58468007001
00074963104
00409127532
00409163910
00409610202
00409610204
00409610210
00409963104
00517570225
00517570425
00517571025
00548143100
21695072125
23490562102
38779022604
38779022605
38779022608
49452322201
49452322202
49452322203
51552094002
51927178400
52637001010
54868229900
54868364500
54868499800
63323028002
63323028004
63323028010
64679075901
64679075902
64679075903
64679075904
64679075905
64679075906
64679075907
64679075908
12/19/2013
HCPCS Description
INJECTION, KETOROLAC TROMETHAMINE,
INJECTION, KETOROLAC TROMETHAMINE,
INJECTION, KETOROLAC TROMETHAMINE,
INJECTION, KETOROLAC TROMETHAMINE,
INJECTION, KETOROLAC TROMETHAMINE,
INJECTION, KETOROLAC TROMETHAMINE,
INJECTION, KETOROLAC TROMETHAMINE,
INJECTION, KETOROLAC TROMETHAMINE,
INJECTION, KETOROLAC TROMETHAMINE,
INJECTION, KETOROLAC TROMETHAMINE,
INJECTION, KETOROLAC TROMETHAMINE,
INJECTION, KETOROLAC TROMETHAMINE,
INJECTION, KETOROLAC TROMETHAMINE,
INJECTION, KETOROLAC TROMETHAMINE,
INJECTION, KETOROLAC TROMETHAMINE,
INJECTION, KETOROLAC TROMETHAMINE,
INJECTION, KETOROLAC TROMETHAMINE,
INJECTION, KETOROLAC TROMETHAMINE,
INJECTION, KETOROLAC TROMETHAMINE,
INJECTION, KETOROLAC TROMETHAMINE,
INJECTION, KETOROLAC TROMETHAMINE,
INJECTION, KETOROLAC TROMETHAMINE,
INJECTION, KETOROLAC TROMETHAMINE,
KETOROLAC, 15MG INJ
INJECTION, LANREOTIDE, 1 MG
INJECTION, LANREOTIDE, 1 MG
INJECTION, LANREOTIDE, 1 MG
INJECTION, LANREOTIDE, 1 MG
INJECTION, LARONIDASE, 0.1 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, FUROSEMIDE, UP TO 20 MG
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
15
15
15
15
15
15
15
15
15
15
15
15
15
15
15
15
15
15
15
15
15
15
15
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
Earliest Start
Date
01/01/2002
10/17/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
02/28/2005
02/28/2005
02/28/2005
11/01/2004
11/01/2004
11/01/2004
01/01/2002
01/01/2002
01/01/2002
04/12/2007
04/12/2007
04/12/2007
04/12/2007
04/12/2007
04/12/2007
04/12/2007
09/01/2008
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2005
01/01/2002
08/31/2005
01/23/2006
02/18/2005
02/21/2005
03/24/2005
04/21/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
03/20/2008
04/30/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2004
09/01/2003
09/08/2003
01/01/2002
09/29/2005
01/01/2002
02/18/2004
01/01/2002
01/01/2002
01/01/2002
04/12/2007
04/12/2007
04/12/2007
04/12/2007
04/12/2007
04/12/2007
04/12/2007
04/12/2007
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/01/2007
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/31/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/28/2010
11/30/2009
12/31/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J1940
J1945
J1950
J1950
J1950
J1950
J1950
J1955
J1955
J1955
J1955
J1955
J1955
J1955
J1955
J1955
J1955
J1955
J1955
J1955
J1955
J1955
J1955
J1955
J1956
J1956
J1956
J1956
J1956
J1956
J1956
J1956
J1956
J1956
J1956
J1956
J1956
J1956
J1956
J1956
J1956
J1960
J1960
J1960
J1960
J1960
J1960
J1960
J1960
J1960
J1960
J1960
J1980
J1980
J1980
J1980
J1980
J1980
J1980
J1990
J2001
J2001
J2001
J2001
J2001
64679075909
50419015057
00074364103
00300364101
00300366301
54868282500
54868327700
00517104525
00703040402
00703040502
49452177501
49452177502
49452177503
49452177601
49452177602
51927186500
54482014701
55390013605
55390043605
63370041435
63370041445
63370041450
63370041453
88395006764
00045006555
00045006601
00045006701
00045006801
00045006951
00045151501
00781334209
25021013282
25021082582
38779236305
50458016420
50458016601
50458016701
50458016801
55045353201
62991270702
62991270703
00406073552
38779088503
38779088506
49452920101
49452920105
49452920106
51927100700
63275120001
63275120002
63275120004
63275120007
00091153605
49452365601
49452365602
51552014102
51552014104
51927183100
68220011105
00187375574
00074132305
00074490334
00074621702
00186011001
00186011201
12/19/2013
HCPCS Description
INJECTION, FUROSEMIDE, UP TO 20 MG
INJECTION, LEPIRUDIN, 50 MG
LEUPROLIDE ACETATE, 3.75MG
INJECTION, LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), PER 3.
LEUPROLIDE ACETATE, 3.75MG
INJECTION, LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), PER 3.
INJECTION, LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), PER 3.
INJECTION, LEVOCARNITINE, PER 1 GM
INJECTION, LEVOCARNITINE, PER 1 GM
INJECTION, LEVOCARNITINE, PER 1 GM
INJECTION, LEVOCARNITINE, PER 1 GM
INJECTION, LEVOCARNITINE, PER 1 GM
INJECTION, LEVOCARNITINE, PER 1 GM
INJECTION, LEVOCARNITINE, PER 1 GM
INJECTION, LEVOCARNITINE, PER 1 GM
INJECTION, LEVOCARNITINE, PER 1 GM
INJECTION, LEVOCARNITINE, PER 1 GM
INJECTION, LEVOCARNITINE, PER 1 GM
INJECTION, LEVOCARNITINE, PER 1 GM
INJECTION, LEVOCARNITINE, PER 1 GM
INJECTION, LEVOCARNITINE, PER 1 GM
INJECTION, LEVOCARNITINE, PER 1 GM
INJECTION, LEVOCARNITINE, PER 1 GM
INJECTION, LEVOCARNITINE, PER 1 GM
INJECTION, LEVOFLOXACIN, 250 MG
INJECTION, LEVOFLOXACIN, 250 MG
INJECTION, LEVOFLOXACIN, 250 MG
INJECTION, LEVOFLOXACIN, 250 MG
INJECTION, LEVOFLOXACIN, 250 MG
INJECTION, LEVOFLOXACIN, 250 MG
INJ, LEVOFLOXACIN, PER 250MG
LEVOFLOXACIN INJ, PER 250 MG
LEVOFLOXACIN INJ, PER 250 MG
INJECTION, LEVOFLOXACIN, 250 MG
LEVOLFLOXACIN 250MG INJ
LEVOFLOXACIN INJ, PER 250 MG
LEVOFLOXACIN INJ, PER 250 MG
INJ, LEVOFLOXACIN, PER 250MG
INJECTION, LEVOFLOXACIN, 250 MG
INJECTION, LEVOFLOXACIN, 250 MG
INJECTION, LEVOFLOXACIN, 250 MG
INJECTION, LEVORPHANOL TARTRATE, UP TO 2 MG
INJECTION, LEVORPHANOL TARTRATE, UP TO 2 MG
INJECTION, LEVORPHANOL TARTRATE, UP TO 2 MG
INJECTION, LEVORPHANOL TARTRATE, UP TO 2 MG
INJECTION, LEVORPHANOL TARTRATE, UP TO 2 MG
INJECTION, LEVORPHANOL TARTRATE, UP TO 2 MG
INJECTION, LEVORPHANOL TARTRATE, UP TO 2 MG
INJECTION, LEVORPHANOL TARTRATE, UP TO 2 MG
INJECTION, LEVORPHANOL TARTRATE, UP TO 2 MG
INJECTION, LEVORPHANOL TARTRATE, UP TO 2 MG
INJECTION, LEVORPHANOL TARTRATE, UP TO 2 MG
INJECTION, HYOSCYAMINE SULFATE, UP TO 0.25 MG
INJECTION, HYOSCYAMINE SULFATE, UP TO 0.25 MG
INJECTION, HYOSCYAMINE SULFATE, UP TO 0.25 MG
INJECTION, HYOSCYAMINE SULFATE, UP TO 0.25 MG
INJECTION, HYOSCYAMINE SULFATE, UP TO 0.25 MG
INJECTION, HYOSCYAMINE SULFATE, UP TO 0.25 MG
INJ, HYOSCAMINE SULFATE, 0.25MG
INJECTION, CHLORDIAZEPOXIDE HCL, UP TO 100 MG
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS INFUSION, 10 MG
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS INFUSION, 10 MG
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS INFUSION, 10 MG
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS INFUSION, 10 MG
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS INFUSION, 10 MG
Earliest Start
Date
04/12/2007
01/01/2006
09/09/2009
01/01/2002
01/01/2006
03/10/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2004
01/01/2002
01/01/2002
12/04/2003
01/01/2002
01/01/2002
01/01/2002
10/24/2006
10/24/2006
10/24/2006
10/24/2006
09/03/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
11/05/2004
07/08/2011
07/07/2011
12/28/2011
10/25/2007
11/01/2009
08/04/2010
08/04/2010
08/04/2010
01/02/2007
01/01/2008
01/01/2008
01/01/2002
11/22/2002
11/22/2002
11/14/2004
11/15/2004
11/15/2004
09/08/2003
12/03/2002
12/03/2002
12/03/2002
12/03/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
09/08/2003
09/01/2009
01/01/2002
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
Latest End
Date
12/31/2078
06/20/2014
12/31/2078
08/01/2011
10/01/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
05/31/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/31/2011
12/31/2011
12/31/2011
12/31/2011
09/30/2010
02/28/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/01/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/12/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/01/2007
08/01/2007
12/31/2078
05/31/2013
12/31/2012
Page 1 of 1
HCPCS
NDC
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
00186011291
00186012001
00186013501
00186013701
00186014501
00186015501
00186021003
00186021503
00186023003
00186023203
00186023503
00186024044
00186024113
00186024213
00186024312
00186024444
00186024554
00186025502
00186027512
00186027613
00186027713
00186027844
00264959410
00264959420
00264959810
00264959820
00338040902
00338040903
00338041102
00409132305
00409206605
00409405601
00409427001
00409427501
00409427601
00409427602
00409427701
00409427702
00409427801
00409427902
00409428201
00409428202
00409428301
00409471302
00409471332
00409477601
00409490334
00409490434
00409793124
00409793132
00409793932
00409913705
00517062525
00517062625
00548107800
00548107900
00548108000
00548108100
00548119000
00548119200
00548219000
00548339000
08888713115
08888713123
08888713131
12/19/2013
HCPCS Description
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
LIDOCAINE
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
HCL
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INTRAVENOUS
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
Earliest Start
Date
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
12/08/2005
09/06/2005
10/31/2005
02/27/2006
12/30/2005
08/12/2005
07/07/2005
06/13/2005
08/12/2005
06/29/2005
08/31/2005
09/09/2005
02/08/2006
05/16/2005
11/21/2005
09/06/2005
02/06/2006
12/01/2005
08/23/2005
05/18/2005
09/16/2005
01/11/2006
06/30/2005
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
Latest End
Date
01/31/2013
10/31/2012
12/31/2012
03/31/2013
05/31/2013
05/31/2013
02/28/2013
06/30/2012
03/31/2013
10/31/2012
03/31/2013
12/31/2078
06/30/2013
05/31/2013
10/31/2012
12/31/2078
12/31/2078
12/31/2078
09/30/2012
05/31/2013
06/30/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
05/31/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/30/2012
07/31/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
06/30/2011
11/30/2008
08/31/2011
09/30/2014
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2001
J2010
J2010
08888714113
12280023001
17317073501
17317073502
17317073503
17317073504
17317073506
35356018050
38779008204
38779008205
38779008208
38779008209
49452405001
49452405002
49452405003
49999067150
51552010604
51552010605
51552010606
51552010609
51927121300
54569531200
54569531201
54868179500
54868179801
54868206400
54868206401
54868233100
54868233101
54868339200
54868389400
54868429800
54868571900
55045323101
55045324905
55553005550
55553005650
58016484001
58016933101
62991109501
62991109502
62991109503
62991109504
62991109506
63275999104
63275999105
63275999108
63323020102
63323020110
63323020202
63323020805
63323048450
63323049205
63323049257
63323049505
63323049507
63323049527
63370014514
63370014525
63370014535
63370014550
63370014555
66312017014
00009055501
00009055502
12/19/2013
HCPCS Description
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
LIDOCAINE HCL FOR INFUSION, PER 10MG
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
LIDOCAINE HCL FOR INFUSION, PER 10MG
LIDOCAINE HCL FOR INFUSION, PER 10MG
LIDOCAINE HCL FOR INFUSION, PER 10MG
LIDOCAINE HCL FOR INFUSION, PER 10MG
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INJECTION, LINCOMYCIN HCL, UP TO 300 MG
INJECTION, LINCOMYCIN HCL, UP TO 300 MG
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
INFUSION, 10 MG
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
INFUSION,
10
10
10
10
10
10
MG
MG
MG
MG
MG
MG
Earliest Start
Date
01/01/2004
08/16/2005
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
05/16/2008
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
05/16/2008
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
11/08/2007
11/08/2007
01/01/2004
01/01/2004
01/01/2004
06/23/2006
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
12/11/2006
07/01/2006
07/01/2006
01/01/2004
01/01/2004
02/01/2006
08/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
04/01/2008
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
07/02/2010
10/01/2004
01/20/2011
02/26/2010
08/05/2011
09/30/1990
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
08/15/2006
01/01/2002
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
05/30/2014
03/30/2014
12/31/2078
01/30/2015
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J2010
J2010
J2010
J2010
J2010
J2010
J2010
J2020
J2020
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
38779003404
38779003405
38779003408
51552067405
51552067407
51927317700
54569138700
00009513701
00009514001
00409153931
00409198501
00409198505
00409198510
00409198530
00409677802
00409677862
00409677902
00409678002
00409678102
00591336545
00591336570
00641604425
10019010201
10019010210
10019010237
10019010239
10019010301
10019010310
10019010337
10019010339
10019010501
10019010502
10019010544
10019010571
10019010601
10019010602
10019010644
10019010671
17478004001
38779092701
38779092703
38779092704
38779092705
38779092706
38779092708
49452414001
49452414002
49452414003
49452414004
51552072901
51552072902
51552072904
51552072905
51552072909
51927100500
54868356600
54868356601
54868356602
55390016810
55390016910
55390017010
55390017110
60977011201
60977011202
60977011271
12/19/2013
HCPCS Description
INJECTION, LINCOMYCIN HCL, UP
INJECTION, LINCOMYCIN HCL, UP
INJECTION, LINCOMYCIN HCL, UP
INJECTION, LINCOMYCIN HCL, UP
INJECTION, LINCOMYCIN HCL, UP
INJECTION, LINCOMYCIN HCL, UP
INJECTION, LINCOMYCIN HCL, UP
INJECTION, LINEZOLID, 200MG
INJECTION, LINEZOLID, 200MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
LORAZEPAM INJ PER 2MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
TO
TO
TO
TO
TO
TO
TO
300
300
300
300
300
300
300
MG
MG
MG
MG
MG
MG
MG
Earliest Start
Date
01/01/2002
01/01/2002
08/26/2002
09/01/2003
09/01/2003
09/08/2003
01/01/2002
01/01/2002
01/01/2002
12/23/2005
04/25/2005
02/08/2008
11/16/2005
06/01/2005
01/27/2006
06/28/2005
01/05/2006
12/29/2005
01/23/2006
02/22/2005
02/22/2005
04/01/2012
01/01/2002
01/01/2002
05/05/2007
05/05/2007
01/01/2002
01/01/2002
05/05/2007
05/05/2007
05/03/2006
05/03/2006
05/05/2007
05/05/2007
05/03/2006
05/03/2006
05/05/2007
05/05/2007
03/28/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/08/2003
01/01/2002
01/01/2002
01/10/2007
09/13/2006
09/13/2006
09/13/2006
09/13/2006
02/13/2004
02/13/2004
05/05/2007
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/01/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/31/2008
08/30/2008
12/31/2078
02/28/2014
08/31/2013
08/31/2013
02/28/2014
01/31/2014
12/31/2013
12/31/2078
01/31/2014
11/30/2013
09/30/2013
11/30/2013
09/30/2013
01/31/2014
12/31/2013
01/31/2014
12/31/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/28/2014
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2060
J2150
J2150
J2150
J2150
J2150
J2150
J2150
J2150
J2150
J2150
J2150
J2150
J2150
J2150
J2150
J2150
J2150
J2150
J2150
J2150
J2150
J2150
J2150
J2150
J2150
J2150
J2150
J2150
J2170
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
60977011281
60977011301
60977011302
60977011371
60977011381
62991168201
62991168202
63275997902
63275997904
63275997905
63370093510
63370093515
63370093525
63370093535
00409403101
00517405025
10106255505
17317101001
17317101003
17317101005
17317101008
17317101101
17317101105
17317101108
17317101109
17317101201
17317101203
17317101208
38779059901
38779059908
38779059909
49452438001
49452438002
49452438003
51552038001
51552038005
51552038006
51552038008
51552038009
51927178100
62991156801
63323002425
15054104005
00074117921
00074117930
00074118130
00074120301
00074125502
00074603004
00338269175
00406158555
00409117630
00409117830
00409117930
00409118069
00409118130
00409120120
00409120301
00409125301
00409125401
00409125502
00409125601
00409603004
00641605225
00641605425
12/19/2013
Earliest Start
Date
HCPCS Description
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, LORAZEPAM, 2 MG
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MANNITOL, 25% IN 50 ML
INJECTION, MECASERMIN, 1 MG
INJECTION, MEPERIDINE HYDROCHLORIDE,
INJECTION, MEPERIDINE HYDROCHLORIDE,
INJECTION, MEPERIDINE HYDROCHLORIDE,
INJECTION, MEPERIDINE HYDROCHLORIDE,
INJECTION, MEPERIDINE HYDROCHLORIDE,
INJECTION, MEPERIDINE HYDROCHLORIDE,
INJECTION, MEPERIDINE HYDROCHLORIDE,
INJECTION, MEPERIDINE HYDROCHLORIDE,
INJECTION, MEPERIDINE HYDROCHLORIDE,
INJECTION, MEPERIDINE HYDROCHLORIDE,
INJECTION, MEPERIDINE HYDROCHLORIDE,
INJECTION, MEPERIDINE HYDROCHLORIDE,
INJECTION, MEPERIDINE HYDROCHLORIDE,
INJECTION, MEPERIDINE HYDROCHLORIDE,
INJECTION, MEPERIDINE HYDROCHLORIDE,
INJECTION, MEPERIDINE HYDROCHLORIDE,
INJECTION, MEPERIDINE HYDROCHLORIDE,
INJECTION, MEPERIDINE HYDROCHLORIDE,
INJECTION, MEPERIDINE HYDROCHLORIDE,
INJECTION, MEPERIDINE HYDROCHLORIDE,
MEPERIDINE, 100MG INJ
MEPERIDINE, 100MG INJ
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
05/05/2007
02/13/2004
02/13/2004
05/05/2007
05/05/2007
10/01/2002
10/01/2002
12/04/2002
12/04/2002
12/04/2002
07/08/2003
07/08/2003
07/08/2003
07/08/2003
10/19/2004
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
12/04/2003
09/15/2003
01/01/2002
01/01/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
08/25/2005
09/14/2005
12/08/2005
09/14/2005
01/31/2006
03/09/2006
12/16/2005
01/04/2006
03/20/2006
11/23/2005
01/26/2006
01/02/2007
10/07/2011
12/01/2011
Latest End
Date
02/28/2014
01/31/2014
12/31/2013
12/31/2013
01/31/2014
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
05/01/2007
09/01/2009
11/01/2009
05/01/2009
09/01/2007
09/30/2010
01/31/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2175
J2185
J2185
J2185
J2185
J2185
J2210
J2210
J2212
J2212
J2212
J2212
J2248
J2248
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
10019015568
10019015768
10019015868
10019015901
10019015944
10019016001
10019016044
10019016101
10019016144
10019016201
10019016244
38779176603
38779176604
38779176605
49452003101
49452003102
49452003103
51552068601
51552068602
51552068604
51552068606
51927101800
54868061600
54868323001
54868361000
54868475100
54868475101
54868580800
58298054325
61553017041
61553017248
61553017348
63275710004
63275710005
63370093715
63370093725
63370093735
00310032130
00310032165
00310032520
00310032564
00409350601
00078005303
00517074020
65649055102
65649055103
65649055204
65649055305
00469321110
00469325010
00074259603
00409230502
00409230505
00409230517
00409230549
00409230550
00409230561
00409230562
00409230622
00409230662
00409230721
00409230760
00409230801
00409230802
00409230849
12/19/2013
HCPCS Description
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, MEROPENEM, 100 MG
INJECTION, MEROPENEM, 100 MG
INJECTION, MEROPENEM, 100 MG
INJECTION, MEROPENEM, 100 MG
MEROPENEM INJ, PER 100MG
INJECTION, METHYLERGONOVINE MALEATE, UP TO 0.2 MG
METHYLERGONOVINE, INJ, PER 0.2MG
INJ, METHYLNALTREXONE, 0.1MG
INJ, METHYLNALTREXONE, 0.1MG
INJ, METHYLNALTREXONE, 0.1MG
INJ, METHYLNALTREXONE, 0.1MG
INJECTION, MICAFUNGIN SODIUM, 1 MG
INJECTION, MICAFUNGIN SODIUM, 1 MG
INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG
INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG
INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG
MIDAZOLAM 1MG INJ
INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG
INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG
INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG
INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG
INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG
INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG
INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG
INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG
INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG
INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG
INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG
Earliest Start
Date
03/27/2002
03/27/2002
03/27/2002
01/07/2004
05/05/2007
01/07/2004
05/05/2007
01/07/2004
05/05/2007
01/07/2004
05/05/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/08/2003
01/01/2002
01/01/2002
01/01/2002
03/11/2003
07/03/2003
08/21/2007
04/03/2006
02/02/2004
02/02/2004
02/02/2004
12/03/2002
12/03/2002
07/08/2003
07/08/2003
07/08/2003
01/01/2004
07/17/2006
01/01/2004
07/17/2006
06/24/2010
01/01/2002
06/21/2010
01/01/2013
01/01/2013
01/01/2013
01/01/2013
01/01/2007
01/01/2007
01/01/2002
08/15/2005
12/21/2005
10/01/2007
08/02/2005
09/13/2005
10/03/2005
10/03/2005
07/20/2007
03/10/2005
07/20/2007
04/25/2005
06/07/2005
10/10/2005
12/29/2005
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
02/28/2013
02/28/2013
04/30/2013
04/30/2013
09/28/2009
09/28/2009
03/31/2013
03/31/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/18/2015
12/31/2078
01/31/2014
12/31/2078
03/31/2015
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
05/01/2012
12/31/2078
12/31/2078
05/01/2012
12/31/2078
07/01/2011
08/01/2011
01/01/2012
12/31/2078
06/01/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2250
J2260
J2260
J2260
J2260
00409230850
00409258705
00409258753
00409259603
00409259605
00409259652
00409259653
00641605710
00641605910
10019002701
10019002702
10019002703
10019002704
10019002705
10019002709
10019002710
10019002729
10019002736
10019002737
10019002739
10019002764
10019002802
10019002803
10019002804
10019002805
10019002810
10019002836
10019002837
10019002839
23490593201
23490593301
23490593302
54868458000
54868571100
55045285701
55045288702
55390012510
55390012605
55390012610
55390013702
55390013705
55390013801
55390013802
59911591102
59911591402
59911591502
61703032107
61703032132
61703032142
61703032153
63323041110
63323041112
63323041125
63323041202
63323041205
63323041210
63323041225
66758001801
66758001802
66758001901
66758001902
00024120301
00024120302
00024120315
00074277501
12/19/2013
HCPCS Description
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
MIDAZOLAM 1MG INJ
MIDAZOLAM 1MG INJ
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
MIDAZOLAM 1MG INJ
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
MIDAZOLAM 1MG INJ
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
MIDAZOLAM 1MG INJ
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MIDAZOLAM HYDROCHLORIDE,
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
PER
PER
PER
PER
PER
PER
PER
1
1
1
1
1
1
1
MG
MG
MG
MG
MG
MG
MG
PER
PER
PER
PER
PER
1
1
1
1
1
MG
MG
MG
MG
MG
PER
PER
PER
PER
PER
1
1
1
1
1
MG
MG
MG
MG
MG
PER 1 MG
PER 1 MG
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
Earliest Start
Date
11/18/2005
01/27/2006
03/07/2006
10/28/2005
01/11/2006
01/23/2006
09/27/2005
04/01/2012
01/01/2012
12/08/2005
01/01/2002
12/10/2003
12/10/2003
12/08/2005
06/21/2000
01/01/2002
05/05/2007
05/05/2007
05/05/2007
05/05/2007
04/01/2009
12/08/2005
12/10/2003
06/21/2000
01/01/2002
01/01/2002
05/05/2007
05/05/2007
05/05/2007
04/30/2007
04/30/2007
04/30/2007
01/01/2002
12/27/2006
12/01/2005
08/27/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
12/08/2003
01/01/2002
01/01/2002
01/01/2002
01/07/2004
10/02/2003
10/02/2003
10/02/2003
10/02/2003
01/01/2002
01/01/2002
01/01/2002
06/05/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/28/2011
12/31/2078
03/28/2011
12/31/2078
10/30/2008
06/30/2013
05/31/2013
12/31/2078
12/31/2078
12/31/2078
05/31/2013
06/30/2013
04/28/2011
04/28/2011
11/30/2013
10/31/2013
10/31/2013
12/31/2078
10/31/2013
10/31/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
11/30/2008
03/31/2009
12/31/2078
01/01/2007
Page 1 of 1
HCPCS
NDC
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2260
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
00143970801
00143970910
00143971810
00143971910
00338601048
00338601137
00409277502
00409277602
00409277623
00703800503
00703800603
00703800801
10019007001
10019007002
10019007010
10019007020
10139005710
10139005720
55390001910
55390002010
55390002101
55390007410
55390007510
55390007601
59911590502
59911590602
59911590702
60505071800
60505071801
61703024221
61703024232
61703024250
63323061710
63323061720
63323061750
67457016020
00074602804
00338268975
00338269075
00409125830
00409126069
00409126130
00409176230
00409189001
00409189101
00409381512
00409405812
00409606202
00409606211
00409617714
00409617914
00548191125
00548193110
00548193310
00548193700
00548290125
00548339110
00548604225
00548604325
00548604525
00641017021
00641017025
00641606801
00641607025
00641607325
12/19/2013
HCPCS Description
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MILRINONE LACTATE, 5 MG
INJECTION, MORPHINE SULFATE, UP TO
INJECTION, MORPHINE SULFATE, UP TO
INJECTION, MORPHINE SULFATE, UP TO
INJECTION, MORPHINE SULFATE, UP TO
INJECTION, MORPHINE SULFATE, UP TO
INJECTION, MORPHINE SULFATE, UP TO
INJECTION, MORPHINE SULFATE, UP TO
MS04 2MG/ML
MS04 4MG/ML
INJECTION, MORPHINE SULFATE, UP TO
INJECTION, MORPHINE SULFATE, UP TO
INJECTION, MORPHINE SULFATE, UP TO
INJECTION, MORPHINE SULFATE, UP TO
INJECTION, MORPHINE SULFATE, UP TO
INJECTION, MORPHINE SULFATE, UP TO
INJECTION, MORPHINE SULFATE, UP TO
INJECTION, MORPHINE SULFATE, UP TO
INJECTION, MORPHINE SULFATE, UP TO
INJECTION, MORPHINE SULFATE, UP TO
INJECTION, MORPHINE SULFATE, UP TO
INJECTION, MORPHINE SULFATE, UP TO
INJECTION, MORPHINE SULFATE, UP TO
INJECTION, MORPHINE SULFATE, UP TO
INJECTION, MORPHINE SULFATE, UP TO
INJECTION, MORPHINE SULFATE, UP TO
INJECTION, MORPHINE SULFATE, UP TO
INJECTION, MORPHINE SULFATE, UP TO
INJECTION, MORPHINE SULFATE, UP TO
INJECTION, MORPHINE SULFATE, UP TO
10
10
10
10
10
10
10
MG
MG
MG
MG
MG
MG
MG
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
10
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
Earliest Start
Date
03/29/2011
03/29/2011
02/23/2011
02/23/2011
06/05/2002
06/05/2002
12/31/2004
03/08/2006
06/15/2005
06/19/2003
06/19/2003
06/19/2003
05/22/2002
05/22/2002
05/05/2007
05/05/2007
04/15/2005
04/07/2005
05/31/2002
05/31/2002
05/31/2002
05/31/2002
05/31/2002
05/31/2002
05/31/2002
05/31/2002
05/31/2002
02/28/2005
02/28/2005
09/23/2002
09/23/2002
09/23/2002
05/14/2002
05/14/2002
05/14/2002
10/30/2003
01/01/2002
01/01/2002
01/01/2002
05/10/2005
03/22/2006
07/21/2005
05/27/2005
08/23/2012
09/23/2012
06/28/2005
10/07/2005
01/10/2006
07/22/2005
07/14/2005
09/01/2005
01/01/2002
01/01/2002
01/01/2002
01/23/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
12/08/2004
01/01/2002
02/08/2012
02/08/2012
02/08/2012
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/31/2008
06/30/2008
12/31/2078
06/30/2013
06/30/2013
06/30/2013
06/30/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/29/2012
02/29/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/01/2008
09/30/2010
12/31/2078
09/01/2013
10/01/2013
03/01/2014
11/01/2013
12/31/2078
12/31/2078
12/31/2078
08/01/2011
07/01/2011
10/01/2011
12/31/2078
12/31/2078
12/31/2078
09/30/2011
02/28/2009
02/28/2009
10/31/2010
08/31/2012
02/28/2010
10/31/2008
03/31/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2270
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
J2271
00641607525
10019017639
10019017644
10019017737
10019017739
10019017744
10019017768
10019017836
10019017837
10019017839
10019017844
10019017862
10019017868
10019017939
54868418900
54868475200
54868475201
54868480400
54868574500
61553017741
61553017848
61553017948
61553018102
61553018348
61553018502
61553018667
61553018775
61703022321
00406152153
00406152155
00406152156
00406152157
00409113403
00409113405
00409126431
00409602804
00574200625
00641019021
00641019025
00641607125
00641607201
10019017936
10019017944
10019017963
10019017968
38779067303
38779067304
38779067305
38779067307
49452002801
49452002802
49452002803
49452002804
51552067802
51552067804
51552067806
51927100000
54868405000
58298054501
58298054502
61553064975
61553065176
61703022521
61703022543
63275102504
12/19/2013
HCPCS Description
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
MORPHINE
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
SULFATE,
UP TO 10
UP TO 10
UP TO 10
UP TO 10
UP TO 10
UP TO 10
UP TO 10
UP TO 10
UP TO 10
UP TO 10
UP TO 10
UP TO 10
UP TO 10
UP TO 10
UP TO 10
UP TO 10
UP TO 10
UP TO 10
UP TO 10
UP TO 10
UP TO 10
UP TO 10
UP TO 10
UP TO 10
UP TO 10
UP TO 10
UP TO 10
UP TO 10
100MG
100MG
100MG
100MG
100MG
100MG
100MG
100MG
100MG
100MG
100MG
100 MG
100 MG
100MG
100MG
100MG
100MG
100MG
100MG
100MG
100MG
100MG
100MG
100MG
100MG
100MG
100MG
100MG
100MG
100MG
100MG
100MG
100MG
100MG
100MG
100MG
100MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
Earliest Start
Date
02/08/2012
08/21/1998
01/01/2002
05/05/2007
09/13/2001
01/01/2002
01/01/2002
05/05/2007
08/21/1998
05/05/2007
12/22/2005
01/01/2002
01/01/2002
05/05/1999
01/01/2002
03/11/2003
05/26/2004
05/30/2003
01/10/2007
02/02/2004
02/02/2004
02/02/2004
02/02/2004
02/02/2004
02/02/2004
02/02/2004
02/02/2004
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/14/2005
08/08/2005
12/16/2005
03/23/2007
01/01/2002
12/08/2004
01/01/2002
02/08/2012
02/08/2012
05/05/2007
01/01/2002
01/01/2002
09/06/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
09/01/2003
09/08/2003
01/01/2002
04/03/2006
04/03/2006
03/03/2005
03/03/2005
01/01/2002
01/01/2002
12/03/2002
Latest End
Date
12/31/2078
10/31/2013
10/31/2013
01/13/2012
01/31/2013
01/31/2013
01/13/2012
07/31/2013
01/13/2012
11/30/2013
11/30/2013
07/31/2013
01/13/2012
01/31/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
06/01/2013
12/31/2078
01/31/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
10/31/2013
01/31/2013
10/31/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J2271
J2271
J2271
J2271
J2271
J2275
J2275
J2275
J2275
J2275
J2275
J2275
J2275
J2275
J2275
J2275
J2275
J2275
J2275
J2275
J2275
J2275
J2275
J2275
J2275
J2275
J2275
J2275
J2275
J2275
J2275
J2275
J2275
J2275
J2275
J2275
J2275
J2278
J2278
J2278
J2278
J2278
J2278
J2280
J2300
J2300
J2300
J2300
J2300
J2300
J2300
J2300
J2300
J2300
J2300
J2300
J2300
J2300
J2300
J2300
J2300
J2300
J2300
J2300
J2300
63275110005
63370095025
63370095035
63370095045
63370095050
00186115002
00186115102
00186115212
00186115312
00186115903
00186116003
00409113502
00409189001
00409189101
00409189301
00409189401
00409381412
00409381512
00409405712
00555112710
00555112810
00555112910
00555113010
00641601910
00641602010
00641603901
00641604001
60977001602
60977001673
60977001701
60977001773
60977011401
60977011474
60977011501
60977011574
63323029180
63323029280
18860072010
18860072210
18860072310
59075072010
59075072210
59075072310
00085173701
00409146301
00409146401
00409146501
00409146701
00555111909
00555112009
00555112105
00555112205
23490595501
49452480001
49452480002
49452480003
51927214000
54569411200
54569579500
54868347100
54868360800
54868360801
54868360900
54868368600
54868368601
12/19/2013
Earliest Start
Date
HCPCS Description
INJECTION, MORPHINE SULFATE, 100MG
INJECTION, MORPHINE SULFATE, 100MG
INJECTION, MORPHINE SULFATE, 100MG
INJECTION, MORPHINE SULFATE, 100MG
INJECTION, MORPHINE SULFATE, 100MG
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
MSO4 PF PER 10MG
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE
INJ, MSO4, PF, PER 10MG
MSO4, PF, PER 10MG
INJECTION, ZICONOTIDE, 1 MICROGRAM
INJECTION, ZICONOTIDE, 1 MICROGRAM
INJECTION, ZICONOTIDE, 1 MICROGRAM
INJECTION, ZICONOTIDE, 1 MICROGRAM
INJECTION, ZICONOTIDE, 1 MICROGRAM
INJECTION, ZICONOTIDE, 1 MICROGRAM
INJECTION, MOXIFLOXACIN, 100 MG
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
SOLUT
SOLUT
SOLUT
SOLUT
SOLUT
SOLUT
SOLUT
SOLUT
SOLUT
SOLUT
SOLUT
SOLUT
SOLUT
SOLUT
SOLUT
SOLUT
SOLUT
SOLUT
SOLUT
SOLUT
SOLUT
SOLUT
SOLUT
SOLUT
SOLUT
SOLUT
SOLUT
SOLUT
SOLUT
12/03/2002
07/08/2003
07/08/2003
07/08/2003
07/08/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
07/21/2005
08/23/2012
08/06/2012
08/15/2012
08/10/2012
07/19/2005
09/30/1990
12/13/2005
07/10/2007
07/10/2007
07/10/2007
07/10/2007
07/03/2012
07/03/2012
07/25/2012
07/25/2012
01/15/2004
05/05/2007
01/15/2004
05/05/2007
01/01/2004
05/05/2007
01/01/2004
05/05/2007
10/01/2009
02/26/2010
01/31/2011
01/31/2011
01/31/2011
01/01/2006
01/01/2006
01/01/2006
08/17/2005
03/09/2005
07/13/2005
11/18/2004
05/12/2005
05/25/2007
05/25/2007
05/25/2007
05/25/2007
04/09/2007
01/29/2002
01/29/2002
01/29/2002
09/08/2003
01/01/2002
05/12/2006
01/01/2002
01/01/2002
05/24/2007
01/01/2002
01/01/2002
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/28/2012
03/31/2012
08/31/2011
12/31/2078
11/30/2011
04/30/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/01/2012
06/30/2011
03/31/2011
10/31/2010
10/31/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/28/2015
02/28/2015
02/28/2015
02/28/2015
10/31/2014
10/31/2014
09/30/2014
09/30/2014
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
04/01/2013
04/01/2013
01/01/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
04/30/2011
11/30/2010
03/31/2011
02/28/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
Earliest Start
Date
Latest End
Date
00078018101 INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR IN
01/01/2004
12/31/2078
J2354
00078018201 INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR IN
01/01/2004
12/31/2078
J2354
00078018325 INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR IN
01/01/2004
12/31/2078
J2354
00078018425 INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR IN
01/01/2004
12/31/2078
HCPCS
NDC
J2300
J2300
J2300
J2300
J2300
J2310
J2310
J2310
J2310
J2310
J2310
J2310
J2310
J2310
J2310
J2310
J2310
J2310
J2310
J2310
J2310
J2310
J2310
J2310
J2310
J2310
J2310
J2310
J2315
J2321
J2321
J2321
J2321
J2321
J2321
J2321
J2321
J2321
J2321
J2321
J2321
J2321
J2321
J2321
J2321
J2321
J2322
J2322
J2322
J2322
J2323
J2323
J2325
J2353
J2353
J2353
J2354
58016477001
58016938401
63481043210
63481043310
63481050905
00074121901
00074178221
00406149252
00409121201
00409121501
00409121901
00409178269
00548146600
00548146900
00548336600
00548336900
38779076703
38779076706
49452483602
49452483603
49452483604
51927333500
54569524700
54868074800
54868206200
55045351501
63481035810
76329336901
63459030042
00591671702
00591671747
49452483803
49452483804
49452483805
51552104302
51927351400
54868555500
62991218602
62991218603
62991218604
62991218605
63370095510
63370095515
63370095525
63370095535
63370095545
00591218653
00591218654
54868489300
54868489301
59075073015
64406000801
65847020525
00078034061
00078034161
00078034261
00078018001
J2354
12/19/2013
HCPCS Description
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG
INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG
INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG
INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG
INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG
INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG
INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG
INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG
INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG
INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG
INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG
INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG
INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG
INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG
INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG
INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG
INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG
INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG
INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG
INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG
INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG
INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG
NALOXONE HCL, 1MG/ML
INJECTION, NALTREXONE, DEPOT FORM, 1 MG
INJECTION, NANDROLONE DECANOATE, UP TO 100 MG
INJECTION, NANDROLONE DECANOATE, UP TO 100 MG
INJECTION, NANDROLONE DECANOATE, UP TO 100 MG
INJECTION, NANDROLONE DECANOATE, UP TO 100 MG
INJECTION, NANDROLONE DECANOATE, UP TO 100 MG
INJECTION, NANDROLONE DECANOATE, UP TO 100 MG
INJECTION, NANDROLONE DECANOATE, UP TO 100 MG
INJECTION, NANDROLONE DECANOATE, UP TO 100 MG
INJECTION, NANDROLONE DECANOATE, UP TO 100 MG
INJECTION, NANDROLONE DECANOATE, UP TO 100 MG
INJECTION, NANDROLONE DECANOATE, UP TO 100 MG
INJECTION, NANDROLONE DECANOATE, UP TO 100 MG
INJECTION, NANDROLONE DECANOATE, UP TO 100 MG
INJECTION, NANDROLONE DECANOATE, UP TO 100 MG
INJECTION, NANDROLONE DECANOATE, UP TO 100 MG
INJECTION, NANDROLONE DECANOATE, UP TO 100 MG
INJECTION, NANDROLONE DECANOATE, UP TO 100 MG
INJECTION, NANDROLONE DECANOATE, UP TO 200 MG
INJECTION, NANDROLONE DECANOATE, UP TO 200 MG
INJECTION, NANDROLONE DECANOATE, UP TO 200 MG
INJECTION, NANDROLONE DECANOATE, UP TO 200 MG
INJECTION, NATALIZUMAB, 1 MG
INJECTION, NATALIZUMAB, 1 MG
INJECTION, NESIRITIDE, 0.1 MG
INJECTION, OCTREOTIDE, DEPOT FORM FOR INTRAMUSCULAR INJECTIO
INJECTION, OCTREOTIDE, DEPOT FORM FOR INTRAMUSCULAR INJECTIO
INJECTION, OCTREOTIDE, DEPOT FORM FOR INTRAMUSCULAR INJECTIO
INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR IN
02/01/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/07/2005
01/01/2002
01/01/2002
06/16/2005
07/08/2005
04/03/2006
09/29/2005
01/01/2002
01/01/2002
01/15/2002
01/15/2002
01/01/2002
01/01/2002
04/15/2002
04/16/2002
04/16/2002
09/08/2003
01/01/2002
01/01/2002
01/01/2002
07/12/2006
01/01/2002
04/19/2012
01/01/2007
04/29/2003
04/29/2003
01/01/2003
01/01/2003
01/01/2003
09/01/2003
09/08/2003
04/11/2006
01/01/2008
01/01/2008
01/01/2008
01/01/2008
07/08/2003
07/08/2003
07/08/2003
07/08/2003
07/08/2003
07/09/2003
07/09/2003
08/13/2003
08/14/2003
01/01/2008
04/02/2013
01/01/2006
07/26/2004
08/18/2004
07/14/2004
01/01/2004
12/31/2078
12/31/2078
01/31/2007
11/30/2006
10/31/2006
11/01/2006
12/31/2078
12/31/2078
01/01/2012
12/31/2078
12/31/2078
12/31/2078
05/31/2008
01/31/2014
05/31/2008
02/28/2014
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/30/2006
12/31/2078
05/31/2010
12/31/2078
06/30/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
06/30/2009
12/31/2078
12/31/2078
12/31/2078
10/31/2016
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
J2354
J2354
00703330101 OCTREOTIDE 25MCG, SC OR IV
00703330104 INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR IN
J2354
J2354
00703331101 OCTREOTIDE 25MCG, SC OR IV
00703331104 INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR IN
01/01/2007
11/14/2005
12/31/2078
12/31/2078
J2354
J2354
00703332101 OCTREOTIDE 25MCG, SC OR IV
00703332104 INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR IN
01/01/2007
11/14/2005
12/31/2078
12/31/2078
J2354
00703333301 INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR IN
11/23/2005
12/31/2078
J2354
00703334301 INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR IN
11/23/2005
12/31/2078
J2354
00781916475 INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR IN
04/07/2005
06/29/2014
J2354
00781916575 INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR IN
04/07/2005
11/17/2014
J2354
00781916695 INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR IN
04/07/2005
12/31/2078
J2354
00781916795 INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR IN
04/07/2005
12/31/2078
J2354
00781916895 INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR IN
04/07/2005
12/31/2078
J2354
55390016010 INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR IN
05/04/2005
12/31/2078
J2354
55390016110 INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR IN
04/04/2005
12/31/2078
J2354
55390016210 INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR IN
04/04/2005
12/31/2078
J2354
55390016301 INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR IN
05/25/2005
12/31/2078
J2354
55390016401 INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR IN
05/25/2005
12/31/2078
J2354
J2354
62756034844 OCTREOTIDE 25MCG, SC OR IV
63323036501 INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR IN
10/19/2007
04/13/2006
12/31/2078
12/31/2078
J2354
63323037601 INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR IN
04/13/2006
12/31/2078
J2354
63323037701 INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR IN
04/13/2006
12/31/2078
J2354
63323037805 INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR IN
05/12/2006
12/31/2078
J2354
63323037905 INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR IN
05/12/2006
12/31/2078
J2355
J2355
J2355
J2355
J2357
J2360
J2360
J2360
J2360
J2360
J2360
J2360
J2360
J2360
J2360
J2360
J2360
J2360
J2360
J2370
J2370
J2370
54868556900
58394000401
58394000402
58394000408
50242004062
00089054006
00463109210
00591322247
10139023010
11584101602
11584101605
17478053802
49452493601
49452493602
51552083905
51927211800
52959017906
55390005910
55553012910
00074180001
00409180001
00517029925
04/13/2006
01/01/2002
01/01/2002
09/01/2008
01/01/2005
01/01/2002
01/01/2002
09/07/2004
01/05/2007
01/01/2002
01/01/2002
10/01/2006
05/15/2002
05/15/2002
09/01/2003
09/08/2003
01/01/2002
04/28/2003
01/01/2002
01/01/2002
04/14/2005
01/01/2002
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
10/31/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/01/2010
08/01/2014
12/31/2078
12/19/2013
INJECTION, OPRELVEKIN, 5 MG
INJECTION, OPRELVEKIN, 5 MG
INJECTION, OPRELVEKIN, 5 MG
OPRELEVKIN, 5MG
INJECTION, OMALIZUMAB, 5 MG
INJECTION, ORPHENADRINE CITRATE, UP TO 60
INJECTION, ORPHENADRINE CITRATE, UP TO 60
INJECTION, ORPHENADRINE CITRATE, UP TO 60
INJECTION, ORPHENADRINE CITRATE, UP TO 60
INJECTION, ORPHENADRINE CITRATE, UP TO 60
INJECTION, ORPHENADRINE CITRATE, UP TO 60
INJECTION, ORPHENADRINE CITRATE, UP TO 60
INJECTION, ORPHENADRINE CITRATE, UP TO 60
INJECTION, ORPHENADRINE CITRATE, UP TO 60
INJECTION, ORPHENADRINE CITRATE, UP TO 60
INJECTION, ORPHENADRINE CITRATE, UP TO 60
INJECTION, ORPHENADRINE CITRATE, UP TO 60
INJECTION, ORPHENADRINE CITRATE, UP TO 60
INJECTION, ORPHENADRINE CITRATE, UP TO 60
INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML
INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML
INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
01/01/2007
11/14/2005
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J2370
J2370
J2370
J2370
J2370
J2370
J2370
J2370
J2370
J2370
J2400
J2400
J2400
J2400
J2400
J2400
J2400
J2400
J2400
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
00517040525
00703163104
10019016301
10019016312
54868571600
66758001601
66758001602
66758001603
66758001604
66758001701
00186097166
00186097266
00186099166
00186099266
00409416901
00409417001
54868492500
55390040320
55390040420
00143977106
00143989105
00173044200
00173044202
00173046100
00338176241
00409112062
00409475501
00409475502
00409475503
00409475561
00409475562
00409475901
00409476013
00641607825
00641608001
00641608025
00703722102
00703722103
00703722104
00703722601
00703722603
00703723939
00781301072
00781301095
00781305714
00781305780
10019090501
10019090502
10019090503
10019090517
10019090603
10019090663
23360001602
23360001620
25021077702
54569587400
54868450900
54868588800
55390012101
55390012110
55390030701
55390030710
60505074401
60505074406
61703024407
12/19/2013
Earliest Start
Date
HCPCS Description
INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML
INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML
INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML
INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML
INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML
INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML
INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML
INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML
INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML
INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML
INJECTION, CHLOROPROCAINE HYDROCHLORIDE, PER 30
INJECTION, CHLOROPROCAINE HYDROCHLORIDE, PER 30
INJECTION, CHLOROPROCAINE HYDROCHLORIDE, PER 30
INJECTION, CHLOROPROCAINE HYDROCHLORIDE, PER 30
INJECTION, CHLOROPROCAINE HYDROCHLORIDE, PER 30
INJECTION, CHLOROPROCAINE HYDROCHLORIDE, PER 30
INJECTION, CHLOROPROCAINE HYDROCHLORIDE, PER 30
INJECTION, CHLOROPROCAINE HYDROCHLORIDE, PER 30
INJECTION, CHLOROPROCAINE HYDROCHLORIDE, PER 30
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
ONDANSETRON HCL INJ, PER 1MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
ONDANSETRON HCL INJ, PER 1MG
ONDANSETRON HCL INJ, PER 1MG
ONDANSETRON HCL INJ, PER 1MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
ONDANSETRON HCL INJ, PER 1MG
ONDANSETRON HCL INJ, PER 1MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
ONDANSETRON HCL INJ, PER 1MG
ONDANSETRON HCL INJ, PER 1MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
ONDANSETRON HCL INJ, PER 1MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
ML
ML
ML
ML
ML
ML
ML
ML
ML
01/01/2002
01/01/2002
01/01/2002
01/01/2002
12/11/2006
01/08/2004
01/08/2004
06/08/2005
06/08/2005
01/08/2004
01/01/2002
01/01/2002
01/01/2002
01/01/2002
06/20/2005
04/20/2005
09/25/2003
01/01/2002
01/01/2002
02/05/2009
04/03/2007
01/01/2002
01/01/2002
01/01/2002
12/27/2006
01/22/2007
12/26/2006
08/24/2007
01/01/2009
12/26/2006
10/01/2007
12/26/2006
02/01/2007
11/09/2011
11/09/2011
11/09/2011
11/22/2006
11/22/2006
11/22/2006
11/22/2006
11/22/2006
11/22/2006
01/01/2009
01/01/2009
11/22/2006
11/22/2006
12/26/2006
06/04/2009
06/24/2009
05/05/2007
12/26/2006
05/05/2007
10/15/2008
10/15/2008
09/17/2012
01/12/2007
01/01/2002
05/09/2008
12/26/2006
12/26/2006
12/26/2006
12/26/2006
12/26/2006
12/26/2006
12/26/2006
Latest End
Date
12/31/2078
10/31/2012
08/30/2011
07/31/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
04/30/2010
12/31/2078
01/01/2013
07/01/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/31/2012
04/01/2009
07/25/2012
03/01/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
11/01/2011
12/31/2078
12/31/2078
12/31/2078
06/30/2011
12/31/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/31/2011
01/31/2010
09/30/2013
09/30/2013
09/30/2013
09/30/2013
07/31/2013
07/31/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2405
J2410
J2410
J2425
J2425
J2426
J2426
J2426
J2426
J2426
J2430
J2430
J2430
J2430
J2430
J2430
J2430
J2430
J2430
J2430
J2430
J2430
J2430
J2430
J2430
J2430
J2430
J2430
J2430
J2430
J2430
J2430
J2430
J2430
J2440
J2440
J2440
J2440
J2440
J2440
J2440
J2440
J2440
J2440
J2440
J2440
J2440
J2440
J2440
J2440
J2440
J2440
61703024522
61703041549
62756018101
62756018201
62991259901
62991259902
63275995501
63275995506
63275995507
63323037302
63323037420
64679072601
64679072701
66860008706
63481044410
63481062410
55513052001
55513052006
50458056001
50458056101
50458056201
50458056301
50458056401
00078046391
00078046461
00703407559
00703408551
00703408591
00781314784
00781314870
15210040111
15210040211
55390012701
55390012901
55390015701
55390015901
55390020401
55390060401
61703032418
61703032439
61703032518
61703032618
61703035618
63323073410
63323073435
63323073510
63323073535
00517400225
00517401001
17317039801
17317039804
38779045403
38779045404
38779045405
49452500001
49452500002
49452500003
51552041602
51552041604
51552041605
51552041607
51927177500
55390010710
62991120302
62991120304
12/19/2013
Earliest Start
Date
HCPCS Description
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
ONDANSETRON HCL INJ, PER 1MG
INJECTION, OXYMORPHONE HCL, UP TO 1 MG
INJECTION, OXYMORPHONE HCL, UP TO 1 MG
INJECTION, PALIFERMIN, 50 MICROGRAMS
INJECTION, PALIFERMIN, 50 MICROGRAMS
INJECTION, PALIPERIDONE PALMITATE EXTENDED RELEASE,
INJECTION, PALIPERIDONE PALMITATE EXTENDED RELEASE,
INJECTION, PALIPERIDONE PALMITATE EXTENDED RELEASE,
INJECTION, PALIPERIDONE PALMITATE EXTENDED RELEASE,
INJECTION, PALIPERIDONE PALMITATE EXTENDED RELEASE,
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
INJECTION, PAPAVERINE HCL, UP TO 60 MG
INJECTION, PAPAVERINE HCL, UP TO 60 MG
INJECTION, PAPAVERINE HCL, UP TO 60 MG
INJECTION, PAPAVERINE HCL, UP TO 60 MG
INJECTION, PAPAVERINE HCL, UP TO 60 MG
INJECTION, PAPAVERINE HCL, UP TO 60 MG
INJECTION, PAPAVERINE HCL, UP TO 60 MG
INJECTION, PAPAVERINE HCL, UP TO 60 MG
INJECTION, PAPAVERINE HCL, UP TO 60 MG
INJECTION, PAPAVERINE HCL, UP TO 60 MG
INJECTION, PAPAVERINE HCL, UP TO 60 MG
INJECTION, PAPAVERINE HCL, UP TO 60 MG
INJECTION, PAPAVERINE HCL, UP TO 60 MG
INJECTION, PAPAVERINE HCL, UP TO 60 MG
INJECTION, PAPAVERINE HCL, UP TO 60 MG
INJECTION, PAPAVERINE HCL, UP TO 60 MG
INJECTION, PAPAVERINE HCL, UP TO 60 MG
INJECTION, PAPAVERINE HCL, UP TO 60 MG
1
1
1
1
1
MG
MG
MG
MG
MG
12/26/2006
12/26/2006
12/27/2006
12/27/2006
01/01/2006
01/01/2006
01/27/2005
01/27/2005
01/27/2005
12/27/2006
12/27/2006
12/26/2006
12/26/2006
09/01/2008
01/01/2002
05/07/2007
01/01/2006
01/01/2006
09/01/2009
09/01/2009
09/01/2009
09/01/2009
09/01/2009
07/13/2006
07/13/2006
11/08/2005
11/08/2005
07/01/2003
10/03/2005
10/03/2005
07/12/2006
07/12/2006
01/01/2002
01/01/2002
01/01/2003
01/01/2003
04/02/2002
04/02/2002
12/15/2006
09/15/2005
01/27/2003
09/15/2005
12/15/2006
04/25/2002
07/20/2004
04/25/2002
09/11/2003
09/15/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/08/2003
01/01/2002
01/01/2002
09/15/2003
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/29/2012
09/30/2011
12/31/2078
12/31/2078
12/31/2078
02/28/2010
05/31/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/31/2012
08/31/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J2440
J2440
J2440
J2440
J2440
J2440
J2440
J2440
J2440
J2460
J2460
J2460
J2469
J2469
J2469
J2469
J2501
J2501
J2501
J2501
J2503
J2504
J2505
J2505
J2507
J2510
J2510
J2510
J2510
J2515
J2515
J2515
J2540
J2540
J2540
J2540
J2540
J2540
J2540
J2540
J2543
J2543
J2543
J2543
J2543
J2543
J2543
J2543
J2543
J2543
J2543
J2543
J2543
J2543
J2543
J2543
J2543
J2543
J2543
J2543
J2543
J2543
J2543
J2543
63275999002
63275999004
63275999005
63370016515
63370016525
63370016535
66758001401
66758001402
66758001501
38779004205
51552106902
51927325800
58063079725
58063079737
62856079701
62856079801
00074165801
00074165802
00074165805
00074463701
68782000101
57665000101
54868522900
55513019001
54396080101
60793013010
60793013110
61570008510
61570008610
51927361300
67386050152
67386050155
00049052083
00049053028
00338102141
00338102341
00338102541
00781613595
00781613694
54868448800
00206845216
00206845217
00206845417
00206845455
00206845517
00206845525
00206862011
00206882002
00206882102
00206882202
00206885216
00206885218
00206885408
00206885416
00206885418
00206885516
00206885518
00206885910
00206886002
00206886102
00206886202
00409338513
00409339004
60505068704
12/19/2013
HCPCS Description
INJECTION, PAPAVERINE HCL, UP TO 60 MG
INJECTION, PAPAVERINE HCL, UP TO 60 MG
INJECTION, PAPAVERINE HCL, UP TO 60 MG
INJECTION, PAPAVERINE HCL, UP TO 60 MG
INJECTION, PAPAVERINE HCL, UP TO 60 MG
INJECTION, PAPAVERINE HCL, UP TO 60 MG
INJECTION, PAPAVERINE HCL, UP TO 60 MG
INJECTION, PAPAVERINE HCL, UP TO 60 MG
INJECTION, PAPAVERINE HCL, UP TO 60 MG
INJECTION, OXYTETRACYCLINE HCL, UP TO 50 MG
INJECTION, OXYTETRACYCLINE HCL, UP TO 50 MG
INJECTION, OXYTETRACYCLINE HCL, UP TO 50 MG
INJECTION, PALONOSETRON HCL, 25 MCG
INJECTION, PALONOSETRON HCL, 25 MCG
INJECTION, PALONOSETRON HCL, 25 MCG
INJECTION, PALONOSETRON HCL, 25 MCG
INJECTION, PARICALCITOL, 1 MCG
INJECTION, PARICALCITOL, 1 MCG
PARACALCITOL, 1MCG
INJECTION, PARICALCITOL, 1 MCG
INJECTION, PEGAPTANIB SODIUM, 0.3 MG
INJECTION, PEGADEMASE BOVINE, 25 IU
INJECTION, PEGFILGRASTIM, 6 MG
INJECTION, PEGFILGRASTIM, 6 MG
INJECTION, PEGLOTICASE, 1 MG
INJECTION, PENICILLIN G PROCAINE, AQUEOUS, UP TO 600,000 UNI
INJECTION, PENICILLIN G PROCAINE, AQUEOUS, UP TO 600,000 UNI
INJECTION, PENICILLIN G PROCAINE, AQUEOUS, UP TO 600,000 UNI
INJECTION, PENICILLIN G PROCAINE, AQUEOUS, UP TO 600,000 UNI
INJECTION, PENTOBARBITAL SODIUM, PER 50 MG
INJECTION, PENTOBARBITAL SODIUM, PER 50 MG
INJECTION, PENTOBARBITAL SODIUM, PER 50 MG
INJECTION, PENICILLIN G POTASSIUM, UP TO 600,000 UNITS
INJECTION, PENICILLIN G POTASSIUM, UP TO 600,000 UNITS
INJECTION, PENICILLIN G POTASSIUM, UP TO 600,000 UNITS
INJECTION, PENICILLIN G POTASSIUM, UP TO 600,000 UNITS
INJECTION, PENICILLIN G POTASSIUM, UP TO 600,000 UNITS
INJECTION, PENICILLIN G POTASSIUM, UP TO 600,000 UNITS
INJECTION, PENICILLIN G POTASSIUM, UP TO 600,000 UNITS
INJECTION, PENICILLIN G POTASSIUM, UP TO 600,000 UNITS
INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.1
INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.1
INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.1
INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.1
INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.1
INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.1
INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.1
INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.1
INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.1
INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.1
INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.1
INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.1
PIPERCILLIN/TAZOBACTAM PER 1.125GM TOTAL
INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.1
INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.1
INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.1
INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.1
INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.1
INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.1
INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.1
INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.1
PIPERCILLIN/TAZOBACTAM PER 1.125GM TOTAL
INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/ 0.
PIPERACILLIN/TAZOBACTAM PER 1GM
Earliest Start
Date
12/04/2002
12/04/2002
12/04/2002
07/08/2003
07/08/2003
07/08/2003
02/20/2004
02/20/2004
02/20/2004
04/25/2002
09/01/2003
09/08/2003
01/01/2005
07/02/2008
04/01/2009
07/10/2008
01/01/2003
01/01/2003
05/25/2011
01/01/2003
01/01/2006
01/01/2006
02/23/2006
01/01/2004
01/01/2012
09/14/2007
09/14/2007
12/04/2002
12/06/2002
03/26/2004
06/11/2003
06/11/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
11/25/2002
11/25/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
04/05/2006
04/28/2006
10/01/2009
03/06/2006
04/05/2006
03/13/2006
04/05/2006
04/28/2006
01/09/2006
01/09/2006
01/09/2006
10/22/2010
10/22/2010
10/01/2009
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
05/31/2011
05/31/2011
09/30/2011
12/31/2078
12/31/2078
12/31/2078
08/31/2011
02/28/2011
12/31/2078
12/31/2078
12/31/2078
07/01/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/31/2014
08/31/2014
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/31/2007
08/31/2007
02/28/2008
06/30/2007
07/31/2007
11/30/2007
12/31/2007
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
06/30/2008
12/31/2078
06/30/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
J2545
54868252800 PENTAMIDINE ISETHIONATE, INHALATION SOLUTION, COMPOUNDED PRO
J2545
J2545
63323011310 PENTAMIDINE ISETHIONATE, INHALATION SOLUTION, FDA-APPROVED F
63323087715 PENTAMIDINE ISETHIONATE, INHALATION SOLUTION, COMPOUNDED PRO
07/05/1991
01/01/2007
12/31/2078
12/31/2078
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2550
J2560
00143986822
00143986922
00409231202
00409231231
00591315754
00591315783
00591315883
00641092821
00641092921
00641092925
00641094831
00641094931
00641095521
00641095621
00641149531
00641149631
00641608225
00703219104
00703220104
10019009701
10019009744
38779025304
38779025305
38779025308
38779025309
39822550003
49452608701
49452608702
49452608704
51552014701
51552014702
51552014704
51552014705
51927901800
54868026200
54868026201
54868059700
54868208800
54868269500
54868402100
55045351401
60977000101
60977000103
60977000143
60977000144
60977000202
60977000204
60977000243
60977000244
62991112501
62991112502
62991112504
63370020325
63370020335
63370020345
63370020350
66860009803
66860009903
67457015210
00409234331
08/04/2008
08/04/2008
08/29/2008
04/05/2005
01/20/2003
01/23/2003
01/23/2003
12/08/2004
12/08/2004
12/27/2002
12/08/2004
05/05/2007
05/05/2007
05/05/2007
05/05/2007
05/05/2007
01/01/2012
09/30/2002
09/30/2002
01/17/2005
05/05/2007
01/01/2002
01/01/2002
01/01/2002
09/03/2002
08/12/2011
02/28/2002
02/28/2002
02/28/2002
01/01/2002
09/01/2003
09/01/2003
09/01/2003
09/08/2003
01/01/2002
09/29/2005
01/01/2002
09/29/2005
01/01/2002
01/01/2002
07/12/2006
01/01/2004
10/21/2004
05/05/2007
05/05/2007
01/01/2004
10/21/2004
05/05/2007
05/05/2007
01/01/2002
01/01/2002
01/01/2002
07/08/2003
07/08/2003
07/08/2003
07/08/2003
03/26/2009
03/26/2009
07/01/2005
09/19/2005
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/31/2009
03/31/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
06/30/2013
06/30/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/31/2014
04/30/2013
01/31/2014
04/30/2013
04/30/2014
12/31/2078
04/30/2014
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/19/2013
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
PROMETHAZINE INJ UP TO 50MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
INJECTION, PHENOBARBITAL SODIUM, UP TO 120 MG
01/01/2007
12/31/2078
Page 1 of 1
HCPCS
NDC
J2560
J2560
J2560
J2560
J2560
J2560
J2560
J2560
J2562
J2590
J2590
J2590
J2590
J2590
J2590
J2590
J2590
J2590
J2590
J2590
J2590
J2590
J2590
J2590
J2597
J2597
J2597
J2597
J2597
J2597
J2597
J2597
J2597
J2650
J2650
J2650
J2650
J2650
J2650
J2650
J2650
J2650
J2650
J2650
J2650
J2670
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
00409234931
00641047621
00641047721
17317041301
38779085304
38779085305
49452520003
54868385901
58468014001
00591355369
00703627104
00703627503
10019029102
10019029104
10019029112
10019029171
42023011601
42023011625
61553073203
61570041605
63323001201
63323001210
63323001212
63323001230
00075245101
00075245153
00406806103
00409226501
00703505103
00703505401
54868388900
55566503001
55566504001
00463101930
00463102010
51927132500
52637032510
62991169201
62991169202
62991169203
63370019515
63370019525
63370019535
63370019550
63370019555
51927259300
00517075001
00574043000
00574043001
00574043025
00574043100
00574043101
00574043125
00574043200
00591312879
17317062601
17317062602
17317062603
17317062608
17317093401
17317093402
17317093403
17317093408
38779004301
38779004304
12/19/2013
HCPCS Description
INJECTION, PHENOBARBITAL SODIUM, UP TO 120 MG
INJECTION, PHENOBARBITAL SODIUM, UP TO 120 MG
INJECTION, PHENOBARBITAL SODIUM, UP TO 120 MG
INJECTION, PHENOBARBITAL SODIUM, UP TO 120 MG
INJECTION, PHENOBARBITAL SODIUM, UP TO 120 MG
INJECTION, PHENOBARBITAL SODIUM, UP TO 120 MG
INJECTION, PHENOBARBITAL SODIUM, UP TO 120 MG
INJECTION, PHENOBARBITAL SODIUM, UP TO 120 MG
PLERIXAFOR, 1MG
INJECTION, OXYTOCIN, UP TO 10 UNITS
INJECTION, OXYTOCIN, UP TO 10 UNITS
INJECTION, OXYTOCIN, UP TO 10 UNITS
INJECTION, OXYTOCIN, UP TO 10 UNITS
INJECTION, OXYTOCIN, UP TO 10 UNITS
INJECTION, OXYTOCIN, UP TO 10 UNITS
INJECTION, OXYTOCIN, UP TO 10 UNITS
INJECTION, OXYTOCIN, UP TO 10 UNITS
INJECTION, OXYTOCIN, UP TO 10 UNITS
INJECTION, OXYTOCIN, UP TO 10 UNITS
INJECTION, OXYTOCIN, UP TO 10 UNITS
INJECTION, OXYTOCIN, UP TO 10 UNITS
INJECTION, OXYTOCIN, UP TO 10 UNITS
INJECTION, OXYTOCIN, UP TO 10 UNITS
INJECTION, OXYTOCIN, UP TO 10 UNITS
INJECTION, DESMOPRESSIN ACETATE, PER 1 MCG
INJECTION, DESMOPRESSIN ACETATE, PER 1 MCG
INJECTION, DESMOPRESSIN ACETATE, PER 1 MCG
INJECTION, DESMOPRESSIN ACETATE, PER 1 MCG
INJECTION, DESMOPRESSIN ACETATE, PER 1 MCG
INJECTION, DESMOPRESSIN ACETATE, PER 1 MCG
INJECTION, DESMOPRESSIN ACETATE, PER 1 MCG
INJECTION, DESMOPRESSIN ACETATE, PER 1 MCG
INJECTION, DESMOPRESSIN ACETATE, PER 1 MCG
INJECTION, PREDNISOLONE ACETATE, UP TO 1 ML
INJECTION, PREDNISOLONE ACETATE, UP TO 1 ML
INJECTION, PREDNISOLONE ACETATE, UP TO 1 ML
INJECTION, PREDNISOLONE ACETATE, UP TO 1 ML
INJECTION, PREDNISOLONE ACETATE, UP TO 1 ML
INJECTION, PREDNISOLONE ACETATE, UP TO 1 ML
INJECTION, PREDNISOLONE ACETATE, UP TO 1 ML
INJECTION, PREDNISOLONE ACETATE, UP TO 1 ML
INJECTION, PREDNISOLONE ACETATE, UP TO 1 ML
INJECTION, PREDNISOLONE ACETATE, UP TO 1 ML
INJECTION, PREDNISOLONE ACETATE, UP TO 1 ML
INJECTION, PREDNISOLONE ACETATE, UP TO 1 ML
INJECTION, TOLAZOLINE HCL, UP TO 25 MG
INJECTION, PROGESTERONE, PER 50 MG
INJECTION, PROGESTERONE, PER 50 MG
INJECTION, PROGESTERONE, PER 50 MG
INJECTION, PROGESTERONE, PER 50 MG
INJECTION, PROGESTERONE, PER 50 MG
INJECTION, PROGESTERONE, PER 50 MG
INJECTION, PROGESTERONE, PER 50 MG
INJECTION, PROGESTERONE, PER 50 MG
INJECTION, PROGESTERONE, PER 50 MG
INJECTION, PROGESTERONE, PER 50 MG
INJECTION, PROGESTERONE, PER 50 MG
INJECTION, PROGESTERONE, PER 50 MG
INJECTION, PROGESTERONE, PER 50 MG
INJECTION, PROGESTERONE, PER 50 MG
INJECTION, PROGESTERONE, PER 50 MG
INJECTION, PROGESTERONE, PER 50 MG
INJECTION, PROGESTERONE, PER 50 MG
INJECTION, PROGESTERONE, PER 50 MG
INJECTION, PROGESTERONE, PER 50 MG
Earliest Start
Date
09/07/2005
12/08/2004
12/08/2004
01/01/2002
05/23/2002
05/23/2002
01/01/2002
01/01/2002
12/30/2008
12/06/2006
01/24/2008
01/24/2008
05/07/2007
05/07/2007
05/29/2007
05/29/2007
02/29/2008
02/01/2008
02/06/2004
01/01/2002
01/01/2002
01/01/2002
01/28/2008
09/24/2007
01/01/2002
01/01/2002
01/01/2002
02/04/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/08/2003
01/01/2002
09/01/2002
09/01/2002
09/01/2002
07/08/2003
07/08/2003
07/08/2003
07/08/2003
07/08/2003
09/08/2003
09/29/2010
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
12/17/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/28/2009
04/30/2011
01/28/2011
02/28/2013
01/31/2013
02/28/2013
01/31/2013
12/31/2078
12/31/2078
12/31/2078
05/31/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/31/2011
07/31/2010
12/31/2078
07/31/2010
07/31/2013
07/31/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
38779004305
38779004308
38779004309
38779005701
38779005704
38779005705
38779005709
38779031009
39822600001
39822600003
39822600007
39822610001
39822610003
39822610007
49452606002
49452606003
49452606004
49452606006
49452606102
49452606103
49452606104
49452606105
49452607001
49452607002
49452607003
49452607004
49452607006
49452608002
49452608003
49452608004
49452608006
51552000501
51552000503
51552000504
51552000505
51552000507
51552000601
51552000603
51552000604
51552000605
51552000607
51552064307
51552073804
51552073805
51552073806
51552073807
51552082901
51552082903
51552082904
51552082905
51552082906
51552082907
51552082908
51927104600
51927353000
51927901700
62991112203
62991112205
62991112402
62991112403
62991112405
62991218401
62991218402
62991218403
62991218404
12/19/2013
HCPCS Description
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PROGESTERONE,
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
Earliest Start
Date
01/01/2002
04/25/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/08/2003
09/08/2003
09/08/2003
09/15/2003
09/15/2003
01/01/2002
10/01/2007
10/01/2007
09/01/2002
09/01/2002
09/01/2002
09/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/28/2013
02/28/2013
02/28/2013
06/30/2013
06/30/2013
06/30/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2675
J2680
J2680
J2680
J2680
J2680
J2690
J2690
J2690
J2690
J2690
J2690
J2700
J2700
J2700
J2700
J2700
J2700
J2700
J2700
J2700
J2700
J2700
J2700
J2700
J2700
J2700
J2700
J2700
J2700
J2700
J2700
J2700
J2700
J2700
J2700
J2710
J2710
J2710
J2710
J2710
J2710
62991250402
62991250403
62991250404
63275998105
63275998108
63275998109
63323026110
63370019935
63370019945
63370019950
63370019955
63370019962
63370020035
63370020045
63370020050
63370020055
63370020235
63370020245
63370020250
63370020435
63370020445
63370020450
63370020455
63370020462
00703500301
51927223400
55390046505
60505066402
63323027205
00409190201
00409190301
51552039704
51552039705
51927311500
54868313600
00015797018
00015797089
00015798118
00015798189
00338101341
00338101541
00781309415
00781309492
00781309580
00781309592
00781309995
00781310180
00781310195
00781310395
00781910985
00781910995
00781911015
00781911092
00781911180
00781911195
00781911220
00781911292
00781911346
00781911395
00517003325
00517003425
00703270403
00703271103
00703271403
10019027010
12/19/2013
Earliest Start
Date
HCPCS Description
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
PROGESTERONE, PER 50 MG
PROGESTERONE, PER 50 MG
PROGESTERONE, PER 50 MG
PROGESTERONE, PER 50 MG
PROGESTERONE, PER 50 MG
PROGESTERONE, PER 50 MG
PROGESTERONE, PER 50 MG
PROGESTERONE, PER 50 MG
PROGESTERONE, PER 50 MG
PROGESTERONE, PER 50 MG
PROGESTERONE, PER 50 MG
PROGESTERONE, PER 50 MG
PROGESTERONE, PER 50 MG
PROGESTERONE, PER 50 MG
PROGESTERONE, PER 50 MG
PROGESTERONE, PER 50 MG
PROGESTERONE, PER 50 MG
PROGESTERONE, PER 50 MG
PROGESTERONE, PER 50 MG
PROGESTERONE, PER 50 MG
PROGESTERONE, PER 50 MG
PROGESTERONE, PER 50 MG
PROGESTERONE, PER 50 MG
PROGESTERONE, PER 50 MG
FLUPHENAZINE DECANOATE, UP TO 25 MG
FLUPHENAZINE DECANOATE, UP TO 25 MG
FLUPHENAZINE DECANOATE, UP TO 25 MG
FLUPHENAZINE DECANOATE, UP TO 25 MG
FLUPHENAZINE DECANOATE, UP TO 25 MG
PROCAINAMIDE HCL, UP TO 1 GM
PROCAINAMIDE HCL, UP TO 1 GM
PROCAINAMIDE HCL, UP TO 1 GM
PROCAINAMIDE HCL, UP TO 1 GM
PROCAINAMIDE HCL, UP TO 1 GM
PROCAINAMIDE HCL, UP TO 1 GM
OXACILLIN SODIUM, UP TO 250 MG
OXACILLIN SODIUM, UP TO 250 MG
OXACILLIN SODIUM, UP TO 250 MG
OXACILLIN SODIUM, UP TO 250 MG
OXACILLIN SODIUM, UP TO 250 MG
OXACILLIN SODIUM, UP TO 250 MG
OXACILLIN SODIUM, UP TO 250 MG
OXACILLIN SODIUM, UP TO 250 MG
OXACILLIN SODIUM, UP TO 250 MG
OXACILLIN SODIUM, UP TO 250 MG
OXACILLIN SODIUM, UP TO 250 MG
OXACILLIN SODIUM, UP TO 250 MG
OXACILLIN SODIUM, UP TO 250 MG
OXACILLIN SODIUM, UP TO 250 MG
OXACILLIN SODIUM, UP TO 250 MG
OXACILLIN SODIUM, UP TO 250 MG
OXACILLIN SODIUM, UP TO 250 MG
OXACILLIN SODIUM, UP TO 250 MG
OXACILLIN SODIUM, UP TO 250 MG
OXACILLIN SODIUM, UP TO 250 MG
OXACILLIN SODIUM, UP TO 250 MG
OXACILLIN SODIUM, UP TO 250 MG
OXACILLIN SODIUM, UP TO 250 MG
OXACILLIN SODIUM, UP TO 250 MG
NEOSTIGMINE METHYLSULFATE, UP TO 0.5
NEOSTIGMINE METHYLSULFATE, UP TO 0.5
NEOSTIGMINE METHYLSULFATE, UP TO 0.5
NEOSTIGMINE METHYLSULFATE, UP TO 0.5
NEOSTIGMINE METHYLSULFATE, UP TO 0.5
NEOSTIGMINE METHYLSULFATE, UP TO 0.5
MG
MG
MG
MG
MG
MG
09/15/2003
09/15/2003
09/15/2003
12/04/2002
12/04/2002
12/04/2002
01/01/2002
02/25/2004
02/25/2004
02/25/2004
02/25/2004
02/25/2004
12/19/2003
12/19/2003
07/08/2003
12/19/2003
07/12/2004
07/12/2004
07/12/2004
02/25/2004
02/25/2004
02/25/2004
02/25/2004
02/25/2004
01/01/2002
09/08/2003
01/01/2002
01/01/2002
01/01/2002
03/10/2006
08/24/2005
09/01/2003
09/01/2003
09/08/2003
02/18/2004
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
03/19/2008
03/19/2008
03/19/2008
03/19/2008
02/08/2005
02/01/2007
07/02/2004
08/31/2004
02/01/2007
03/01/2006
03/19/2008
03/19/2008
02/01/2007
05/04/2006
03/19/2008
03/19/2008
02/01/2007
05/03/2006
01/15/2003
01/15/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
04/30/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/28/2009
02/28/2009
07/31/2013
Page 1 of 1
HCPCS
NDC
J2710
J2710
J2710
J2710
J2710
J2710
J2715
J2720
J2720
J2720
J2720
J2720
J2720
J2720
J2724
J2724
J2725
J2730
J2730
J2730
J2730
J2730
J2730
J2730
J2760
J2760
J2760
J2760
J2760
J2760
J2760
J2760
J2760
J2760
J2760
J2760
J2760
J2760
J2760
J2760
J2760
J2760
J2760
J2760
J2760
J2760
J2760
J2760
J2760
J2760
J2765
J2765
J2765
J2765
J2765
J2765
J2765
J2765
J2765
J2765
J2765
J2765
J2765
J2765
J2765
10019027039
10019027102
10019027110
51552070102
63323038210
63323038310
00641605225
49452610901
49452610902
49452610903
63323022905
63323022915
63323022930
63323022935
00944417505
00944417510
51927348400
00641037401
49452597101
49452597102
49452597103
51927230000
60977014101
60977014127
38779150200
38779150203
38779150206
38779150209
49452521701
49452521702
49452521704
49452521705
51552049601
51552049602
51552049604
51552049605
51552049609
51927266900
55390011301
62991110801
62991110802
62991110803
62991110804
63275998901
63275998906
63275998907
63370017006
63370017009
63370017010
63370017015
00409217332
00409341301
00409341401
00703450204
10019045002
10019045039
23490591401
38779040301
38779040304
38779040305
49452471501
49452471502
49452471503
51552018003
51552018004
12/19/2013
HCPCS Description
NEOSTIGMINE, 0.5MG, INJ
INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG
INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG
INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG
INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG
INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
INJECTION, PROTAMINE SULFATE, PER 10 MG
INJECTION, PROTAMINE SULFATE, PER 10 MG
INJECTION, PROTAMINE SULFATE, PER 10 MG
INJECTION, PROTAMINE SULFATE, PER 10 MG
INJECTION, PROTAMINE SULFATE, PER 10 MG
INJECTION, PROTAMINE SULFATE, PER 10 MG
INJECTION, PROTAMINE SULFATE, PER 10 MG
INJECTION, PROTEIN C CONCENTRATE, INTRAVENOUS, HUMAN, 10 IU
INJECTION, PROTEIN C CONCENTRATE, INTRAVENOUS, HUMAN, 10 IU
INJECTION, PROTIRELIN, PER 250 MCG
INJECTION, PRALIDOXIME CHLORIDE, UP TO 1 GM
INJECTION, PRALIDOXIME CHLORIDE, UP TO 1 GM
INJECTION, PRALIDOXIME CHLORIDE, UP TO 1 GM
INJECTION, PRALIDOXIME CHLORIDE, UP TO 1 GM
INJECTION, PRALIDOXIME CHLORIDE, UP TO 1 GM
INJECTION, PRALIDOXIME CHLORIDE, UP TO 1 GM
INJECTION, PRALIDOXIME CHLORIDE, UP TO 1 GM
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
METOCLOPRAMIDE, 10MG, INJ
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
Earliest Start
Date
10/01/2009
01/01/2002
01/01/2002
09/01/2003
01/01/2002
01/01/2002
10/07/2011
01/01/2003
01/01/2003
01/01/2003
01/01/2002
01/07/2008
01/01/2002
01/07/2008
01/01/2008
01/01/2008
09/08/2003
12/08/2004
01/01/2003
01/01/2003
01/01/2003
12/04/2003
12/20/2004
05/05/2007
01/01/2002
05/22/2002
01/01/2002
05/22/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/08/2003
01/01/2002
01/01/2002
01/01/2002
09/15/2003
09/15/2003
12/04/2002
12/04/2002
12/04/2002
07/08/2003
07/08/2003
07/08/2003
07/08/2003
11/28/2005
04/21/2005
01/01/2007
01/01/2002
01/01/2002
05/05/2007
04/09/2007
04/25/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
Latest End
Date
07/31/2013
06/30/2007
07/31/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/31/2013
01/13/2012
01/13/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J2765
J2765
J2765
J2765
J2765
J2765
J2765
J2765
J2765
J2765
J2765
J2765
J2765
J2765
J2765
J2765
J2765
J2765
J2765
J2765
J2765
J2770
J2778
J2778
J2780
J2780
J2780
J2780
J2780
J2780
J2780
J2780
J2780
J2780
J2780
J2780
J2780
J2780
J2780
J2780
J2780
J2780
J2780
J2780
J2780
J2780
J2780
J2780
J2780
J2780
J2780
J2780
J2783
J2783
J2785
J2788
J2788
J2788
J2788
J2788
J2788
J2790
J2790
J2790
J2790
51552018005
51927108200
54868416700
58016481101
60977045101
60977045102
60977045103
60977045117
60977045171
60977045182
61703021007
61703021011
61703021021
61703021031
61703021035
62991204201
62991204202
62991204203
63370014115
63370014125
63370014135
61570026010
50242008001
50242008201
00173036238
00173036300
00173036301
00173044100
38779053604
38779053605
38779053608
38779053609
49452621201
49452621204
49452621205
49452621206
51552062002
51552062004
51552062005
51927302300
54868577500
55390061601
55390061610
55390061801
62991113201
62991113202
62991113203
62991113204
63370021825
63370021835
63370021845
63370021850
00024515010
00024515175
00469650189
00562780601
00562780605
00562780625
00562780801
00562780806
00562780826
00562780501
00562780505
00562780525
13533063102
12/19/2013
HCPCS Description
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
INJECTION, QUINUPRISTIN/DALFOPRISTIN, 500 MG (150/350)
INJECTION, RANIBIZUMAB, 0.1 MG
INJECTION, RANIBIZUMAB, 0. 1 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
INJECTION, RASBURICASE, 0.5 MG
INJECTION, RASBURICASE, 0.5 MG
0.1MG REGADENOSON
INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, MINIDOSE, 50 MICROG
INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, MINIDOSE, 50 MICROG
INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, MINIDOSE, 50 MICROG
INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, MINIDOSE, 50 MICROG
INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, MINIDOSE, 50 MICROG
INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, MINIDOSE, 50 MICROG
INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, FULL DOSE, 300 MICR
INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, FULL DOSE, 300 MICR
INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, FULL DOSE, 300 MICR
INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, FULL DOSE, 300 MICR
Earliest Start
Date
09/01/2003
09/08/2003
01/01/2002
02/01/2006
01/01/2004
01/01/2004
01/01/2004
05/05/2007
05/05/2007
05/05/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
05/01/2003
01/01/2002
01/01/2002
01/01/2002
07/08/2003
07/08/2003
07/08/2003
06/27/2003
01/01/2008
11/05/2012
01/01/2002
01/01/2002
01/01/2002
01/01/2002
05/20/2002
05/20/2002
05/20/2002
05/20/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
09/01/2003
09/08/2003
06/06/2007
11/22/2004
11/22/2004
03/29/2006
09/15/2003
09/15/2003
09/15/2003
09/15/2003
07/08/2003
07/08/2003
07/08/2003
07/08/2003
01/01/2004
06/27/2006
01/01/2010
09/01/2007
09/01/2007
09/01/2007
08/08/2006
01/01/2003
01/01/2003
09/01/2007
09/01/2007
09/01/2007
10/01/2004
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/13/2012
01/13/2012
01/13/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J2790
J2790
J2791
J2791
J2792
J2792
J2792
J2792
J2792
J2792
J2792
J2792
J2792
J2792
J2792
J2792
J2792
J2792
J2792
J2793
J2794
J2794
J2794
J2794
J2795
J2795
J2795
J2795
J2795
J2795
J2795
J2795
J2795
J2795
J2795
J2795
J2795
J2795
J2795
J2795
J2795
J2795
J2795
J2795
J2795
J2795
J2796
J2796
J2800
J2800
J2800
J2800
J2800
J2800
J2800
J2800
J2800
J2800
J2800
J2805
J2810
J2810
J2810
J2810
J2810
44206030001
44206030010
44206030001
44206030010
00944295002
00944295004
00944295006
00944296701
00944296703
00944296705
00944296707
00944296709
13533063102
13533063106
53270300001
53270310001
53270330001
53270350001
54569576400
61755000101
50458030611
50458030711
50458030811
50458030911
00186085944
00186085954
00186085977
00186085981
00186085991
00186086354
00186086361
00186086369
00186086377
00186086754
00186086844
00186086854
00186086877
63323028520
63323028564
63323028567
63323028620
63323028630
63323028631
63323028637
63323028810
63323028820
55513022101
55513022201
12280022901
38779194305
38779194308
38779194309
51552101805
51927251900
60977015001
60977015071
63370014335
63370014345
63370014350
00270055615
00074766823
00264955400
00264955410
00264955810
00264955820
12/19/2013
HCPCS Description
INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, FULL DOSE, 300 MCG
INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, FULL DOSE, 300 MCG
INJECTION, RHO(D) IMMUNE GLOBULIN (HUMAN), (RHOPHYLAC), INTR
INJECTION, RHO(D) IMMUNE GLOBULIN (HUMAN), (RHOPHYLAC), INTR
INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN, SOLVEN
INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN, SOLVEN
INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN, SOLVEN
INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN, SOLVEN
INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN, SOLVEN
INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN, SOLVEN
INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN, SOLVEN
INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN, SOLVEN
INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN, SOLVEN
INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN, SOLVEN
INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN, SOLVEN
INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN, SOLVEN
INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN, SOLVEN
INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN, SOLVEN
INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN, SOLVEN
INJECTION, RILONACEPT, 1 MG
INJECTION, RISPERIDONE, LONG ACTING, 0.5 MG
INJECTION, RISPERIDONE, LONG ACTING, 0.5 MG
INJECTION, RISPERIDONE, LONG ACTING, 0.5 MG
INJECTION, RISPERIDONE, LONG ACTING, 0.5 MG
INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG
INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG
INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG
INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG
INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG
INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG
INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG
INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG
INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG
INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG
INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG
INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG
INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG
ROPIVICAINE HCL, 1MG
ROPIVICAINE HCL, 1MG
ROPIVICAINE HCL, 1MG
INJ, ROPIVICAINE HCL, PER 1 MG
INJ, ROPIVICAINE HCL, PER 1 MG
ROPIVICAINE HCL, 1MG
ROPIVICAINE HCL, 1MG
INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG
INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG
ROMIPLOSTIN, PER 10MCG
ROMIPLOSTIN, PER 10MCG
INJECTION, METHOCARBAMOL, UP TO 10 ML
INJECTION, METHOCARBAMOL, UP TO 10 ML
INJECTION, METHOCARBAMOL, UP TO 10 ML
INJECTION, METHOCARBAMOL, UP TO 10 ML
INJECTION, METHOCARBAMOL, UP TO 10 ML
INJECTION, METHOCARBAMOL, UP TO 10 ML
INJECTION, METHOCARBAMOL, UP TO 10 ML
INJECTION, METHOCARBAMOL, UP TO 10 ML
INJECTION, METHOCARBAMOL, UP TO 10 ML
INJECTION, METHOCARBAMOL, UP TO 10 ML
INJECTION, METHOCARBAMOL, UP TO 10 ML
INJECTION, SINCALIDE, 5 MICROGRAMS
INJECTION, THEOPHYLLINE, PER 40 MG
INJECTION, THEOPHYLLINE, PER 40 MG
INJECTION, THEOPHYLLINE, PER 40 MG
INJECTION, THEOPHYLLINE, PER 40 MG
INJECTION, THEOPHYLLINE, PER 40 MG
Earliest Start
Date
01/01/2006
01/01/2002
01/01/2008
01/01/2008
03/25/2005
03/25/2005
03/25/2005
03/01/2006
03/01/2006
03/01/2006
03/01/2006
03/01/2006
12/21/2005
12/21/2005
06/01/2010
06/01/2010
06/01/2010
06/01/2010
01/12/2006
01/01/2012
01/01/2005
01/01/2005
01/01/2005
04/23/2007
01/01/2002
01/01/2002
01/19/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/19/2007
01/01/2002
01/01/2002
01/01/2002
08/21/2006
10/01/2009
10/01/2009
11/01/1996
07/20/2009
07/20/2009
02/26/2010
07/01/2009
11/01/1996
11/01/1996
01/01/2010
01/01/2010
08/16/2005
04/25/2002
04/25/2002
04/25/2002
09/01/2003
09/08/2003
01/01/2004
05/05/2007
07/08/2003
07/08/2003
07/08/2003
01/01/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/30/2012
09/30/2012
10/31/2012
10/31/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/31/2013
04/30/2013
06/30/2013
12/31/2078
04/30/2013
03/31/2012
03/31/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
04/30/2014
04/30/2014
12/31/2078
12/31/2078
12/31/2078
12/31/2078
06/01/2007
12/31/2078
12/31/2078
09/30/2013
12/31/2078
Page 1 of 1
HCPCS
NDC
J2810
J2810
J2810
J2810
J2810
J2810
J2810
J2810
J2810
J2810
J2810
J2810
J2810
J2810
J2810
J2810
J2810
J2810
J2810
J2810
J2820
J2820
J2820
J2820
J2820
J2820
J2820
J2850
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
00338043903
00338044103
00409766503
00409766509
00409766603
00409766662
00409766823
00409767713
00409770562
17317057101
17317057104
17317057105
17317057108
38779181605
38779181608
49452772001
49452772002
49452772003
51552048705
51927151000
50419000233
50419005030
50419059501
50419059505
54868318800
58468018002
58468018101
67066000601
00074181222
00074210205
00074536505
00223849602
00223849605
00409191832
00409191833
00409191835
00409210202
00409210205
00517280225
00641049517
08166110903
08166110905
08290031002
08290031003
08290032003
08290032005
08290033003
08290033005
08290033006
08290033010
08290091002
08290091003
08290092005
08290093010
08290094010
08290095010
08450090102
08450090303
08450090505
08450090610
55045371001
58016499501
63323018602
63807010011
63807010030
12/19/2013
HCPCS Description
INJECTION, THEOPHYLLINE, PER 40 MG
INJECTION, THEOPHYLLINE, PER 40 MG
INJECTION, THEOPHYLLINE, PER 40 MG
INJECTION, THEOPHYLLINE, PER 40 MG
INJECTION, THEOPHYLLINE, PER 40 MG
INJECTION, THEOPHYLLINE, PER 40 MG
INJECTION, THEOPHYLLINE, PER 40 MG
INJECTION, THEOPHYLLINE, PER 40 MG
INJECTION, THEOPHYLLINE, PER 40 MG
INJECTION, THEOPHYLLINE, PER 40 MG
INJECTION, THEOPHYLLINE, PER 40 MG
INJECTION, THEOPHYLLINE, PER 40 MG
INJECTION, THEOPHYLLINE, PER 40 MG
INJECTION, THEOPHYLLINE, PER 40 MG
INJECTION, THEOPHYLLINE, PER 40 MG
INJECTION, THEOPHYLLINE, PER 40 MG
INJECTION, THEOPHYLLINE, PER 40 MG
INJECTION, THEOPHYLLINE, PER 40 MG
INJECTION, THEOPHYLLINE, PER 40 MG
INJECTION, THEOPHYLLINE, PER 40 MG
INJECTION, SARGRAMOSTIM (GM-CSF), 50 MCG
INJECTION, SARGRAMOSTIM (GM-CSF), 50 MCG
INJECTION, SARGRAMOSTIM (GM-CSF), 50 MCG
INJECTION, SARGRAMOSTIM (GM-CSF), 50 MCG
INJECTION, SARGRAMOSTIM (GM-CSF), 50 MCG
SARGRAMOSTIM, 50MCG
SARGRAMOSTIM, 50MCG
INJECTION, SECRETIN, SYNTHETIC, HUMAN, 1 MICROGRAM
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
Earliest Start
Date
01/01/2002
01/01/2002
12/29/2005
04/25/2005
05/27/2006
01/27/2006
02/06/2007
08/10/2006
05/27/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
05/01/2002
05/01/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/08/2003
10/23/2003
10/23/2003
06/29/2007
01/30/2006
05/23/2006
01/01/2010
01/01/2010
01/01/2006
01/01/2002
09/13/2005
01/01/2002
01/01/2002
01/01/2002
11/23/2005
02/17/2005
04/08/2005
08/16/2005
04/03/2006
01/01/2002
12/08/2004
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
11/01/2005
11/01/2003
11/01/2003
11/01/2003
11/01/2003
07/24/2006
07/01/2006
01/01/2002
01/01/2002
01/01/2002
Latest End
Date
09/30/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/31/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
10/01/2006
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/31/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2912
J2916
J2916
J2916
J2920
J2920
J2920
J2920
J2920
J2920
J2920
J2920
J2920
J2920
J2920
J2930
J2930
J2930
J2930
J2930
J2930
J2930
J2930
J2930
J2930
J2930
J2930
J2930
J2930
J2930
J2930
J2930
J2930
J2930
J2930
J2930
J2930
J2930
J2930
J2930
J2930
J2930
J2930
J2930
J2930
63807010033
63807010035
63807010050
63807010051
63807010056
63807010075
63807010092
63807010211
64253011121
64253011122
64253011123
64253011125
64253011130
64253011133
64253011135
68883090001
68883090003
68883090004
68883090005
68883090010
68883090016
00024279150
00024279210
52544092226
00009003928
00009011312
00009011319
00009019016
00409321705
00409568401
00409568423
54868076800
55390020910
58016489701
63323025503
00009004722
00009004725
00009011319
00009019009
00009019016
00009069801
00009075801
00009076502
00009079601
00009338901
00409321805
00409568502
00409568523
12280023201
21695058710
51927355200
54569155500
54569155501
54868362300
54868363700
54868363701
55045350901
55390021010
55390021801
55390021901
55390025801
55390025901
58016945201
63323025803
63323026530
12/19/2013
HCPCS Description
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
SODIUM FERRIC GLUCONATE COMPLEX PER 12.5MG
SODIUM FERRIC GLUCONATE COMPLEX PER 12.5MG
INJECTION, SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE INJECT
METHYLPREDNISOLONE, 40MG
METHYLPREDNISOLONE NA SUCC, UP TO 40MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 40 MG
METHYLPREDNISOLONE SOD SUCC, 40MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 40 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 40 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 40 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 40 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 40 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 40 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 40 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
METHYLPREDNISOLONE INJ, UP TO 125 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
METHYLPREDNISOLONE NA SUCC, UP TO 125MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
Earliest Start
Date
01/01/2002
05/25/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/05/2006
01/05/2006
01/05/2006
01/05/2006
01/05/2006
01/05/2006
05/07/2010
04/14/2011
01/02/2003
01/01/2010
01/01/2007
01/01/2002
01/01/2006
10/02/2006
11/01/2005
09/30/1990
01/01/2002
02/22/2007
07/01/2006
09/22/2004
09/30/1990
08/04/2010
01/01/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
10/02/2006
11/01/2005
08/12/2009
08/18/2005
08/09/2007
09/08/2003
01/01/2002
06/05/2002
01/01/2002
01/01/2002
01/01/2002
07/10/2006
02/22/2007
02/22/2007
02/22/2007
02/01/2008
02/01/2008
01/01/2002
08/23/2004
10/27/2004
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
10/31/2014
12/31/2078
10/31/2011
12/31/2078
08/31/2009
01/01/2012
12/01/2012
12/31/2078
12/31/2078
05/01/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/01/2012
12/01/2012
12/01/2012
12/31/2078
12/31/2078
09/01/2011
12/31/2078
11/01/2012
12/31/2078
12/31/2078
05/01/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2941
J2993
J2993
J2993
J2993
J2995
J2997
J2997
J2997
J2997
J3000
J3000
J3000
J3000
00002733511
00002733516
00002814701
00002814801
00002814901
00013262681
00013262694
00013264681
00013264694
00013264902
00013265002
00013265102
00013265202
00013265302
00013265402
00013265502
00013265602
00013265702
00013265802
00169770411
00169770511
00169770811
00169776811
00169777011
00781300107
00781300126
00781300144
00781400436
12280007215
12280009215
44087000407
44087000507
44087000607
44087008804
44087100502
44087108001
44087108801
44087338807
50242001821
50242001902
50242002020
50242002220
50242004314
50242007203
50242007301
54569493000
54868560100
54868563400
54868576000
57844071319
57844071341
58016477101
67286004001
67286004002
67286040001
67286040002
00053177001
50242004163
50242004164
50242004413
50242008527
38779081304
38779081305
38779081308
38779081309
12/19/2013
HCPCS Description
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
SOMATROPIN, 1 MG
RETEPLASE, 18.1 MG
RETEPLASE, 18.1 MG
RETEPLASE, 18.1 MG
RETEPLASE, 18.1 MG
STREPTOKINASE, PER 250,000 IU
ALTEPLASE RECOMBINANT, 1 MG
ALTEPLASE RECOMBINANT, 1 MG
ALTEPLASE RECOMBINANT, 1 MG
ALTEPLASE RECOMBINANT, 1 MG
STREPTOMYCIN, UP TO 1 GM
STREPTOMYCIN, UP TO 1 GM
STREPTOMYCIN, UP TO 1 GM
STREPTOMYCIN, UP TO 1 GM
Earliest Start
Date
03/01/2006
01/01/2002
08/30/2005
08/30/2005
08/30/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/24/2005
01/02/2006
01/24/2005
01/01/2002
01/01/2002
03/12/2008
03/12/2008
03/12/2008
01/15/2007
03/21/2005
03/23/2005
01/01/2002
01/01/2002
01/01/2002
10/15/2007
01/01/2002
10/22/2004
01/01/2002
04/07/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
05/10/2002
01/01/2002
01/28/2008
01/01/2002
05/22/2006
06/30/2006
08/17/2007
01/18/2005
01/18/2005
02/01/2006
11/30/2005
11/30/2005
03/10/2008
03/10/2008
09/17/2002
01/18/2007
01/01/2002
01/01/2002
01/01/2002
05/15/2002
05/15/2002
05/15/2002
05/15/2002
Latest End
Date
12/31/2078
03/31/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
06/30/2009
12/31/2078
09/30/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
06/30/2012
09/30/2012
09/30/2012
03/31/2012
11/30/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
11/30/2013
05/31/2012
11/30/2013
03/31/2013
12/31/2078
05/31/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
05/31/2008
12/31/2078
12/31/2078
12/31/2078
04/30/2011
04/30/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J3000
J3000
J3000
J3000
J3000
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
39822070602
51552097805
51927178800
63370023335
63370023350
00074909332
00074909335
00074909336
00074909338
00074909428
00074909431
00406113052
00409127632
00409909332
00409909335
00409909336
00409909338
00409909422
00409909425
00409909428
00409909431
00409909461
00641602410
00641602510
00641602605
00641602725
00641602825
00641602925
00641603001
10019003372
10019003473
10019003574
10019003639
10019003682
10019003727
10019003730
10019003783
10019003867
11098003002
11098003005
11098003010
11098003020
38779175600
38779175603
38779175606
38779175609
49452003201
49452003202
51552068701
51552068709
51927101900
54868373800
54868373801
58298052502
58298052505
61553010702
61553010972
61553011148
61553011248
61553011302
61553011402
61553011648
61553011841
61553060248
61553073068
12/19/2013
HCPCS Description
INJECTION, STREPTOMYCIN, UP TO 1 GM
INJECTION, STREPTOMYCIN, UP TO 1 GM
INJECTION, STREPTOMYCIN, UP TO 1 GM
INJECTION, STREPTOMYCIN, UP TO 1 GM
INJECTION, STREPTOMYCIN, UP TO 1 GM
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
FENTANYL CITRATE, 0.1MG INJ
FENTANYL CITRATE, 0.1MG INJ
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
Earliest Start
Date
01/01/2002
09/01/2003
09/08/2003
07/08/2003
07/08/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
07/27/2005
11/14/2005
12/13/2005
07/12/2006
03/03/2006
10/12/2005
11/07/2005
02/14/2006
09/23/2005
12/30/2005
10/10/2012
11/13/2012
10/10/2012
07/25/2012
07/25/2012
10/10/2012
07/25/2012
01/01/2002
01/01/2002
01/01/2002
08/21/1998
01/01/2002
08/04/2010
08/04/2010
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
04/23/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
09/08/2003
01/01/2002
01/01/2002
04/03/2006
04/03/2006
02/02/2004
02/02/2004
02/02/2004
02/02/2004
02/02/2004
02/02/2004
02/02/2004
02/02/2004
02/02/2004
11/21/2007
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/01/2007
09/01/2007
09/01/2007
09/01/2007
09/01/2007
04/01/2007
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/01/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
05/31/2015
06/28/2010
12/31/2078
01/28/2009
01/28/2009
05/31/2014
04/30/2014
05/31/2014
04/30/2015
12/31/2011
07/31/2011
12/31/2078
09/30/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3010
J3030
J3030
J3030
J3030
J3030
J3030
J3030
J3030
J3030
J3030
J3030
J3030
J3030
J3070
J3070
J3070
J3070
J3100
J3101
J3105
J3105
J3105
J3105
J3105
J3105
J3105
J3110
J3110
J3130
J3130
J3130
J3130
J3130
J3130
J3130
J3130
J3130
J3130
J3130
J3130
J3130
J3130
J3130
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
61553079168
61553079268
61553079368
61553079468
61553079568
63275510001
63275510002
63275510006
63370092006
63370092009
63370092010
63370092015
00173044902
00173073900
00173073902
00703735102
00781317414
54569370400
54868265200
54868265201
54868318100
55045351201
55390031510
63323027301
68115077002
00409192010
00409194101
21695024101
54868253000
50242003861
50242003861
00143974610
00703127104
55390010110
55390019310
63323066501
66591043411
66591043511
00002897101
54868540600
00574082105
00591322126
38779085503
38779085504
49452764901
49452764902
49452764903
54396032816
54396032840
54868501600
62991270001
63370098315
63370098325
63370098335
63370098350
00463106910
00574046005
00574046025
17317056702
17317056703
17317056708
38779016303
38779016304
38779016305
38779016308
12/19/2013
Earliest Start
Date
HCPCS Description
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, FENTANYL CITRATE, 0.1 MG
INJECTION, SUMATRIPTAN SUCCINATE, 6 MG (CODE MAY
INJECTION, SUMATRIPTAN SUCCINATE, 6 MG (CODE MAY
INJECTION, SUMATRIPTAN SUCCINATE, 6 MG (CODE MAY
INJECTION, SUMATRIPTAN SUCCINATE, 6 MG (CODE MAY
INJECTION, SUMATRIPTAN SUCCINATE, 6 MG (CODE MAY
INJECTION, SUMATRIPTAN SUCCINATE, 6 MG (CODE MAY
INJECTION, SUMATRIPTAN SUCCINATE, 6 MG (CODE MAY
INJECTION, SUMATRIPTAN SUCCINATE, 6 MG (CODE MAY
INJECTION, SUMATRIPTAN SUCCINATE, 6 MG (CODE MAY
INJECTION, SUMATRIPTAN SUCCINATE, 6 MG (CODE MAY
SUMATRIPTIN INJ, PER 6 MG
SUMATRIPTIN INJ, PER 6 MG
INJECTION, SUMATRIPTAN SUCCINATE, 6 MG (CODE MAY
INJECTION, PENTAZOCINE, 30 MG
INJECTION, PENTAZOCINE, 30 MG
INJECTION, PENTAZOCINE, 30 MG
INJECTION, PENTAZOCINE, 30 MG
INJECTION, TENECTEPLASE, 50MG
INJECTION, TENECTEPLASE, 1 MG
TERBUTALINE 1MG INJ
INJECTION, TERBUTALINE SULFATE, UP TO 1 MG
INJECTION, TERBUTALINE SULFATE, UP TO 1 MG
INJECTION, TERBUTALINE SULFATE, UP TO 1 MG
INJECTION, TERBUTALINE SULFATE, UP TO 1 MG
INJECTION, TERBUTALINE SULFATE, UP TO 1 MG
INJECTION, TERBUTALINE SULFATE, UP TO 1 MG
INJECTION, TERIPARATIDE, 10 MCG
INJECTION, TERIPARATIDE, 10 MCG
INJECTION, TESTOSTERONE ENANTHATE, UP TO 200 MG
INJECTION, TESTOSTERONE ENANTHATE, UP TO 200 MG
INJECTION, TESTOSTERONE ENANTHATE, UP TO 200 MG
INJECTION, TESTOSTERONE ENANTHATE, UP TO 200 MG
INJECTION, TESTOSTERONE ENANTHATE, UP TO 200 MG
INJECTION, TESTOSTERONE ENANTHATE, UP TO 200 MG
INJECTION, TESTOSTERONE ENANTHATE, UP TO 200 MG
INJECTION, TESTOSTERONE ENANTHATE, UP TO 200 MG
INJECTION, TESTOSTERONE ENANTHATE, UP TO 200 MG
INJECTION, TESTOSTERONE ENANTHATE, UP TO 200 MG
INJECTION, TESTOSTERONE ENANTHATE, UP TO 200 MG
INJECTION, TESTOSTERONE ENANTHATE, UP TO 200 MG
INJECTION, TESTOSTERONE ENANTHATE, UP TO 200 MG
INJECTION, TESTOSTERONE ENANTHATE, UP TO 200 MG
INJECTION, TESTOSTERONE ENANTHATE, UP TO 200 MG
INJECTION, TESTOSTERONE SUSPENSION, UP TO 50 MG
INJECTION, TESTOSTERONE SUSPENSION, UP TO 50 MG
INJECTION, TESTOSTERONE SUSPENSION, UP TO 50 MG
INJECTION, TESTOSTERONE SUSPENSION, UP TO 50 MG
INJECTION, TESTOSTERONE SUSPENSION, UP TO 50 MG
INJECTION, TESTOSTERONE SUSPENSION, UP TO 50 MG
INJECTION, TESTOSTERONE SUSPENSION, UP TO 50 MG
INJECTION, TESTOSTERONE SUSPENSION, UP TO 50 MG
INJECTION, TESTOSTERONE SUSPENSION, UP TO 50 MG
INJECTION, TESTOSTERONE SUSPENSION, UP TO 50 MG
BE
BE
BE
BE
BE
BE
BE
BE
BE
BE
USED
USED
USED
USED
USED
USED
USED
USED
USED
USED
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
FOR
BE USED FOR
12/01/2006
12/01/2006
12/01/2006
12/01/2006
12/01/2006
12/03/2002
09/01/2002
12/03/2002
07/08/2003
07/08/2003
07/08/2003
07/08/2003
01/01/2002
03/17/2006
03/17/2006
02/06/2009
01/01/2009
01/01/2002
01/01/2002
08/28/2006
01/01/2002
07/11/2006
01/01/2010
03/04/2009
01/20/2004
09/29/2005
11/18/2005
01/01/2007
01/01/2002
01/01/2002
01/01/2009
10/01/2010
07/22/2004
04/28/2004
11/19/2004
06/21/2004
05/23/2003
09/21/2004
01/01/2005
09/06/2005
08/01/2007
03/09/2004
04/25/2002
04/25/2002
01/01/2003
01/01/2003
01/01/2003
01/01/2002
01/01/2002
03/09/2004
01/01/2008
01/19/2004
01/19/2004
01/19/2004
01/19/2004
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
04/30/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/31/2012
12/31/2078
12/31/2078
03/01/2012
12/31/2078
12/31/2078
12/31/2078
06/30/2012
06/30/2012
12/31/2078
12/31/2011
12/31/2078
06/30/2012
12/31/2078
12/31/2078
12/31/2078
12/01/2009
12/31/2078
09/30/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3140
J3150
J3150
J3150
J3150
J3150
J3150
J3150
J3150
J3150
J3150
J3150
J3150
J3150
J3150
J3150
J3150
J3150
J3150
J3150
J3150
J3150
J3150
J3150
J3150
J3150
J3150
J3150
J3230
J3230
J3230
J3230
J3230
J3230
38779016309
49452765001
49452765002
49452765003
49452765201
49452765202
49452765203
51552002901
51552002902
51552002904
51552002907
51552056404
51552056405
51552056407
51927102600
51927102700
62991215001
62991215002
62991215003
62991215004
63275998304
63275998305
63275998308
63275998309
63370097025
63370097035
63370097045
63370097050
63370097125
63370097135
63370097145
63370097150
00463107310
00574046105
00574046125
17317056802
17317056803
17317056808
38779016503
38779016504
38779016505
38779016508
49452001101
49452001102
49452001103
51552003001
51552003002
51552003004
51552003005
51552003008
51552003009
51927102900
62991141201
62991141202
62991141203
63370098525
63370098535
63370098545
63370098550
00641139731
00641139835
38779042304
38779042305
49452199001
49452199002
12/19/2013
HCPCS Description
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE SUSPENSION, UP TO 50 MG
TESTOSTERONE PROPIONATE, UP TO 100 MG
TESTOSTERONE PROPIONATE, UP TO 100 MG
TESTOSTERONE PROPIONATE, UP TO 100 MG
TESTOSTERONE PROPIONATE, UP TO 100 MG
TESTOSTERONE PROPIONATE, UP TO 100 MG
TESTOSTERONE PROPIONATE, UP TO 100 MG
TESTOSTERONE PROPIONATE, UP TO 100 MG
TESTOSTERONE PROPIONATE, UP TO 100 MG
TESTOSTERONE PROPIONATE, UP TO 100 MG
TESTOSTERONE PROPIONATE, UP TO 100 MG
TESTOSTERONE PROPIONATE, UP TO 100 MG
TESTOSTERONE PROPIONATE, UP TO 100 MG
TESTOSTERONE PROPIONATE, UP TO 100 MG
TESTOSTERONE PROPIONATE, UP TO 100 MG
TESTOSTERONE PROPIONATE, UP TO 100 MG
TESTOSTERONE PROPIONATE, UP TO 100 MG
TESTOSTERONE PROPIONATE, UP TO 100 MG
TESTOSTERONE PROPIONATE, UP TO 100 MG
TESTOSTERONE PROPIONATE, UP TO 100 MG
TESTOSTERONE PROPIONATE, UP TO 100 MG
TESTOSTERONE PROPIONATE, UP TO 100 MG
TESTOSTERONE PROPIONATE, UP TO 100 MG
TESTOSTERONE PROPIONATE, UP TO 100 MG
TESTOSTERONE PROPIONATE, UP TO 100 MG
TESTOSTERONE PROPIONATE, UP TO 100 MG
TESTOSTERONE PROPIONATE, UP TO 100 MG
TESTOSTERONE PROPIONATE, UP TO 100 MG
CHLORPROMAZINE HCL, UP TO 50 MG
CHLORPROMAZINE HCL, UP TO 50 MG
CHLORPROMAZINE HCL, UP TO 50 MG
CHLORPROMAZINE HCL, UP TO 50 MG
CHLORPROMAZINE HCL, UP TO 50 MG
CHLORPROMAZINE HCL, UP TO 50 MG
Earliest Start
Date
04/30/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/08/2003
09/08/2003
09/01/2002
09/01/2002
09/01/2002
09/01/2002
12/04/2002
12/04/2002
12/04/2002
12/04/2002
01/31/2002
01/31/2002
01/31/2002
01/31/2002
12/19/2003
12/19/2003
12/19/2003
12/19/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
04/30/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/08/2003
09/01/2002
09/01/2002
09/01/2002
07/08/2003
07/08/2003
07/08/2003
07/08/2003
05/05/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J3230
J3230
J3230
J3230
J3230
J3240
J3243
J3243
J3246
J3246
J3246
J3246
J3246
J3250
J3250
J3250
J3250
J3250
J3250
J3250
J3250
J3250
J3250
J3250
J3250
J3250
J3250
J3250
J3250
J3250
J3260
J3260
J3260
J3260
J3260
J3260
J3260
J3260
J3260
J3260
J3260
J3260
J3260
J3260
J3260
J3262
J3262
J3262
J3265
J3265
J3285
J3285
J3285
J3285
J3301
J3301
J3301
J3301
J3301
J3301
J3301
J3301
J3301
J3301
J3301
49452199003
51552013904
51552013905
51552013907
51927309800
58468184904
00008499002
00008536002
25208000201
25208000202
61379012001
61379012002
61379012005
00409195232
00463110820
38779219603
38779219604
38779219605
42023011801
42023011925
49452792401
49452792402
49452792403
51927198100
51927357200
54868060800
54868075600
55045356501
61570054120
61570054325
00074357801
00409325503
00409346913
00409347023
00409357701
00409357801
00409359002
00703940204
00703941601
54868410600
63323030502
63323030602
63323030630
63323030655
63323030751
50242013501
50242013601
50242013701
00004026706
00004026806
66302010101
66302010201
66302010501
66302011001
00003029305
00003029320
00003029328
00003049420
00065054301
00781324375
00781324572
35356008201
51552003301
54569182701
54868023400
12/19/2013
HCPCS Description
INJECTION, CHLORPROMAZINE HCL, UP TO 50 MG
INJECTION, CHLORPROMAZINE HCL, UP TO 50 MG
INJECTION, CHLORPROMAZINE HCL, UP TO 50 MG
INJECTION, CHLORPROMAZINE HCL, UP TO 50 MG
INJECTION, CHLORPROMAZINE HCL, UP TO 50 MG
INJECTION, THYROTROPIN ALPHA, 0.9 MG, PROVIDED IN 1.1 MG VIA
INJECTION, TIGECYCLINE, 1 MG
INJECTION, TIGECYCLINE, 1 MG
INJECTION, TIROFIBAN HCL, 0.25MG
INJECTION, TIROFIBAN HCL, 0.25MG
INJECTION, TIROFIBAN HCL, 0.25MG
INJECTION, TIROFIBAN HCL, 0.25MG
INJECTION, TIROFIBAN HCL, 0.25MG
INJECTION, TRIMETHOBENZAMIDE HCL, UP TO 200 MG
INJECTION, TRIMETHOBENZAMIDE HCL, UP TO 200 MG
INJECTION, TRIMETHOBENZAMIDE HCL, UP TO 200 MG
INJECTION, TRIMETHOBENZAMIDE HCL, UP TO 200 MG
INJECTION, TRIMETHOBENZAMIDE HCL, UP TO 200 MG
INJECTION, TRIMETHOBENZAMIDE HCL, UP TO 200 MG
INJECTION, TRIMETHOBENZAMIDE HCL, UP TO 200 MG
INJECTION, TRIMETHOBENZAMIDE HCL, UP TO 200 MG
INJECTION, TRIMETHOBENZAMIDE HCL, UP TO 200 MG
INJECTION, TRIMETHOBENZAMIDE HCL, UP TO 200 MG
INJECTION, TRIMETHOBENZAMIDE HCL, UP TO 200 MG
INJECTION, TRIMETHOBENZAMIDE HCL, UP TO 200 MG
INJECTION, TRIMETHOBENZAMIDE HCL, UP TO 200 MG
INJECTION, TRIMETHOBENZAMIDE HCL, UP TO 200 MG
INJECTION, TRIMETHOBENZAMIDE HCL, UP TO 200 MG
INJECTION, TRIMETHOBENZAMIDE HCL, UP TO 200 MG
INJECTION, TRIMETHOBENZAMIDE HCL, UP TO 200 MG
INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG
INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG
INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG
INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG
INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG
INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG
INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG
INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG
INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG
INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG
INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG
INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG
INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG
INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG
INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG
TOCLIZUMAB, PER 1MG
INJECTION, TOCILIZUMAB, 1 MG
TOCLIZUMAB, PER 1MG
INJECTION, TORSEMIDE, 10 MG/ML
INJECTION, TORSEMIDE, 10 MG/ML
INJECTION, TREPROSTINIL, 1 MG
INJECTION, TREPROSTINIL, 1 MG
INJECTION, TREPROSTINIL, 1 MG
INJECTION, TREPROSTINIL, 1 MG
INJECTION, TRIAMCINOLONE ACETONIDE, PER 10MG
INJECTION, TRIAMCINOLONE ACETONIDE, PER 10MG
INJECTION, TRIAMCINOLONE ACETONIDE, PER 10MG
INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED
INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED
TRIAMCINOLONE ACT, PER 10MG
TRIAMCINOLONE ACT, PER 10MG
INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED
TRIAMCINOLONE ACT, PER 10MG
INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED
INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED
Earliest Start
Date
01/01/2002
09/01/2003
09/01/2003
09/01/2003
09/08/2003
01/01/2002
07/27/2007
01/01/2007
04/01/2008
04/01/2008
10/01/2005
11/01/2005
01/01/2005
01/09/2006
01/01/2002
04/25/2002
04/25/2002
04/25/2002
08/01/2008
07/22/2008
01/01/2003
01/01/2003
01/01/2003
09/12/2003
09/08/2003
01/01/2002
01/01/2002
07/01/2006
01/01/2002
04/25/2006
01/01/2002
03/31/2005
05/30/2005
09/26/2005
03/31/2005
11/02/2004
02/15/2006
01/01/2002
01/01/2002
01/01/2002
04/05/2004
04/05/2004
04/05/2004
04/19/2004
04/05/2004
01/18/2010
01/01/2010
01/18/2010
01/01/2002
01/01/2002
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2007
01/01/2007
01/01/2002
11/29/2007
07/22/2009
07/22/2009
02/08/2008
01/01/2006
01/01/2002
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/30/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/01/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/30/2010
09/30/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J3301
J3301
J3301
J3301
J3301
J3302
J3302
J3302
J3302
J3302
J3302
J3302
J3302
J3302
J3302
J3302
J3302
J3302
J3303
J3303
J3303
J3303
J3303
J3303
J3303
J3303
J3305
J3305
J3310
J3315
J3315
J3315
J3315
J3350
J3350
J3350
J3350
J3350
J3350
J3350
J3350
J3350
J3350
J3350
J3350
J3350
J3350
J3350
J3350
J3350
J3350
J3350
J3350
J3355
J3355
J3355
J3355
J3355
J3355
J3355
J3357
J3357
J3360
J3360
J3360
55045324801
63370030015
63370030020
63370030025
63370030035
00463109105
38779016603
38779016604
38779016605
49452791001
49452791002
49452791003
49452791004
51552027801
51552027802
51552027803
51927337000
55553004205
00781308475
00781308571
00781308575
54643105400
54643105500
54643105600
54868334400
58016485501
58178002010
58178002101
51927235100
52544015302
52544015376
52544015402
52544015476
00406864212
10106420601
10106420605
17317059301
17317059305
17317059308
17317146601
17317146605
38779010108
38779010109
49452807001
49452807002
49452807003
51552005704
51552005706
51552005708
51927126900
53191016101
53191016105
62991138201
44087607501
44087607503
44087607504
44087615001
54569264600
55566850502
55566850506
57894006003
57894006103
00409127332
00409321302
00409321312
12/19/2013
HCPCS Description
INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE
INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE
INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE
INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE
INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE
INJECTION, TRIAMCINOLONE DIACETATE, PER 5MG
INJECTION, TRIAMCINOLONE DIACETATE, PER 5MG
INJECTION, TRIAMCINOLONE DIACETATE, PER 5MG
INJECTION, TRIAMCINOLONE DIACETATE, PER 5MG
INJECTION, TRIAMCINOLONE DIACETATE, PER 5MG
INJECTION, TRIAMCINOLONE DIACETATE, PER 5MG
INJECTION, TRIAMCINOLONE DIACETATE, PER 5MG
INJECTION, TRIAMCINOLONE DIACETATE, PER 5MG
INJECTION, TRIAMCINOLONE DIACETATE, PER 5MG
INJECTION, TRIAMCINOLONE DIACETATE, PER 5MG
INJECTION, TRIAMCINOLONE DIACETATE, PER 5MG
INJECTION, TRIAMCINOLONE DIACETATE, PER 5MG
INJECTION, TRIAMCINOLONE DIACETATE, PER 5MG
INJECTION, TRIAMCINOLONE HEXACETONIDE, PER 5MG
INJ, TRIAMCIN HEXACETONIDE, 5MG
INJ, TRIAMCIN HEXACETONIDE, 5MG
INJECTION, TRIAMCINOLONE HEXACETONIDE, PER 5MG
INJECTION, TRIAMCINOLONE HEXACETONIDE, PER 5MG
INJECTION, TRIAMCINOLONE HEXACETONIDE, PER 5MG
INJECTION, TRIAMCINOLONE HEXACETONIDE, PER 5MG
INJECTION, TRIAMCINOLONE HEXACETONIDE, PER 5MG
INJECTION, TRIMETREXATE GLUCURONATE, PER 25 MG
INJECTION, TRIMETREXATE GLUCURONATE, PER 25 MG
INJECTION, PERPHENAZINE, UP TO 5 MG
INJECTION, TRIPTORELIN PAMOATE, 3.75 MG
INJECTION, TRIPTORELIN PAMOATE, 3.75 MG
INJECTION, TRIPTORELIN PAMOATE, 3.75 MG
INJECTION, TRIPTORELIN PAMOATE, 3.75 MG
INJECTION, UREA, UP TO 40 GM
INJECTION, UREA, UP TO 40 GM
INJECTION, UREA, UP TO 40 GM
INJECTION, UREA, UP TO 40 GM
INJECTION, UREA, UP TO 40 GM
INJECTION, UREA, UP TO 40 GM
INJECTION, UREA, UP TO 40 GM
INJECTION, UREA, UP TO 40 GM
INJECTION, UREA, UP TO 40 GM
INJECTION, UREA, UP TO 40 GM
INJECTION, UREA, UP TO 40 GM
INJECTION, UREA, UP TO 40 GM
INJECTION, UREA, UP TO 40 GM
INJECTION, UREA, UP TO 40 GM
INJECTION, UREA, UP TO 40 GM
INJECTION, UREA, UP TO 40 GM
INJECTION, UREA, UP TO 40 GM
INJECTION, UREA, UP TO 40 GM
INJECTION, UREA, UP TO 40 GM
INJECTION, UREA, UP TO 40 GM
INJECTION, UROFOLLITROPIN, 75 IU
INJECTION, UROFOLLITROPIN, 75 IU
INJECTION, UROFOLLITROPIN, 75 IU
INJECTION, UROFOLLITROPIN, 75 IU
INJECTION, UROFOLLITROPIN, 75 IU
INJECTION, UROFOLLITROPIN, 75 IU
INJECTION, UROFOLLITROPIN, 75 IU
INJECTION, USTEKINUMAB, 1 MG
INJECTION, USTEKINUMAB, 1 MG
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, DIAZEPAM, UP TO 5 MG
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
Earliest Start
Date
07/21/2006
07/08/2003
07/08/2003
07/08/2003
07/08/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
09/08/2003
01/01/2002
01/29/2007
01/01/2007
01/01/2007
03/15/2004
03/15/2004
03/15/2004
01/01/2002
02/01/2006
01/01/2002
01/01/2002
08/09/2003
12/30/2004
04/01/2005
12/30/2004
04/01/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
12/04/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2012
01/01/2012
08/23/2005
05/09/2005
10/01/2007
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
11/30/2007
01/31/2008
12/31/2078
12/31/2078
12/31/2078
09/30/2006
12/31/2078
12/31/2078
02/28/2009
12/31/2078
11/30/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
04/01/1997
04/01/1997
04/01/1997
04/01/1997
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J3360
J3360
J3360
J3360
J3360
J3360
J3360
J3360
J3360
J3360
J3360
J3360
J3360
J3360
J3360
J3360
J3360
J3360
J3360
J3360
J3360
J3360
J3360
J3360
J3360
J3360
J3365
J3365
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3370
J3385
00641140833
00641228941
00641228943
23490754502
38779092505
38779092508
38779092509
49452254001
49452254002
49452254003
51552102502
51552102504
51552102505
51927101400
54569535100
54868061701
54868061702
54868071600
54868232001
54868232002
54868458600
55045213303
63874022901
63874022910
66758002001
66758002002
24430100101
24430100301
00069258910
00074433201
00338355148
00338355248
00409433201
00409433249
00409650901
00409650949
00409653301
00409653349
00409653361
00409653401
00409653449
00409653501
00409653549
10139050112
23360015140
23360015250
38779027403
38779027404
38779027406
51552103601
51552103609
51927174200
62991252201
62991252202
62991252203
62991252204
63323022110
63323028420
63323029561
63323031461
63370035010
63370035015
63370035025
63370035035
54092070104
12/19/2013
HCPCS Description
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, DIAZEPAM, UP TO 5 MG
INJECTION, IV, UROKINASE, 250,000 I.U. VIAL
INJECTION, IV, UROKINASE, 250,000 I.U. VIAL
VANCOMYCIN, PER 500, INJ
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
VANCOMYCIN, PER 500, INJ
VANCOMYCIN, PER 500, INJ
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VANCOMYCIN HCL, 500 MG
INJECTION, VELAGLUCERASE ALFA, 100 UNITS
Earliest Start
Date
01/01/2002
01/01/2002
08/05/2004
04/09/2007
04/25/2002
04/25/2002
04/25/2002
01/01/2003
01/01/2003
01/01/2003
09/01/2003
09/01/2003
09/01/2003
09/08/2003
03/07/2002
03/07/2002
04/03/2008
01/01/2002
01/01/2002
01/01/2002
01/23/2002
03/24/2003
04/04/2008
04/04/2008
10/02/2003
10/02/2003
04/01/2007
04/07/2008
04/28/2011
01/01/2002
01/01/2002
01/01/2002
04/25/2005
08/04/2005
06/06/2005
06/03/2005
03/15/2005
04/06/2005
10/01/2007
06/08/2005
06/10/2005
03/29/2005
04/06/2005
08/19/2008
10/01/2010
10/01/2010
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
09/08/2003
09/15/2003
09/15/2003
09/15/2003
09/15/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
07/08/2003
07/08/2003
07/08/2003
07/08/2003
01/01/2012
Latest End
Date
12/31/2078
07/28/2008
07/28/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/01/2007
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
05/31/2012
02/28/2013
02/28/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J3396
J3410
J3410
J3410
J3410
J3410
J3410
J3410
J3410
J3410
J3410
J3410
J3410
J3410
J3410
J3410
J3410
J3410
J3410
J3410
J3410
J3410
J3410
J3410
J3411
J3411
J3411
J3411
J3411
J3411
J3411
J3411
J3411
J3411
J3411
J3415
J3415
J3415
J3415
J3415
J3415
J3415
J3415
J3415
J3415
J3415
J3415
J3415
J3415
J3415
J3415
J3415
J3415
J3415
J3415
J3415
J3415
J3415
J3415
J3420
J3420
J3420
J3420
J3420
J3420
00078043761
00463110110
00517420125
00517560125
00517560225
00517561025
38779029804
38779029805
49452365202
49452365203
51927140000
54868023100
54868085800
55553017110
58016929901
62991203501
62991203502
63323002101
63323005101
63323005102
63370010725
63370010735
63370010750
63370010755
00463107430
51927124200
54868248901
62991206802
62991206803
62991206804
63323001302
63370048535
63370048545
63370048550
63370048553
10106334301
17317045502
17317045503
17317045505
17317045506
25332007330
33358031301
38779087304
38779087305
38779087308
38779087309
49452614001
49452614002
49452614003
51552014904
51552014905
51927109300
62991113002
62991113003
63323018001
63370047235
63370047245
63370047250
63370047253
00463101530
00463102130
00463109430
00517003125
00517003225
00517013005
12/19/2013
Earliest Start
Date
HCPCS Description
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
VERTEPORFIN, 0.1 MG
HYDROXYZINE HCL, UP TO 25 MG
HYDROXYZINE HCL, UP TO 25 MG
HYDROXYZINE HCL, UP TO 25 MG
HYDROXYZINE HCL, UP TO 25 MG
HYDROXYZINE HCL, UP TO 25 MG
HYDROXYZINE HCL, UP TO 25 MG
HYDROXYZINE HCL, UP TO 25 MG
HYDROXYZINE HCL, UP TO 25 MG
HYDROXYZINE HCL, UP TO 25 MG
HYDROXYZINE HCL, UP TO 25 MG
HYDROXYZINE HCL, UP TO 25 MG
HYDROXYZINE HCL, UP TO 25 MG
HYDROXYZINE HCL, UP TO 25 MG
HYDROXYZINE HCL, UP TO 25 MG
HYDROXYZINE HCL, UP TO 25 MG
HYDROXYZINE HCL, UP TO 25 MG
HYDROXYZINE HCL, UP TO 25 MG
HYDROXYZINE HCL, UP TO 25 MG
HYDROXYZINE HCL, UP TO 25 MG
HYDROXYZINE HCL, UP TO 25 MG
HYDROXYZINE HCL, UP TO 25 MG
HYDROXYZINE HCL, UP TO 25 MG
HYDROXYZINE HCL, UP TO 25 MG
THIAMINE HCL, 100 MG
THIAMINE HCL, 100 MG
THIAMINE HCL, 100 MG
THIAMINE HCL, 100 MG
THIAMINE HCL, 100 MG
THIAMINE HCL, 100 MG
THIAMINE HCL, 100 MG
THIAMINE HCL, 100 MG
THIAMINE HCL, 100 MG
THIAMINE HCL, 100 MG
THIAMINE HCL, 100 MG
PYRIDOXINE HCL, 100 MG
PYRIDOXINE HCL, 100 MG
PYRIDOXINE HCL, 100 MG
PYRIDOXINE HCL, 100 MG
PYRIDOXINE HCL, 100 MG
PYRIDOXINE HCL, 100 MG
PYRIDOXINE HCL, 100 MG
PYRIDOXINE HCL, 100 MG
PYRIDOXINE HCL, 100 MG
PYRIDOXINE HCL, 100 MG
PYRIDOXINE HCL, 100 MG
PYRIDOXINE HCL, 100 MG
PYRIDOXINE HCL, 100 MG
PYRIDOXINE HCL, 100 MG
PYRIDOXINE HCL, 100 MG
PYRIDOXINE HCL, 100 MG
PYRIDOXINE HCL, 100 MG
PYRIDOXINE HCL, 100 MG
PYRIDOXINE HCL, 100 MG
PYRIDOXINE HCL, 100 MG
PYRIDOXINE HCL, 100 MG
PYRIDOXINE HCL, 100 MG
PYRIDOXINE HCL, 100 MG
PYRIDOXINE HCL, 100 MG
VITAMIN B-12 CYANOCOBALAMIN,
VITAMIN B-12 CYANOCOBALAMIN,
VITAMIN B-12 CYANOCOBALAMIN,
VITAMIN B-12 CYANOCOBALAMIN,
VITAMIN B-12 CYANOCOBALAMIN,
VITAMIN B-12 CYANOCOBALAMIN,
UP
UP
UP
UP
UP
UP
TO
TO
TO
TO
TO
TO
1000
1000
1000
1000
1000
1000
MCG
MCG
MCG
MCG
MCG
MCG
10/18/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
04/30/2002
04/30/2002
01/01/2002
01/01/2002
09/08/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
07/08/2003
07/08/2003
07/08/2003
07/08/2003
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
10/01/2007
01/01/2004
10/26/2006
10/26/2006
10/26/2006
10/26/2006
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
07/10/2007
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
01/01/2004
10/26/2006
10/26/2006
10/26/2006
10/26/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
05/29/2003
Latest End
Date
11/30/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/28/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J3420
J3420
J3420
J3420
J3420
J3420
J3420
J3420
J3420
J3420
J3420
J3420
J3420
J3420
J3420
J3420
J3420
J3420
J3420
J3420
J3420
J3420
J3420
J3420
J3430
J3430
J3430
J3430
J3430
J3430
J3430
J3430
J3430
J3430
J3430
J3430
J3430
J3430
J3465
J3470
J3470
J3470
J3470
J3470
J3470
J3470
J3472
J3473
J3473
J3475
J3475
J3475
J3475
J3475
J3475
J3475
J3475
J3475
J3475
J3475
J3475
J3475
J3475
J3475
J3475
11584102501
25332000430
25332007810
38779046803
38779046804
38779046805
38779046806
49452240002
49452240003
49452240004
51552104501
51552104509
51927166200
52637028210
52637031230
54569553300
54868076200
54868076201
55553009110
55553009130
62991103901
62991103902
62991103903
63323004401
00409915701
00409915801
00548114000
49452441001
49452441002
49452539001
49452539002
49452539003
51552106302
51927172200
51927192500
63370046210
63370046215
63370046225
00049319028
00548909000
00548909010
17478056001
60977031903
67425000101
67425000110
67425000210
67425000210
60977031903
60977031944
00406420012
00409175410
00409216802
00409216803
00409672723
00409672803
00409672903
00409672909
00409672923
00409672924
00409673013
00517260225
00517261025
00517265025
00548103400
10106250601
12/19/2013
HCPCS Description
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
VITAMIN K INJECTION PER 1MG
INJ, PHYTONADIONE 1MG, VIT K
PHYTONADIONE INJ, PER 1MG
INJECTION, PHYTONADIONE (VITAMIN K), PER 1 MG
INJECTION, PHYTONADIONE (VITAMIN K), PER 1 MG
INJECTION, PHYTONADIONE (VITAMIN K), PER 1 MG
INJECTION, PHYTONADIONE (VITAMIN K), PER 1 MG
INJECTION, PHYTONADIONE (VITAMIN K), PER 1 MG
INJECTION, PHYTONADIONE (VITAMIN K), PER 1 MG
INJECTION, PHYTONADIONE (VITAMIN K), PER 1 MG
INJECTION, PHYTONADIONE (VITAMIN K), PER 1 MG
INJECTION, PHYTONADIONE (VITAMIN K), PER 1 MG
INJECTION, PHYTONADIONE (VITAMIN K), PER 1 MG
INJECTION, PHYTONADIONE (VITAMIN K), PER 1 MG
INJECTION, VORICONAZOLE, 10 MG
INJECTION, HYALURONIDASE, UP TO 150 UNITS
INJECTION, HYALURONIDASE, UP TO 150 UNITS
INJECTION, HYALURONIDASE, UP TO 150 UNITS
INJECTION, HYALURONIDASE, UP TO 150 UNITS
INJECTION, HYALURONIDASE, UP TO 150 UNITS
INJECTION, HYALURONIDASE, UP TO 150 UNITS
INJECTION, HYALURONIDASE, UP TO 150 UNITS
INJECTION, HYALURONIDASE, OVINE, PRESERVATIVE FREE, PER 1000
INJECTION, HYALURONIDASE, RECOMBINANT, 1 USP UNIT
INJECTION, HYALURONIDASE, RECOMBINANT, 1 USP UNIT
INJECTION, MAGNESIUM SULFATE, PER 500 MG
INJECTION, MAGNESIUM SULFATE, PER 500 MG
INJECTION, MAGNESIUM SULFATE, PER 500 MG
INJECTION, MAGNESIUM SULFATE, PER 500 MG
INJECTION, MAGNESIUM SULFATE, PER 500 MG
INJECTION, MAGNESIUM SULFATE, PER 500 MG
INJECTION, MAGNESIUM SULFATE, PER 500 MG
INJECTION, MAGNESIUM SULFATE, PER 500 MG
INJECTION, MAGNESIUM SULFATE, PER 500 MG
INJECTION, MAGNESIUM SULFATE, PER 500 MG
INJECTION, MAGNESIUM SULFATE, PER 500 MG
INJECTION, MAGNESIUM SULFATE, PER 500 MG
INJECTION, MAGNESIUM SULFATE, PER 500 MG
INJECTION, MAGNESIUM SULFATE, PER 500 MG
INJECTION, MAGNESIUM SULFATE, PER 500 MG
INJECTION, MAGNESIUM SULFATE, PER 500 MG
Earliest Start
Date
01/01/2002
01/01/2002
01/01/2002
04/25/2003
04/25/2003
04/25/2003
04/25/2003
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
12/04/2003
01/01/2002
01/01/2002
09/19/2003
01/01/2002
09/18/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2006
01/01/2006
09/30/1990
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
12/04/2003
09/08/2003
10/25/2006
10/25/2006
10/25/2006
01/01/2004
11/01/2004
04/25/2005
05/16/2007
03/30/2006
01/28/2005
01/28/2005
01/28/2005
01/01/2012
01/01/2007
04/27/2007
01/01/2002
11/27/2006
01/31/2005
10/22/2004
09/20/2005
12/01/2006
08/16/2005
09/22/2005
10/06/2005
12/01/2006
04/03/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/30/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/30/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/30/2011
07/30/2011
12/31/2078
12/31/2078
12/31/2078
10/01/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/28/2010
12/31/2078
Page 1 of 1
HCPCS
NDC
J3475
J3475
J3475
J3475
J3475
J3475
J3475
J3475
J3475
J3475
J3475
J3475
J3475
J3475
J3475
J3475
J3475
J3475
J3475
J3475
J3475
J3475
J3475
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
10106250605
17317034501
17317034505
17317034508
17317034601
17317034605
17317034608
17317141301
17317141303
23535060861
23535060868
49452430001
49452430002
49452430003
51927229800
51927273200
54868572400
61553042104
61553042302
63323006402
63323006410
63323006420
63323006450
00074393402
00074665106
00264194010
00264194020
00264786500
00338031802
00338069104
00338069504
00338070341
00338070348
00338070434
00338070541
00338070548
00338070948
00406683804
00406683806
00406684504
00406685804
00409151302
00409390703
00409663501
00409663601
00409665106
00409665305
00409707426
00409707514
00409707526
00409707626
00409707714
00409707726
00409711509
00409711609
10106304601
10106304605
10106305201
10106305205
17317043801
17317043805
17317043808
49072057130
49452577001
49452577002
12/19/2013
HCPCS Description
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
MAGNESIUM SULFATE, PER 500 MG
MAGNESIUM SULFATE, PER 500 MG
MAGNESIUM SULFATE, PER 500 MG
MAGNESIUM SULFATE, PER 500 MG
MAGNESIUM SULFATE, PER 500 MG
MAGNESIUM SULFATE, PER 500 MG
MAGNESIUM SULFATE, PER 500 MG
MAGNESIUM SULFATE, PER 500 MG
MAGNESIUM SULFATE, PER 500 MG
MAGNESIUM SULFATE, PER 500 MG
MAGNESIUM SULFATE, PER 500 MG
MAGNESIUM SULFATE, PER 500 MG
MAGNESIUM SULFATE, PER 500 MG
MAGNESIUM SULFATE, PER 500 MG
MAGNESIUM SULFATE, PER 500 MG
MAGNESIUM SULFATE, PER 500 MG
MAGNESIUM SULFATE, PER 500 MG
MAGNESIUM SULFATE, PER 500 MG
MAGNESIUM SULFATE, PER 500 MG
MAGNESIUM SULFATE, PER 500 MG
MAGNESIUM SULFATE, PER 500 MG
MAGNESIUM SULFATE, PER 500 MG
MAGNESIUM SULFATE, PER 500 MG
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
POTASSIUM CHLORIDE, PER 2 MEQ
Earliest Start
Date
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
12/04/2003
12/04/2003
12/12/2006
02/01/2005
07/11/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
05/21/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
06/16/2005
11/24/2004
09/21/2005
08/09/2005
11/10/2005
08/09/2005
04/25/2005
06/08/2005
04/11/2005
02/08/2006
06/28/2005
05/04/2005
04/06/2005
06/22/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/01/2008
07/01/2007
10/31/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3480
J3485
J3486
J3487
J3487
J3487
J3487
J3487
J3487
J3488
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
49452577003
49452578001
49452578002
49452578003
51552006106
51552032406
51552032408
51552032409
51927109000
54868076700
54868076701
62991154901
62991154902
63323096505
63323096510
63323096515
63323096520
63323096730
00173010793
00049392083
00078059061
23155018631
25021080166
42023015101
47335003540
53150087101
00078043561
00003218710
00004003822
00004018809
00004035009
00004035239
00004038039
00005010432
00006353750
00006353904
00006409406
00006409431
00006498000
00006498100
00006499200
00006499500
00006499541
00007440106
00008092355
00008536002
00009023301
00009072809
00009077526
00009087026
00009090218
00009312403
00009337502
00009338102
00009338202
00009344703
00015710128
00015722518
00029657126
00029657131
00029657140
00029657921
00049101028
00049338225
00052027201
12/19/2013
HCPCS Description
INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ
INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ
INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ
INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ
INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ
INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ
INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ
INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ
INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ
INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ
INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ
INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ
INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ
INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ
INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ
INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ
INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ
INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ
INJECTION, ZIDOVUDINE, 10 MG
INJECTION, ZIPRASIDONE MESYLATE, 10 MG
ZOLDERONIC ACID PER 1MG (ZOMETA)
ZOLDERONIC ACID PER 1MG (ZOMETA)
ZOLDERONIC ACID PER 1MG (ZOMETA)
ZOLDERONIC ACID PER 1MG (ZOMETA)
ZOLDERONIC ACID PER 1MG (ZOMETA)
ZOLDERONIC ACID PER 1MG (ZOMETA)
INJECTION, ZOLEDRONIC ACID (RECLAST), 1 MG
UNCLASSIFIED DRUGS
IMMUNOSUPPRESSIVE DRUG, NOT OTHERWISE CLASSIFIED
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
Earliest Start
Date
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
09/01/2003
09/01/2003
12/04/2003
01/01/2002
03/16/2007
09/15/2003
09/15/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2004
09/20/2011
03/30/2013
03/05/2013
03/05/2013
03/08/2013
05/13/2013
01/01/2008
01/03/2006
01/01/2002
02/24/2006
10/16/2002
01/19/2004
03/12/2003
01/01/2002
01/01/2002
01/01/2002
06/19/2007
06/19/2007
01/01/2002
01/01/2002
07/09/2002
07/09/2002
07/16/2002
01/27/2006
05/18/2004
06/17/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
04/25/2006
10/19/2005
08/10/2006
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
05/31/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/30/2012
12/31/2078
07/13/2014
06/30/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/30/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
11/30/2012
12/31/2078
09/01/2010
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
00052030151
00068059701
00074116201
00074141204
00074141210
00074156010
00074161050
00074338225
00074405201
00074574922
00074744401
00085127901
00085129101
00085129701
00085129702
00085130401
00085131601
00085131602
00085132301
00085132302
00085136801
00085137001
00085137002
00186102603
00186103001
00186103002
00186103012
00186103091
00186103101
00186103301
00186103302
00186103312
00186103391
00186103501
00186103701
00186103702
00186103712
00264553532
00310030011
00310030022
00310030050
00310030061
00310030064
00310030065
00338101741
00338101948
00338105548
00338519741
00338519841
00406067252
00409115801
00409115802
00409115901
00409115902
00409116001
00409116101
00409116201
00409116202
00409116301
00409116401
00409116501
00409116502
00409141204
00409141210
00409155910
12/19/2013
HCPCS Description
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
Earliest Start
Date
05/01/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
02/02/2004
03/07/2005
01/01/2002
02/02/2004
03/07/2005
02/02/2004
03/07/2005
01/01/2002
02/02/2004
03/07/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
11/18/2004
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
11/01/2003
01/01/2002
07/27/2005
10/28/2005
06/29/2005
08/10/2005
04/12/2005
10/18/2004
03/08/2006
11/22/2005
03/30/2005
03/24/2006
12/08/2005
05/24/2005
06/14/2006
06/29/2006
08/22/2005
Latest End
Date
12/31/2078
12/31/2078
09/01/2007
08/01/2007
04/01/2007
05/01/2007
09/01/2007
07/01/2006
03/01/2007
06/01/2006
03/01/2007
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/31/2012
04/30/2013
10/31/2012
10/31/2012
02/28/2012
04/30/2013
05/31/2013
11/30/2011
04/30/2013
03/31/2012
05/31/2013
04/30/2012
11/30/2012
12/31/2078
12/31/2078
09/30/2010
09/30/2010
10/31/2010
07/31/2010
07/31/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
00409155930
00409156010
00409156029
00409158210
00409158229
00409158750
00409161050
00409176102
00409338031
00409338032
00409338035
00409338049
00409338050
00409338051
00409338221
00409338222
00409338225
00409361301
00409405001
00409405101
00409405201
00409405303
00409405403
00409405503
00409419701
00409427201
00409427301
00409427401
00409434673
00409469924
00409469930
00409469933
00409469940
00409469961
00409744401
00409744501
00409744716
00409781124
00409781137
00517912025
00703285604
00703285809
00703285903
00703950303
00703951403
00703952601
00781312485
00781312495
00781312585
00781312592
00781312595
00781312646
00781312695
00781312892
00781312992
00781615395
00781912485
00781912495
00781912585
00781912595
00781912646
00781912695
00781922415
00781922492
00781922520
12/19/2013
HCPCS Description
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
Earliest Start
Date
09/07/2005
08/31/2005
08/05/2005
07/22/2005
08/04/2005
01/10/2006
11/22/2005
06/06/2005
09/01/2005
11/03/2005
12/28/2005
11/29/2005
11/07/2005
10/12/2005
07/15/2005
07/18/2005
10/19/2005
01/07/2005
05/13/2005
05/31/2005
07/05/2005
05/11/2005
02/18/2005
02/24/2005
03/31/2005
04/06/2006
06/28/2006
03/31/2006
04/13/2005
03/22/2006
03/22/2006
03/22/2006
01/31/2008
12/01/2007
04/03/2006
11/10/2005
01/09/2006
08/31/2005
09/22/2005
03/12/2003
06/26/2007
06/26/2007
06/26/2007
01/01/2002
01/01/2002
01/01/2002
09/09/2005
04/27/2004
09/09/2005
02/23/2005
04/27/2004
09/09/2005
04/27/2004
04/17/2006
02/22/2006
01/01/2002
02/01/2007
02/01/2006
02/01/2007
02/01/2006
03/31/2007
02/01/2006
02/01/2007
09/18/2006
02/01/2007
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
10/01/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
10/01/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
05/31/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
00781922592
03221020811
03221040711
03221041511
03221060811
03221081411
03221101611
03221122511
10019001301
10019001302
10019001303
10019001306
10019004502
10019004517
10019004603
10019004604
10019004614
10019004663
10019004701
10019004717
10019004802
10019004803
10019004814
10019004863
10019005006
10019005021
10019005036
10019005037
10019005039
10019005043
10019021301
10019021302
10019021303
10019021311
10019021320
10019021352
10019050602
10019050610
10019050645
10106108001
10139007501
10139007502
10139007505
10139007510
10139007512
10139007515
11098005001
11098005002
11098005005
11994001104
15054104005
16887021101
16887021105
17317004901
17317004904
17317004905
24208041601
25332008805
25682000101
38779000603
38779000604
38779000605
38779001501
38779001504
38779001505
12/19/2013
HCPCS Description
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
Earliest Start
Date
09/18/2006
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2002
01/01/2002
01/01/2002
10/01/2002
11/01/2003
05/05/2007
01/01/2002
11/01/2003
05/05/2007
05/05/2007
11/01/2003
05/05/2007
11/01/2003
01/01/2004
05/05/2007
05/05/2007
01/01/2002
01/01/2002
05/05/2007
05/05/2007
05/05/2007
01/01/2002
09/10/2002
09/10/2002
09/10/2002
05/05/2007
05/05/2007
05/05/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
11/20/2006
11/20/2006
11/20/2006
11/20/2006
11/20/2006
11/20/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
11/01/2005
12/15/2006
12/15/2006
01/01/2002
01/01/2002
01/01/2002
06/20/2005
01/01/2002
03/26/2007
01/01/2002
01/01/2002
01/01/2002
04/26/2002
04/26/2002
04/26/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
04/30/2009
04/30/2009
10/30/2009
02/28/2008
03/31/2014
03/31/2014
02/28/2014
01/31/2014
01/31/2014
02/28/2014
07/28/2009
12/31/2078
06/28/2009
03/28/2009
12/31/2078
12/31/2078
03/31/2014
11/30/2013
03/31/2014
11/30/2013
12/31/2012
12/31/2012
06/30/2009
06/30/2009
06/30/2009
06/30/2009
12/31/2078
12/31/2078
12/31/2078
05/31/2013
02/28/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/31/2012
08/31/2012
07/31/2012
12/31/2078
12/31/2078
02/28/2010
02/28/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
38779006305
38779006308
38779006309
38779012304
38779012305
38779012308
38779012309
38779012601
38779012603
38779012604
38779012606
38779014604
38779014605
38779014608
38779014609
38779053405
38779053408
38779053409
38779065504
38779065505
38779065508
38779098904
38779098905
38779098908
38779098909
38779176400
38779176403
38779176406
38779196807
38779196809
38779210205
38779210209
39822020005
39822027702
39822027707
39822027709
44087111201
44087111301
44087111401
44087115001
44087900501
44087900506
44087903001
44087907001
49281054505
49452040901
49452040902
49452040903
49452040904
49452080001
49452080101
49452097001
49452097002
49452097003
49452107202
49452107203
49452303802
49452303803
49452303804
49452303805
49452354301
49452354302
49452472601
49452472602
49452472603
12/19/2013
HCPCS Description
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
17P, 250MG (COMPOUNDED 250MG/ML)
17P, 250MG (COMPOUNDED 250MG/ML)
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
Earliest Start
Date
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/03/2002
04/25/2002
04/25/2002
04/25/2002
08/21/2002
08/21/2002
08/21/2002
01/28/2002
01/28/2002
01/28/2002
01/28/2002
01/28/2002
01/28/2002
01/28/2002
01/01/2002
01/01/2002
10/31/2009
10/31/2009
01/01/2002
01/01/2002
11/16/2005
02/01/2006
06/15/2004
06/15/2004
06/15/2004
11/10/2003
06/07/2004
06/07/2004
05/10/2004
05/07/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
11/15/2004
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/08/2002
01/31/2002
01/31/2002
01/31/2002
01/31/2002
01/01/2007
01/01/2007
03/19/2002
03/19/2002
03/19/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/31/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
49452622204
49452622205
49452622206
50242005801
50242005804
50242008001
51479004005
51479004110
51479004115
51479004210
51479004215
51479004801
51479004901
51552003803
51552003804
51552003805
51552003806
51552013002
51552013004
51552013006
51552052902
51552052903
51552062801
51552065201
51552065202
51552065204
51552071504
51552071505
51552071506
51552073701
51552073702
51552076305
51552076307
51552088902
51552088903
51552088904
51552088909
51552102802
51552102804
51927119400
51927144900
51927159700
51927168300
51927177600
51927182900
51927195400
51927195600
51927230300
51927321300
51927340800
51927354800
51927363400
54092070001
54569326000
54569531100
54569540800
54569557800
54569562800
54569562900
54569563000
54569578100
54569586200
54868073400
54868221900
54868221901
12/19/2013
HCPCS Description
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
17P, 250MG (COMPOUNDED 250MG/ML)
17P, 250MG (COMPOUNDED 250MG/ML)
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
Earliest Start
Date
01/01/2002
01/01/2002
01/01/2002
10/27/2003
10/27/2003
06/30/2006
09/30/2005
09/30/2005
09/30/2005
09/30/2005
09/30/2005
09/30/2005
09/30/2005
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
01/01/2002
09/01/2003
09/01/2003
09/01/2003
01/01/2002
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/01/2003
10/31/2009
10/31/2009
09/08/2003
09/08/2003
12/04/2003
09/08/2003
09/08/2003
09/08/2003
09/08/2003
09/08/2003
09/08/2003
01/03/2005
09/08/2003
09/08/2003
01/04/2008
07/25/2006
01/01/2002
01/01/2002
07/18/2002
07/21/2004
11/10/2004
11/10/2004
11/10/2004
03/16/2006
11/13/2006
08/27/2002
01/01/2002
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
06/30/2010
06/30/2010
12/31/2078
10/31/2007
03/31/2007
03/31/2012
12/31/2078
11/30/2011
02/04/2011
02/03/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
54868313400
54868313401
54868323600
54868343700
54868369400
54868369500
54868372700
54868415400
54868416900
54868419400
54868462900
54868478100
54868503600
54868503601
55045325105
55045325202
55045377305
55390002601
55390002701
55390002810
55390002910
55390004210
55390010420
55390010450
55390010499
55390010901
55390012301
55390050002
55390050005
55390050010
55390050102
55390050105
55390050110
55513017701
55513017707
55513017728
55513095401
55513095501
55513095601
58016934301
58160081511
58160081546
58160082011
58160082046
58160082111
58160082146
58160085011
58160085046
58160085611
58160085635
58160085646
58160085711
58160085746
58468015001
59148001665
61553018948
61553019048
61553019148
61553019202
61553019341
61553019448
61553022802
61570009501
61570009525
61570009625
12/19/2013
HCPCS Description
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
Earliest Start
Date
01/01/2002
02/02/2007
01/02/2003
02/02/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
03/02/2004
01/01/2002
10/07/2003
04/24/2003
03/31/2004
06/29/2006
07/01/2006
07/01/2006
04/06/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
06/23/2005
06/23/2005
06/23/2005
04/08/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
02/23/2004
10/10/2006
10/10/2006
10/10/2006
01/01/2002
08/06/2007
06/25/2007
02/01/2007
02/01/2007
02/01/2007
03/28/2007
01/01/2002
03/20/2002
01/01/2002
01/01/2002
01/17/2002
03/30/2006
02/01/2002
05/11/2006
12/08/2006
02/02/2004
02/02/2004
02/02/2004
02/02/2004
02/02/2004
02/02/2004
11/21/2007
01/09/2003
01/09/2003
01/09/2003
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/31/2009
03/31/2009
02/28/2009
01/31/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/31/2009
07/31/2009
06/30/2009
10/31/2011
10/31/2007
10/31/2011
12/31/2078
02/28/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/31/2010
08/31/2009
04/30/2009
Page 1 of 1
HCPCS
NDC
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
62794025513
62794025537
62991102102
62991102104
62991113301
62991113302
62991113303
62991113304
62991135201
62991135202
62991135204
62991151301
62991151302
62991151303
62991168501
62991168502
62991168503
62991250101
62991250102
63275620001
63275620006
63275620007
63275620009
63323026920
63323026927
63323026950
63323026957
63323026965
63323026967
63323028202
63323028204
63323028206
63323028260
63323032930
63323038020
63323038120
63323038510
63323038620
63323039050
63323073804
63323073820
63323073912
63370002206
63370002209
63370002215
63370003125
63370003135
63370003145
63370003210
63370003215
63370003225
63370003235
63370003435
63370003445
63370003450
63370009125
63370009135
63370009145
63370010910
63370010916
63370015225
63370015235
63370015245
63370096804
63370096806
12/19/2013
HCPCS Description
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
UNCLASSIFIED
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
DRUGS
Earliest Start
Date
06/21/2004
06/21/2004
01/01/2002
09/15/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2007
01/01/2007
01/01/2007
09/15/2003
09/15/2003
09/15/2003
09/01/2002
09/01/2002
09/01/2002
09/15/2003
09/15/2003
01/01/2002
12/03/2002
12/03/2002
12/03/2002
02/21/2008
01/15/2008
04/28/2008
03/05/2008
03/06/2008
02/01/2008
05/11/2007
05/11/2007
05/11/2007
05/11/2007
04/23/2004
01/12/2004
01/12/2004
08/13/2007
08/13/2007
01/12/2004
01/01/2002
01/01/2002
05/14/2002
12/19/2003
12/19/2003
12/19/2003
07/08/2003
07/08/2003
07/08/2003
07/08/2003
07/08/2003
07/08/2003
07/08/2003
07/12/2004
07/12/2004
07/12/2004
07/12/2004
07/12/2004
07/12/2004
01/01/2007
01/01/2007
07/08/2003
07/08/2003
07/08/2003
07/08/2003
07/08/2003
Latest End
Date
08/31/2007
08/31/2007
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/30/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3490
J3520
J3520
J3520
J3520
J3520
J3520
J3520
J3520
J3520
J3520
J3520
J3520
J3520
J3520
J3520
J3520
J3520
J3520
J3520
J3520
J3520
J3520
J3520
J3520
J3535
J3590
J3590
J3590
J3590
J3590
J3590
J3590
J3590
J3590
J3590
J3590
J3590
J3590
J3590
J3590
J7030
J7030
J7030
J7030
J7030
J7030
J7030
J7030
J7030
J7030
J7040
J7040
J7040
J7040
J7040
J7040
J7040
63459030042
63459039120
66758002501
66758002502
66758002503
66758002504
67871772902
68135002001
00074694003
00406139504
00409694003
10106899401
17317082901
17317082905
17317082908
17317148501
17317148504
17317148505
17317156501
17317156505
17317156508
49452270201
49452270202
49452270203
51552058806
51927131700
62991202602
62991202603
62991202604
63370043235
63370043250
67457014720
54868551100
00944417505
00944417510
13533063601
13533063602
13533063603
13533063605
49999042505
54569473900
54868228901
59730420201
59730420301
59730420401
59730420501
60492005102
60492005202
00264400055
00264780000
00338004904
00409488820
00409798302
00409798303
00409798309
00409798348
54868071000
54868071004
00264400155
00264780000
00264780010
00338004403
00338004903
00409488820
00409798302
12/19/2013
HCPCS Description
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
UNCLASSIFIED DRUGS
EDETATE DISODIUM, PER 150 MG
EDETATE DISODIUM, PER 150 MG
EDETATE DISODIUM, PER 150 MG
EDETATE DISODIUM, PER 150 MG
EDETATE DISODIUM, PER 150 MG
EDETATE DISODIUM, PER 150 MG
EDETATE DISODIUM, PER 150 MG
EDETATE DISODIUM, PER 150 MG
EDETATE DISODIUM, PER 150 MG
EDETATE DISODIUM, PER 150 MG
EDETATE DISODIUM, PER 150 MG
EDETATE DISODIUM, PER 150 MG
EDETATE DISODIUM, PER 150 MG
EDETATE DISODIUM, PER 150 MG
EDETATE DISODIUM, PER 150 MG
EDETATE DISODIUM, PER 150 MG
EDETATE DISODIUM, PER 150 MG
EDETATE DISODIUM, PER 150 MG
EDETATE DISODIUM, PER 150 MG
EDETATE DISODIUM, PER 150 MG
EDETATE DISODIUM, PER 150 MG
EDETATE DISODIUM, PER 150 MG
EDETATE DISODIUM, PER 150 MG
EDETATE DISODIUM, PER 150 MG
DRUG ADMINISTERED THROUGH A METERED DOSE INHALER
UNCLASSIFIED BIOLOGICS
UNCLASSIFIED BIOLOGICS
UNCLASSIFIED BIOLOGICS
UNCLASSIFIED BIOLOGICS
UNCLASSIFIED BIOLOGICS
UNCLASSIFIED BIOLOGICS
UNCLASSIFIED BIOLOGICS
UNCLASSIFIED BIOLOGICS
UNCLASSIFIED BIOLOGICS
UNCLASSIFIED BIOLOGICS
UNCLASSIFIED BIOLOGICS
UNCLASSIFIED BIOLOGICS
UNCLASSIFIED BIOLOGICS
UNCLASSIFIED BIOLOGICS
UNCLASSIFIED BIOLOGICS
INFUSION, NORMAL SALINE SOLUTION , 1000 CC
INFUSION, NORMAL SALINE SOLUTION , 1000 CC
INFUSION, NORMAL SALINE SOLUTION , 1000 CC
NORMAL SALINE INF 1000ML
NORMAL SALINE INF 1000ML
INFUSION, NORMAL SALINE SOLUTION , 1000 CC
INFUSION, NORMAL SALINE SOLUTION , 1000 CC
INFUSION, NORMAL SALINE SOLUTION , 1000 CC
INFUSION, NORMAL SALINE SOLUTION , 1000 CC
INFUSION, NORMAL SALINE SOLUTION , 1000 CC
INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML=1 UNIT)
NORMAL SALINE INF 500ML
INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML=1 UNIT)
INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML=1 UNIT)
INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML=1 UNIT)
NORMAL SALINE INF 500ML
NORMAL SALINE INF 500ML
Earliest Start
Date
06/12/2006
03/31/2008
12/18/2003
12/18/2003
12/18/2003
12/18/2003
10/01/2005
06/05/2005
01/01/2002
01/01/2002
10/17/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/11/2002
01/11/2002
01/01/2002
09/01/2003
12/04/2003
01/01/2002
01/01/2002
09/15/2003
10/24/2006
10/24/2006
07/01/2005
10/21/2008
06/28/2007
06/28/2007
10/14/2006
01/18/2006
01/18/2006
01/18/2006
07/06/2004
01/01/2003
01/01/2003
01/01/2003
01/01/2003
01/03/2005
01/01/2004
10/01/2007
10/01/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2006
01/01/2006
01/01/2006
02/07/2005
04/14/2006
01/01/2002
12/15/2006
01/01/2002
01/01/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2006
01/01/2006
Latest End
Date
05/31/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
06/01/2008
12/31/2078
09/01/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
11/30/2009
06/30/2009
12/31/2078
12/31/2078
06/30/2015
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/30/2015
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J7040
J7040
J7040
J7040
J7040
J7042
J7042
J7042
J7042
J7042
J7042
J7042
J7042
J7042
J7050
J7050
J7050
J7050
J7050
J7050
J7050
J7050
J7050
J7050
J7050
J7050
J7050
J7050
J7050
J7050
J7050
J7050
J7050
J7050
J7050
J7050
J7050
J7050
J7050
J7050
J7050
J7050
J7050
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
00409798303
00409798309
00409798330
00409798355
54868071001
00264761000
00264761010
00264761020
00338008902
00338008903
00338008904
00409794102
00409794103
00409794109
00264180032
00264400255
00264780000
00264780020
00338004402
00338004901
00338004902
00338004911
00338004918
00338004938
00338004948
00338055318
00338630402
00409158301
00409158302
00409158411
00409488820
00409710102
00409710167
00409798302
00409798303
00409798309
00409798353
00409798361
00409798423
00409798437
54868071003
54868071006
63323018600
00074710013
00074792255
00264110155
00264110255
00264110755
00264151031
00264151032
00264151036
00264751000
00264751010
00264751020
00338001602
00338001603
00338001701
00338001702
00338001703
00338001704
00338001710
00338001711
00338001718
00338001731
00338001738
12/19/2013
HCPCS Description
INFUSION, NORMAL SALINE SOLUTION, STERILE (500
INFUSION, NORMAL SALINE SOLUTION, STERILE (500
INFUSION, NORMAL SALINE SOLUTION, STERILE (500
INFUSION, NORMAL SALINE SOLUTION, STERILE (500
INFUSION, NORMAL SALINE SOLUTION, STERILE (500
5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT)
5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT)
5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT)
5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT)
5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT)
5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT)
5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT)
5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT)
5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT)
INFUSION, NORMAL SALINE SOLUTION , 250 CC
INFUSION, NORMAL SALINE SOLUTION , 250 CC
INFUSION, NORMAL SALINE SOLUTION , 250 CC
INFUSION, NORMAL SALINE SOLUTION , 250 CC
INFUSION, NORMAL SALINE SOLUTION , 250 CC
INFUSION, NORMAL SALINE SOLUTION , 250 CC
INFUSION, NORMAL SALINE SOLUTION , 250 CC
INFUSION, NORMAL SALINE SOLUTION , 250 CC
INFUSION, NORMAL SALINE SOLUTION , 250 CC
INFUSION, NORMAL SALINE SOLUTION , 250 CC
INFUSION, NORMAL SALINE SOLUTION , 250 CC
INFUSION, NORMAL SALINE SOLUTION , 250 CC
NORMAL SALINE, IV, PER 250 ML
INFUSION, NORMAL SALINE SOLUTION , 250 CC
INFUSION, NORMAL SALINE SOLUTION , 250 CC
INFUSION, NORMAL SALINE SOLUTION , 250 CC
INFUSION, NORMAL SALINE SOLUTION , 250 CC
INFUSION, NORMAL SALINE SOLUTION , 250 CC
INFUSION, NORMAL SALINE SOLUTION , 250 CC
INFUSION, NORMAL SALINE SOLUTION , 250 CC
INFUSION, NORMAL SALINE SOLUTION , 250 CC
INFUSION, NORMAL SALINE SOLUTION , 250 CC
INFUSION, NORMAL SALINE SOLUTION , 250 CC
INFUSION, NORMAL SALINE SOLUTION , 250 CC
INFUSION, NORMAL SALINE SOLUTION , 250 CC
INFUSION, NORMAL SALINE SOLUTION , 250 CC
INFUSION, NORMAL SALINE SOLUTION , 250 CC
INFUSION, NORMAL SALINE SOLUTION , 250 CC
INFUSION, NORMAL SALINE SOLUTION , 250 CC
D5W 500ML
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
ML=1
ML=1
ML=1
ML=1
ML=1
UNIT)
UNIT)
UNIT)
UNIT)
UNIT)
Earliest Start
Date
01/05/2005
01/01/2006
04/14/2006
04/11/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
05/27/2006
09/20/2005
08/08/2005
01/01/2002
01/01/2002
01/01/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/1991
01/01/2002
01/01/2002
01/01/2002
01/01/2002
03/19/2010
07/20/2005
09/14/2005
09/16/2005
01/01/2006
07/08/2005
08/24/2005
07/01/2005
01/01/2006
01/01/2002
09/30/2005
06/17/2005
05/18/2005
07/15/2005
12/12/2006
01/02/2007
01/01/2002
09/30/1990
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/31/2014
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
11/30/2013
12/31/2078
12/31/2078
10/31/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
11/01/2011
12/01/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/01/2007
12/31/2014
12/31/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7060
J7100
J7100
J7100
J7110
J7110
J7110
J7110
J7120
J7120
J7120
J7120
J7120
J7120
J7120
J7120
J7120
J7120
J7120
J7120
J7120
J7120
J7120
J7120
J7120
J7120
J7120
J7120
J7120
J7120
J7120
J7120
J7120
J7120
00338001741
00338001748
00338055111
00338055118
00338634602
00409108051
00409108201
00409108251
00409152201
00409152202
00409152203
00409152301
00409152311
00409710002
00409710066
00409710067
00409792202
00409792203
00409792209
00409792230
00409792248
00409792253
00409792255
00409792261
00409792313
00409792320
00409792323
00409792336
00409792337
54868029601
54868029602
54868029604
00338027003
00409741803
00409741903
00074150703
00264196010
00338026503
00409150503
00264350055
00264350155
00264351055
00264351155
00264775000
00264775010
00264775020
00264775100
00264775110
00338011702
00338011703
00338011704
00338012503
00338012504
00338081104
00338081504
00338630702
00409711109
00409711309
00409792903
00409792909
00409795302
00409795303
00409795309
00409795330
00409795348
12/19/2013
HCPCS Description
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
5% DEXTROSE/WATER (500 ML = 1 UNIT)
INFUSION, DEXTRAN 40, 500 ML
INFUSION, DEXTRAN 40, 500 ML
INFUSION, DEXTRAN 40, 500 ML
INFUSION, DEXTRAN 75, 500 ML
INFUSION, DEXTRAN 75, 500 ML
INFUSION, DEXTRAN 75, 500 ML
INFUSION, DEXTRAN 75, 500 ML
RINGERS LACTATE INFUSION, UP TO 1000
RINGERS LACTATE INFUSION, UP TO 1000
RINGERS LACTATE INFUSION, UP TO 1000
RINGERS LACTATE INFUSION, UP TO 1000
RINGERS LACTATE INFUSION, UP TO 1000
RINGERS LACTATE INFUSION, UP TO 1000
RINGERS LACTATE INFUSION, UP TO 1000
RINGERS LACTATE INFUSION, UP TO 1000
RINGERS LACTATE INFUSION, UP TO 1000
RINGERS LACTATE INFUSION, UP TO 1000
RINGERS LACTATE INFUSION, UP TO 1000
RINGERS LACTATE INFUSION, UP TO 1000
RINGERS LACTATE INFUSION, UP TO 1000
RINGERS LACTATE INFUSION, UP TO 1000
RINGERS LACTATE INFUSION, UP TO 1000
RINGERS LACTATE INFUSION, UP TO 1000
RINGERS LACTATE INFUSION, UP TO 1000
RINGERS LACTATE INFUSION, UP TO 1000
RINGERS LACTATE INFUSION, UP TO 1000
RINGERS LACTATE INFUSION, UP TO 1000
RINGERS LACTATE INFUSION, UP TO 1000
RINGERS LACTATE INFUSION, UP TO 1000
RINGERS LACTATE INFUSION, UP TO 1000
RINGERS LACTATE INFUSION, UP TO 1000
RINGERS LACTATE INFUSION, UP TO 1000
RINGERS LACTATE INFUSION, UP TO 1000
CC
CC
CC
CC
CC
CC
CC
CC
CC
CC
CC
CC
CC
CC
CC
CC
CC
CC
CC
CC
CC
CC
CC
CC
CC
CC
Earliest Start
Date
01/01/2002
01/01/2002
01/01/2002
01/01/2002
03/01/2007
03/24/2006
04/25/2005
03/29/2006
04/11/2005
03/09/2005
06/16/2005
09/16/2005
07/27/2005
07/22/2005
08/17/2005
09/14/2005
04/05/2005
02/25/2005
02/21/2005
04/14/2006
04/14/2006
09/01/2005
10/31/2006
08/05/2005
06/09/2005
06/17/2005
07/15/2005
04/05/2005
03/16/2005
01/01/2002
01/01/2002
12/12/2006
01/01/2002
02/14/2006
08/09/2005
01/01/2002
01/01/2002
01/01/2002
12/29/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
10/17/2007
08/05/2005
02/21/2005
06/09/2005
02/07/2005
03/09/2005
05/20/2005
05/18/2005
04/14/2006
04/14/2006
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/01/2011
12/31/2078
12/31/2078
12/31/2078
12/01/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/31/2008
12/31/2078
12/31/2078
10/01/2006
09/30/2009
08/31/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
10/31/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J7120
J7185
J7185
J7185
J7185
J7186
J7186
J7186
J7186
J7186
J7186
J7187
J7187
J7187
J7187
J7187
J7187
J7188
J7188
J7188
J7188
J7188
J7188
J7189
J7189
J7189
J7189
J7190
J7190
J7190
J7190
J7190
J7190
J7190
J7190
J7190
J7190
J7190
J7190
J7190
J7190
J7190
J7190
J7190
J7190
J7190
J7192
J7192
J7192
J7192
J7192
J7192
J7192
J7192
J7192
J7192
J7192
J7192
J7192
J7192
J7192
J7192
J7192
J7192
J7192
54868010200
58394001201
58394001301
58394001401
58394001501
68516460001
68516460002
68516460101
68516460201
68516460302
68516460402
00053761505
00053761510
00053761520
00053762005
00053762010
00053762020
00053761505
00053761510
00053761520
00053762005
00053762010
00053762020
00169705001
00169706001
00169706101
00169706201
00026066520
00026066530
00026066550
00053765601
00053765602
00053765604
00053765605
00944130110
00944130210
00944130310
00944130410
00944293501
00944293502
00944293503
00944293504
13533066520
13533066530
13533066550
52769046001
00026037220
00026037230
00026037250
00026037920
00026037930
00026037950
00026378660
00026379660
00053813001
00053813002
00053813004
00944283110
00944283210
00944283310
00944284110
00944293801
00944293802
00944293803
00944294001
12/19/2013
HCPCS Description
RINGERS LACTATE INFUSION, UP TO 1000 CC
FACTOR VIII (ANIT-HEMOPHILIC FACTOR, RECOMBINANT), PER IU
FACTOR VIII (ANIT-HEMOPHILIC FACTOR, RECOMBINANT), PER IU
FACTOR VIII (ANIT-HEMOPHILIC FACTOR, RECOMBINANT), PER IU
FACTOR VIII (ANIT-HEMOPHILIC FACTOR, RECOMBINANT), PER IU
INJECTION, ANTIHEMOPHILIC FACTOR VIII/VON WILLEBRAND FACTOR
INJECTION, ANTIHEMOPHILIC FACTOR VIII/VON WILLEBRAND FACTOR
INJECTION, ANTIHEMOPHILIC FACTOR VIII/VON WILLEBRAND FACTOR
INJECTION, ANTIHEMOPHILIC FACTOR VIII/VON WILLEBRAND FACTOR
INJECTION, ANTIHEMOPHILIC FACTOR VIII/VON WILLEBRAND FACTOR
INJECTION, ANTIHEMOPHILIC FACTOR VIII/VON WILLEBRAND FACTOR
INJECTION, VON WILLEBRAND FACTOR COMPLEX, HUMAN, RISTOCETIN
INJECTION, VON WILLEBRAND FACTOR COMPLEX, HUMAN, RISTOCETIN
INJECTION, VON WILLEBRAND FACTOR COMPLEX, HUMAN, RISTOCETIN
INJECTION, VON WILLEBRAND FACTOR COMPLEX, HUMAN, RISTOCETIN
INJECTION, VON WILLEBRAND FACTOR COMPLEX, HUMAN, RISTOCETIN
INJECTION, VON WILLEBRAND FACTOR COMPLEX, HUMAN, RISTOCETIN
INJECTION, VON WILLEBRAND FACTOR COMPLEX, HUMAN, IU
INJECTION, VON WILLEBRAND FACTOR COMPLEX, HUMAN, IU
INJECTION, VON WILLEBRAND FACTOR COMPLEX, HUMAN, IU
INJECTION, VON WILLEBRAND FACTOR COMPLEX, HUMAN, IU
INJECTION, VON WILLEBRAND FACTOR COMPLEX, HUMAN, IU
INJECTION, VON WILLEBRAND FACTOR COMPLEX, HUMAN, IU
FACTOR VIIA (ANIT-HEMOPHILIC FACTOR, RECOMBINANT), PER 1MCG
FACTOR VIIA (ANTIHEMOPHILIC FACTOR, RECOMBINANT), PER 1 MICR
FACTOR VIIA (ANTIHEMOPHILIC FACTOR, RECOMBINANT), PER 1 MICR
FACTOR VIIA (ANTIHEMOPHILIC FACTOR, RECOMBINANT), PER 1 MICR
FACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U., N
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U., N
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U., N
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U., N
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U., N
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U., N
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U., N
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U., N
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I. U. ,
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U., N
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U., N
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U., N
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.
Earliest Start
Date
12/11/2006
01/01/2010
01/01/2010
01/01/2010
01/01/2010
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
02/15/2006
02/15/2006
02/15/2006
01/01/2006
01/01/2006
01/01/2006
08/04/2008
01/01/2006
01/01/2006
01/01/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
05/26/2004
02/01/2006
02/01/2006
02/01/2006
02/01/2006
01/01/2002
04/17/2006
04/17/2006
04/17/2006
11/01/2007
11/01/2007
11/01/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2006
01/01/2006
01/01/2006
07/02/2007
07/02/2007
01/01/2002
01/01/2002
01/01/2002
10/05/2007
10/05/2007
10/05/2007
05/25/2011
01/01/2002
01/01/2002
01/01/2002
07/28/2003
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/12/2011
11/17/2011
03/10/2012
12/31/2078
12/31/2078
12/31/2078
09/12/2011
11/17/2011
03/10/2012
12/31/2078
12/31/2078
12/31/2078
01/31/2015
03/31/2011
03/31/2011
02/28/2011
08/16/2006
04/25/2007
02/22/2007
12/31/2078
12/31/2078
11/05/2012
10/28/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/27/2010
12/31/2078
10/08/2010
11/28/2012
11/08/2012
03/31/2013
12/30/2007
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/15/2011
02/17/2012
02/24/2012
11/02/2012
04/26/2013
04/26/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J7192
J7192
J7192
J7192
J7192
J7192
J7192
J7192
J7192
J7192
J7192
J7192
J7192
J7192
J7192
J7192
J7193
J7193
J7193
J7194
J7194
J7194
J7194
J7195
J7195
J7195
J7195
J7195
J7195
J7195
J7197
J7197
J7198
J7198
J7198
J7300
J7300
J7302
00944294002
00944294003
00944294004
00944294010
00944294110
00944294210
00944294310
00944294410
00944294510
00944294610
58394000502
58394000504
58394000602
58394000702
58394001102
58394001104
00053766802
00053766804
68516360002
00944058101
64193024402
68516320002
68516320003
58394000101
58394000106
58394000201
58394000206
58394000301
58394000306
58394000802
13533060320
13533060330
64193022203
64193022204
64193022205
51285020401
51285020402
50419042101
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U., N
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U., N
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U., N
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U., N
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U., N
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U., N
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U., N
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U., N
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U., N
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U., N
FACTOR IX (ANTIHEMOPHILIC FACTOR, PURIFIED, NON-RECOMBINANT)
FACTOR IX (ANTIHEMOPHILIC FACTOR, PURIFIED, NON-RECOMBINANT)
FACTOR IX (ANTIHEMOPHILIC FACTOR, PURIFIED, NON-RECOMBINANT)
FACTOR IX, COMPLEX, PER I.U.
FACTOR IX, COMPLEX, PER I.U.
FACTOR IX, COMPLEX, PER I.U.
FACTOR IX, COMPLEX, PER I.U.
FACTOR IX (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.
FACTOR IX (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.
FACTOR IX (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.
FACTOR IX (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.
FACTOR IX (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.
FACTOR IX (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.
FACTOR IX (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.
ANTITHROMBIN III (HUMAN), PER I.U.
ANTITHROMBIN III (HUMAN), PER I.U.
ANTI-INHIBITOR, PER I.U.
ANTI-INHIBITOR, PER I.U.
ANTI-INHIBITOR, PER I.U.
INTRAUERINE COPPER CONTRACEPTIVE
INTRAUERINE COPPER CONTRACEPTIVE
LEVONORGESTREL-RELEASING INTRAUTERINE CONTRACEPTIVE SYSTEM,
J7303
J7303
J7307
J7307
J7308
J7308
J7309
J7310
J7311
J7317
J7317
J7317
J7317
J7317
J7317
J7317
J7321
J7321
J7321
J7321
J7321
J7321
J7321
J7321
J7321
J7322
00052027301
00052027303
00052027201
00052027401
67308010101
67308010106
00299630002
24208041201
24208041601
49452354301
49452354302
62991135201
62991135202
62991135204
63370010910
63370010916
08024072412
08024072420
08363776101
08363776501
18837026502
21695037402
35356003601
35356003602
35356021901
21695031303
HORMONE CONTAINING VAGINAL RING
HORMONE CONTAINING VAGINAL RING
ETONOGESTREL IMPLANT SYSTEM
ETONOGESTREL IMPLANT SYSTEM
AMINOLEVULINIC ACID HCL FOR TOPICAL ADMINISTRATION, 20%, SIN
AMINOLEVULINIC ACID HCL FOR TOPICAL ADMINISTRATION, 20%, SIN
METHYL AMINOLEVULINATE (MAL) FOR TOPICAL ADMINISTRATION, 16.
GANCICLOVIR, 4.5 MG, LONG-ACTING IMPLANT
FLUOCINOLONE ACETONIDE, INTRAVITREAL IMPLANT
SODIUM HYALURONATE, PER 20 TO 25 MG DOSE FOR INTRA-ARTICULAR
SODIUM HYALURONATE, PER 20 TO 25 MG DOSE FOR INTRA-ARTICULAR
SODIUM HYALURONATE, PER 20 TO 25 MG DOSE FOR INTRA-ARTICULAR
SODIUM HYALURONATE, PER 20 TO 25 MG DOSE FOR INTRA-ARTICULAR
SODIUM HYALURONATE, PER 20 TO 25 MG DOSE FOR INTRA-ARTICULAR
SODIUM HYALURONATE, PER 20 TO 25 MG DOSE FOR INTRA-ARTICULAR
SODIUM HYALURONATE, PER 20 TO 25 MG DOSE FOR INTRA-ARTICULAR
HYALURONAN OR DERIVATIVE, HYALGAN OR SUPARTZ, FOR INTRA-ARTI
HYALURONAN OR DERIVATIVE, HYALGAN OR SUPARTZ, FOR INTRA-ARTI
HYALURONAN OR DERIVATIVE, HYALGAN OR SUPARTZ, FOR INTRA-ARTI
HYALURONAN OR DERIVATIVE, HYALGAN OR SUPARTZ, FOR INTRA-ARTI
HYALURONAN OR DERIVATIVE, HYALGAN OR SUPARTZ, FOR INTRA-ARTI
HYALURONAN OR DERIVATIVE, HYALGAN OR SUPARTZ, FOR INTRA-ARTI
HYALURONAN OR DERIVATIVE, HYALGAN OR SUPARTZ, FOR INTRA-ARTI
HYALURONAN OR DERIVATIVE, HYALGAN OR SUPARTZ, FOR INTRA-ARTI
HYALURONAN OR DERIVATIVE, HYALGAN OR SUPARTZ, FOR INTRA-ARTI
HYALURONAN OR DERIVATIVE, SYNVISC, FOR INTRA-ARTICULAR INJEC
12/19/2013
HCPCS Description
Earliest Start
Date
Latest End
Date
01/01/2006
01/01/2006
01/01/2007
09/01/2011
01/01/2003
01/01/2003
01/01/2012
07/26/2005
01/01/2007
01/01/2003
01/01/2003
01/01/2003
01/01/2003
09/15/2003
10/24/2006
10/24/2006
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/10/2008
01/10/2008
06/05/2008
01/01/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
06/30/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/28/2003
07/28/2003
07/28/2003
04/17/2006
01/22/2007
01/22/2007
01/22/2007
01/22/2007
01/22/2007
07/05/2007
11/02/2004
03/26/2008
11/02/2004
11/02/2004
11/02/2004
03/26/2008
01/01/2002
01/01/2002
07/25/2003
01/01/2002
01/01/2002
07/25/2003
07/25/2003
01/01/2002
06/28/2007
01/01/2002
06/28/2007
01/01/2002
06/28/2007
06/28/2007
10/14/2006
10/14/2006
08/20/2004
01/01/2002
02/01/2006
01/01/2007
01/01/2007
01/01/2002
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/31/2011
12/31/2078
12/31/2078
12/31/2078
01/31/2011
12/31/2078
01/07/2013
04/19/2011
12/31/2078
09/30/2012
12/09/2010
01/25/2011
11/30/2011
12/31/2013
10/31/2011
12/31/2013
05/31/2012
04/30/2013
12/31/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/30/2011
12/31/2078
10/31/2016
12/31/2078
Page 1 of 1
Earliest Start
Date
Latest End
Date
30170000001 DERMAL AND EPIDERMAL TISSUE OF HUMAN ORIGIN, WITH OR WITHOUT
01/01/2002
12/31/2078
08541000101
08121860047
08121860055
08121860204
08121860404
08121860407
08121860505
08121860510
08121860530
03221020811
03221040711
03221041511
03221060811
03221081411
03221101611
03221122511
08478400402
08478400405
08478400406
08478400408
08478401402
08478401405
08478401406
08478401408
08478800402
08478800405
08478800406
08478800408
08533649501
08533649503
08533649504
08533649506
08533601002
08533601004
08533601005
08533601006
08533601007
08533601008
08533601009
08533601010
08533601012
08533601013
08533601014
08533602002
08533602003
08533602005
08533603001
08533603002
08533603003
08533607009
08533607440
08533607812
08533607880
07/10/2006
01/01/2005
02/03/2005
01/01/2005
01/01/2005
06/30/2005
01/01/2005
01/01/2005
01/04/2005
08/01/2007
08/01/2007
08/01/2007
08/01/2007
08/01/2007
08/01/2007
08/01/2007
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
HCPCS
NDC
J7322
J7322
J7322
J7322
J7322
J7322
J7323
J7324
J7340
35356003401
35356003403
54868421900
58468009001
66267092103
68115053503
55566410001
59676036001
09978000199
J7340
J7342
J7344
J7344
J7344
J7344
J7344
J7344
J7344
J7344
J7345
J7345
J7345
J7345
J7345
J7345
J7345
J7347
J7347
J7347
J7347
J7347
J7347
J7347
J7347
J7347
J7347
J7347
J7347
J7348
J7348
J7348
J7348
J7349
J7349
J7349
J7349
J7349
J7349
J7349
J7349
J7349
J7349
J7349
J7349
J7349
J7349
J7349
J7349
J7349
J7349
J7349
J7349
J7349
12/19/2013
HCPCS Description
HYALURONAN OR DERIVATIVE, SYNVISC, FOR INTRA-ARTICULAR INJEC
HYALURONAN OR DERIVATIVE, SYNVISC, FOR INTRA-ARTICULAR INJEC
HYALURONAN OR DERIVATIVE, SYNVISC, FOR INTRA-ARTICULAR INJEC
HYALURONAN OR DERIVATIVE, SYNVISC, FOR INTRA-ARTICULAR INJEC
HYALURONAN OR DERIVATIVE, SYNVISC, FOR INTRA-ARTICULAR INJEC
HYALURONAN OR DERIVATIVE, SYNVISC, FOR INTRA-ARTICULAR INJEC
HYALURONAN OR DERIVATIVE, EUFLEXXA, FOR INTRA-ARTICULAR INJE
HYALURONAN OR DERIVATIVE, ORTHOVISC, FOR INTRA-ARTICULAR INJ
DERMAL AND EPIDERMAL TISSUE OF HUMAN ORIGIN, WITH OR WITHOUT
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
DERMAL
TISSUE, OF HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENG
TISSUE, OF HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENG
TISSUE, OF HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENG
TISSUE, OF HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENG
TISSUE, OF HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENG
TISSUE, OF HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENG
TISSUE, OF HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENG
TISSUE, OF HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENG
TISSUE, OF HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENG
(SUBSTITUTE) TISSUE OF NON-HUMAN ORIGIN, WITH OR WITH
(SUBSTITUTE) TISSUE OF NON-HUMAN ORIGIN, WITH OR WITH
(SUBSTITUTE) TISSUE OF NON-HUMAN ORIGIN, WITH OR WITH
(SUBSTITUTE) TISSUE OF NON-HUMAN ORIGIN, WITH OR WITH
(SUBSTITUTE) TISSUE OF NON-HUMAN ORIGIN, WITH OR WITH
(SUBSTITUTE) TISSUE OF NON-HUMAN ORIGIN, WITH OR WITH
(SUBSTITUTE) TISSUE OF NON-HUMAN ORIGIN, WITH OR WITH
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
(SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHO
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2002
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J7500
J7500
J7500
J7500
J7500
J7500
J7500
J7500
J7500
J7500
J7500
J7500
J7500
J7500
J7500
J7500
J7500
J7500
J7500
J7500
J7500
J7500
J7500
J7500
J7500
J7500
J7501
J7501
J7501
J7501
J7501
J7501
J7501
J7501
J7501
J7501
J7501
J7501
J7501
J7501
J7501
J7502
J7502
J7502
J7502
J7502
J7502
J7502
J7502
J7502
J7502
J7502
J7502
J7502
J7502
J7502
J7502
J7502
J7502
J7502
J7502
J7502
J7504
J7505
J7506
00054408425
00054808425
00378100501
00406200301
00781507501
12280013930
23490511009
51079062006
52959007900
54868092101
54868092102
54868092104
54868531000
54868531001
54868531002
54868531003
54868531004
55045347101
57866902101
65483059010
65649023141
65649024141
66479030110
68084022901
68382000301
68382000305
38779031203
38779031204
38779031206
49452078301
49452078302
49452078303
51552077902
51552077904
51552077905
51927225800
55390060020
63370002510
63370002515
63370002525
63370002535
00074646332
00074647932
00074726950
00078011022
00078024015
00078024115
00078024161
00078024815
00078027422
00172731246
00172731320
00185093330
00591222315
00591222455
50111088542
50111092043
54868552200
60432014050
60505013400
60505035401
62584082721
00009722402
59676010101
00054001720
12/19/2013
HCPCS Description
AZATHIOPRINE, ORAL, 50 MG
AZATHIOPRINE, ORAL, 50 MG
AZATHIOPRINE, ORAL, 50 MG
AZATHIOPRINE, ORAL, 50 MG
AZATHIOPRINE, ORAL, 50 MG
AZATHIOPRINE, ORAL, 50 MG
AZATHIOPRINE, ORAL, 50 MG
AZATHIOPRINE, ORAL, 50 MG
AZATHIOPRINE, ORAL, 50 MG
AZATHIOPRINE, ORAL, 50 MG
AZATHIOPRINE, ORAL, 50 MG
AZATHIOPRINE, ORAL, 50 MG
AZATHIOPRINE, ORAL, 50 MG
AZATHIOPRINE, ORAL, 50 MG
AZATHIOPRINE, ORAL, 50 MG
AZATHIOPRINE, ORAL, 50 MG
AZATHIOPRINE, ORAL, 50 MG
AZATHIOPRINE, ORAL, 50 MG
AZATHIOPRINE, ORAL, 50 MG
AZATHIOPRINE, ORAL, 50 MG
AZATHIOPRINE, ORAL, 50 MG
AZATHIOPRINE, ORAL, 50 MG
AZATHIOPRINE, ORAL, 50 MG
AZATHIOPRINE, ORAL, 50 MG
AZATHIOPRINE, ORAL, 50 MG
AZATHIOPRINE, ORAL, 50 MG
AZATHIOPRINE, PARENTERAL, 100 MG
AZATHIOPRINE, PARENTERAL, 100 MG
AZATHIOPRINE, PARENTERAL, 100 MG
AZATHIOPRINE, PARENTERAL, 100 MG
AZATHIOPRINE, PARENTERAL, 100 MG
AZATHIOPRINE, PARENTERAL, 100 MG
AZATHIOPRINE, PARENTERAL, 100 MG
AZATHIOPRINE, PARENTERAL, 100 MG
AZATHIOPRINE, PARENTERAL, 100 MG
AZATHIOPRINE, PARENTERAL, 100 MG
AZATHIOPRINE, PARENTERAL, 100 MG
AZATHIOPRINE, PARENTERAL, 100 MG
AZATHIOPRINE, PARENTERAL, 100 MG
AZATHIOPRINE, PARENTERAL, 100 MG
AZATHIOPRINE, PARENTERAL, 100 MG
CYCLOSPORINE, 100MG, ORAL
CYCLOSPORINE, ORAL, 100 MG
CYCLOSPORINE, ORAL, 100 MG
CYCLOSPORINE, ORAL, 100 MG
CYCLOSPORINE, 100MG, ORAL
CYCLOSPORINE, ORAL, 100 MG
CYCLOSPORINE, ORAL, 100 MG
CYCLOSPORINE, ORAL, 100 MG
CYCLOSPORINE, ORAL, 100 MG
CYCLOSPORINE, ORAL, 100 MG
CYCLOSPORINE, ORAL, 100 MG
CYCLOSPORINE, ORAL, 100 MG
CYCLOSPORINE, ORAL, 100 MG
CYCLOSPORINE, ORAL, 100 MG
CYCLOSPORINE, ORAL, 100 MG
CYCLOSPORINE, ORAL, 100 MG
CYCLOSPORINE, ORAL, 100 MG
CYCLOSPORINE, ORAL, 100 MG
CYCLOSPORINE, ORAL, 100 MG
CYCLOSPORINE, ORAL, 100 MG
CYCLOSPORINE, ORAL, 100 MG
LYMPHOCYTE IMMUNE GLOBULIN, ANTITHYMOCYTE GLOBULIN, EQUINE,
MUROMONAB-CD3, PARENTERAL, 5 MG
PREDNISONE, ORAL, PER 5MG
Earliest Start
Date
01/01/2002
01/01/2002
12/22/2009
07/02/2007
04/04/2003
04/21/2005
04/30/2007
08/04/2010
01/01/2002
01/01/2002
01/01/2002
01/01/2002
05/23/2005
05/23/2005
09/22/2005
02/23/2006
02/28/2006
03/01/2006
04/15/2002
01/01/2002
10/31/2003
10/31/2003
09/26/2006
03/14/2008
05/01/2007
05/01/2007
01/01/2002
01/01/2002
01/01/2002
01/24/2002
01/24/2002
01/01/2002
09/01/2003
09/01/2003
09/01/2003
09/08/2003
01/01/2002
07/08/2003
07/08/2003
07/08/2003
07/08/2003
01/01/2007
01/01/2002
01/18/2002
01/01/2002
01/01/2007
01/01/2002
01/05/2012
01/01/2002
01/01/2002
04/14/2005
04/14/2005
01/01/2002
12/23/2008
12/23/2008
01/25/2002
01/01/2002
02/10/2006
09/28/2004
05/17/2002
08/01/2005
10/19/2006
01/01/2002
01/01/2002
12/01/2004
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
10/31/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/28/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/24/2012
12/31/2078
02/29/2012
12/31/2078
12/31/2078
09/30/2011
12/31/2078
07/31/2011
12/31/2078
Page 1 of 1
HCPCS
NDC
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
00054001725
00054001729
00054001820
00054001825
00054001829
00054001920
00054001925
00054372144
00054372250
00054372263
00054472825
00054472831
00054474125
00054474131
00054474225
00054872216
00054872425
00054873925
00054874025
00143142501
00143147301
00143147310
00143147501
00143147510
00143147701
00143147705
00143147710
00182020189
00182108689
00182133489
00259036421
00259038948
00259039021
00259039148
00463614010
00463614110
00463615510
00591505201
00591505210
00591544201
00591544205
00591544210
00591544301
00591544305
00591544310
00603533521
00603533532
00603533621
00603533715
00603533721
00603533731
00603533732
00603533815
00603533821
00603533828
00603533831
00603533832
00603533921
00603533928
00603533932
00677011701
00677011710
00677042701
00677042705
00677042710
12/19/2013
HCPCS Description
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
Earliest Start
Date
01/01/2005
12/01/2004
09/07/2004
10/14/2004
10/08/2004
09/24/2004
08/10/2004
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
12/09/2004
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/03/2005
01/03/2005
01/03/2005
08/20/2003
01/16/2003
08/20/2003
01/16/2003
03/06/2003
01/30/2003
01/30/2003
04/02/2003
01/30/2003
09/10/2003
09/10/2003
09/10/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/30/2009
03/31/2010
05/31/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
11/30/2009
11/30/2009
02/28/2010
02/28/2010
12/31/2009
Page 1 of 1
HCPCS
NDC
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
00677069801
00677069805
00677069810
10768708501
10768728301
10768728302
10768728303
10768728304
10768773301
10768773302
10768773303
10768773304
16590032610
16590032620
16590032621
16590032630
16590032645
16590032660
16590040410
16590040420
16590040421
16590040430
16590040445
18837026721
18837026730
18837026748
18837035310
18837035330
21695030620
21695030621
21695030628
21695030630
21695030642
21695030710
21695030715
21695030718
21695030720
21695030721
21695030730
21695058005
21695076548
23490111302
23490111303
23490615701
23490615702
23490615703
23490615704
23490615705
23490615706
23490615707
23490615708
23490615800
23490615801
23490615802
23490615803
23490615804
23490615805
23490615807
23490615808
23490615809
23490615901
23490615902
23490615903
23490615904
23490615905
12/19/2013
HCPCS Description
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
Earliest Start
Date
01/01/2002
01/01/2002
01/01/2002
05/12/2006
05/12/2006
05/12/2006
05/12/2006
05/12/2006
05/12/2006
05/12/2006
05/12/2006
05/12/2006
06/01/2006
06/01/2006
06/01/2006
06/01/2006
06/01/2006
11/01/2007
06/01/2006
06/01/2006
06/01/2006
06/01/2006
06/01/2006
02/15/2008
08/01/2007
02/15/2008
09/24/2008
05/22/2008
04/01/2007
04/01/2007
04/01/2007
04/01/2007
04/01/2007
02/01/2007
09/03/2008
04/01/2007
07/27/2007
08/14/2008
02/01/2007
07/25/2007
06/09/2008
10/03/2006
09/21/2006
02/07/2007
02/07/2007
02/07/2007
04/09/2007
02/07/2007
11/30/2007
02/07/2007
04/09/2007
04/09/2007
02/07/2007
02/07/2007
02/07/2007
02/07/2007
10/11/2007
04/09/2007
04/09/2007
10/11/2007
02/07/2007
02/07/2007
02/07/2007
02/07/2007
11/30/2007
Latest End
Date
02/28/2010
01/31/2010
02/28/2010
12/31/2078
11/01/2008
11/01/2008
09/01/2009
11/01/2010
11/01/2008
11/01/2008
09/01/2009
11/01/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
23490615906
23490785400
33358029212
33358029215
33358029221
33358029230
33358029278
33358029320
33358029330
33358029340
33358029415
33358029420
33358029430
33358029440
33358029460
38779015403
38779015404
38779015405
38779015408
38779015409
45802030321
45802030367
45802073321
45802073367
49452600001
49452600002
49452600003
49999000800
49999000805
49999000820
49999000830
49999000840
49999000855
49999002805
49999002812
49999002814
49999002815
49999002820
49999002821
49999002828
49999002830
49999002840
49999002848
49999002850
49999002860
49999002890
49999011000
49999011006
49999011007
49999011010
49999011012
49999011014
49999011015
49999011018
49999011020
49999011021
49999011030
49999039021
49999043703
51079002217
51079002219
51079003217
51079003219
51079003317
51079003319
12/19/2013
HCPCS Description
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
Earliest Start
Date
11/30/2007
11/30/2007
07/10/2007
07/10/2007
07/10/2007
07/10/2007
07/10/2007
07/10/2007
07/10/2007
07/10/2007
07/10/2007
07/10/2007
07/10/2007
07/10/2007
07/10/2007
03/07/2002
01/01/2002
01/01/2002
08/26/2002
08/26/2002
12/12/2007
12/12/2007
12/12/2007
12/12/2007
01/01/2002
01/01/2002
01/01/2002
12/01/2003
05/16/2008
07/16/2002
07/06/2004
01/27/2006
08/28/2002
03/13/2008
07/16/2002
01/27/2006
07/11/2002
07/16/2002
08/08/2008
07/01/2005
07/11/2002
07/16/2002
07/06/2004
07/16/2002
03/30/2005
03/30/2005
07/06/2004
08/27/2002
04/06/2005
07/06/2004
07/06/2004
07/06/2004
03/27/2006
10/15/2004
07/11/2002
02/24/2005
03/26/2003
06/09/2004
08/12/2004
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2011
12/31/2011
11/30/2011
11/30/2011
08/31/2011
08/31/2011
Page 1 of 1
HCPCS
NDC
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
51552002801
51552002802
51552002804
51552002805
51655002024
51655002052
51655002053
51655002080
51655008624
51655008627
51655008651
51655008724
51655008728
51655008749
51927143500
51991045801
51991045810
52959012600
52959012605
52959012607
52959012610
52959012612
52959012615
52959012618
52959012620
52959012621
52959012625
52959012630
52959012637
52959012640
52959012642
52959012644
52959012645
52959012650
52959012660
52959012700
52959012707
52959012710
52959012712
52959012715
52959012718
52959012720
52959012721
52959012725
52959012730
52959012737
52959012742
52959022000
52959022010
52959022020
52959022021
52959022030
52959022036
52959022040
52959022060
52959022075
53489013801
53489013810
53489013901
53489013905
53489013910
53489014001
53489014005
53489014010
54569033000
12/19/2013
HCPCS Description
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
Earliest Start
Date
01/01/2002
09/01/2003
09/01/2003
09/01/2003
01/01/2002
01/01/2002
01/01/2002
06/22/2005
01/01/2002
01/01/2002
06/22/2005
01/01/2005
06/22/2005
06/22/2005
09/08/2003
01/16/2006
01/16/2006
01/01/2002
11/06/2002
11/06/2002
08/19/2003
01/01/2002
01/01/2002
01/15/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
07/18/2007
01/01/2002
01/01/2002
03/01/2004
09/19/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
06/18/2008
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
08/19/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/28/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/31/2012
03/31/2012
04/30/2012
04/30/2012
01/31/2012
04/30/2012
04/30/2012
01/31/2012
12/31/2078
Page 1 of 1
HCPCS
NDC
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
54569033001
54569033003
54569033004
54569033007
54569033100
54569033101
54569033102
54569033104
54569033105
54569033107
54569033108
54569033201
54569033202
54569033203
54569033205
54569033209
54569033300
54569304300
54569304301
54569304302
54569304305
54569304306
54569330200
54569330201
54569341300
54569402604
54569584000
54569584100
54569591100
54868025801
54868025802
54868025804
54868025805
54868025806
54868025808
54868025809
54868083600
54868083602
54868083603
54868083604
54868083605
54868083607
54868083608
54868090800
54868090801
54868090802
54868090803
54868090804
54868092301
54868111901
54868111902
54868111903
54868111904
54868111905
54868118300
54868118301
54868118302
54868118303
54868118307
54868118308
54868118309
54868323400
54868409500
54868409600
54868521300
12/19/2013
HCPCS Description
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
Earliest Start
Date
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
11/07/2006
01/01/2002
01/01/2002
01/01/2002
08/24/2010
10/10/2006
10/10/2006
05/10/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
03/14/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
11/10/2005
02/16/2006
05/16/2006
02/06/2007
01/01/2002
01/01/2002
12/09/2002
12/09/2002
06/01/2004
10/05/2004
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
08/19/2003
08/15/2005
01/01/2002
04/23/2002
11/27/2002
01/25/2005
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
54868523000
55045126000
55045126009
55045144401
55045144402
55045144403
55045144404
55045144407
55045144408
55045148001
55045148002
55045148005
55045148006
55045148007
55045148008
55045148009
55045153301
55045153303
55045153306
55045153307
55045153308
55045153309
55045296301
55045296302
55045328103
55045328104
55289033005
55289033007
55289033010
55289035205
55289035207
55289035209
55289035210
55289035212
55289035214
55289035215
55289035220
55289035221
55289035230
55289037301
55289037312
55289037330
55289037336
55289037342
55289037346
55289037355
55289037360
55289037372
55289043820
55289043821
55289043830
55289043836
55289043838
55289043840
55289043842
55289043850
55289043860
55887064315
55887064321
55887064330
55887064340
55887064342
55887064350
55887064360
55887064390
12/19/2013
HCPCS Description
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
Earliest Start
Date
02/25/2005
12/06/2004
01/01/2003
12/06/2004
05/01/2005
01/01/2004
01/01/2003
01/01/2003
01/01/2003
01/01/2003
12/06/2004
12/06/2004
12/06/2004
01/01/2003
01/01/2003
01/01/2003
05/01/2004
01/01/2003
01/01/2003
01/01/2003
01/01/2003
01/01/2003
12/06/2004
12/06/2004
12/20/2004
02/11/2005
04/25/2008
09/16/2008
01/01/2002
05/01/2008
03/01/2004
01/01/2002
01/01/2002
05/01/2008
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
12/13/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
03/18/2008
01/01/2002
03/05/2002
04/01/2004
01/01/2006
04/01/2004
01/01/2006
04/01/2007
04/01/2007
04/01/2004
04/01/2004
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
55887069621
55887077001
55887077015
55887077020
55887077021
55887077030
55887077039
55887077050
55887077060
55887079618
55887079620
55887079621
55887079630
55887079690
57866432401
57866432404
57866432405
57866432501
57866432502
57866432503
57866432507
57866432508
57866432601
57866432602
57866432604
57866432605
57866432607
57866432608
57866432702
58016012612
58016021600
58016021610
58016021612
58016021614
58016021615
58016021620
58016021621
58016021622
58016021624
58016021628
58016021630
58016021632
58016021640
58016021642
58016021650
58016021660
58016021684
58016021690
58016021700
58016021705
58016021707
58016021710
58016021712
58016021715
58016021716
58016021718
58016021720
58016021721
58016021722
58016021723
58016021724
58016021728
58016021730
58016021740
58016021760
12/19/2013
HCPCS Description
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
Earliest Start
Date
01/01/2002
01/01/2007
04/01/2007
04/01/2007
06/30/2003
04/01/2007
04/01/2007
04/01/2007
04/01/2007
01/01/2007
01/01/2006
04/01/2004
04/01/2004
01/01/2007
04/15/2002
04/15/2002
10/01/2003
04/15/2002
04/15/2002
04/15/2002
11/01/2005
01/02/2006
10/01/2003
04/15/2002
04/15/2002
10/01/2003
10/01/2003
11/01/2005
10/01/2003
01/01/2002
01/01/2002
01/01/2007
03/22/2002
03/22/2002
01/01/2002
03/22/2002
01/01/2002
01/01/2007
03/22/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2007
01/01/2002
01/01/2002
01/01/2007
01/01/2007
01/01/2002
01/01/2007
01/01/2007
03/21/2002
01/01/2007
03/21/2002
03/21/2002
03/21/2002
01/01/2002
01/01/2002
03/21/2002
01/01/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
58016021800
58016021820
58016021821
58016021824
58016021830
58016021833
58016021836
58016021840
58016021850
58016021855
58016021860
58016021869
58016021890
58016483201
58864036220
58864036256
58864042315
58864042320
58864042330
58864042340
58864042409
58864042414
58864042420
58864042430
59746000706
59746000710
59746000806
59746000810
59746017106
59746017110
59746017206
59746017210
59746017306
59746017309
59746017310
59746017506
59746017509
59746017510
60760000221
60760013830
60760063028
62991120601
62991120602
63370019415
63370019425
63370019435
63370019445
63370019450
63629157901
63629157902
63629157903
63629158701
63629158702
63629158703
63629158704
63629160501
63629160502
63629160503
63629160504
63629160505
63739020710
63739020715
63739020810
63739020815
63739020910
12/19/2013
HCPCS Description
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
PREDNISONE,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
5MG
Earliest Start
Date
01/01/2002
03/22/2002
01/01/2002
03/22/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2007
05/31/2005
02/01/2006
03/01/2004
03/01/2004
01/01/2005
06/01/2005
01/01/2002
07/01/2004
01/01/2002
03/02/2004
01/01/2005
03/02/2004
01/01/2002
01/01/2002
01/01/2002
01/01/2002
10/21/2005
10/21/2005
08/03/2007
08/03/2007
08/03/2007
08/03/2007
08/03/2007
08/03/2007
08/03/2007
08/03/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
07/12/2004
07/12/2004
07/12/2004
07/12/2004
07/12/2004
11/01/2004
11/01/2004
11/01/2004
11/01/2004
11/01/2004
11/01/2004
11/01/2004
11/01/2004
11/01/2004
11/01/2004
11/01/2004
11/01/2004
03/01/2007
06/09/2004
03/01/2007
06/09/2004
03/01/2007
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
04/30/2012
12/31/2078
03/31/2012
12/31/2078
12/31/2011
Page 1 of 1
HCPCS
NDC
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
63739020915
63739052010
63874032701
63874032702
63874032710
63874032712
63874032714
63874032715
63874032718
63874032719
63874032720
63874032721
63874032724
63874032725
63874032728
63874032730
63874032732
63874032740
63874032742
63874032750
63874032760
63874037301
63874037302
63874037310
63874037315
63874037320
63874037321
63874037330
63874037333
63874037336
63874037340
63874037350
63874037360
63874039201
63874039202
63874039206
63874039210
63874039214
63874039215
63874039220
63874039221
63874039224
63874039228
63874039230
63874039240
66267017115
66267017120
66267017121
66267017130
66267017140
66267017142
66267017210
66267017215
66267017220
66267017230
66267017320
66267017330
66267017340
66267017342
66267017360
66267094821
66336005810
66336005812
66336005820
66336005821
12/19/2013
HCPCS Description
PREDNISONE, ORAL, PER 5MG
PREDNISONE ORAL PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
Earliest Start
Date
06/09/2004
02/14/2011
05/10/2004
05/10/2004
05/10/2004
05/10/2004
05/10/2004
05/10/2004
05/10/2004
05/10/2004
05/10/2004
05/10/2004
05/10/2004
05/10/2004
05/10/2004
05/10/2004
05/10/2004
05/10/2004
05/10/2004
05/10/2004
05/10/2004
01/15/2006
01/15/2006
01/15/2006
01/15/2006
01/15/2006
01/15/2006
01/15/2006
01/15/2006
01/15/2006
01/15/2006
01/15/2006
01/15/2006
01/15/2006
01/15/2006
01/15/2006
01/15/2006
01/15/2006
01/15/2006
01/15/2006
01/15/2006
01/15/2006
01/15/2006
01/15/2006
01/15/2006
01/01/2002
04/04/2002
01/01/2002
01/01/2002
01/01/2002
04/04/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
04/04/2002
01/01/2002
01/01/2002
03/24/2003
01/01/2002
01/01/2002
10/22/2004
11/04/2005
10/22/2004
10/22/2004
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7506
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7507
J7509
J7509
J7509
J7509
J7509
J7509
66336005830
66336005860
66336009410
66336009418
66336009420
66336009430
66336051510
66336051521
66336051530
66336051540
68115028910
68115028921
68115028930
68115028942
68115029015
68115029020
68115029030
68115029100
68115029121
68115029130
68115094721
68387024010
68387024025
68387024115
00078061605
00078061705
00078061805
00378204501
00378204601
00378204605
00378204701
00469060773
00469061711
00469061773
00469065711
00469065773
00591335901
00781210201
00781210301
00781210401
16729004101
16729004301
21695017000
50742020801
51079081820
51927355700
55111052501
55111052601
55111052701
62175038137
62991266401
62991266402
62991266403
62991266404
63275995801
63275995802
63275995806
63275995807
66105054910
00009002201
00009004902
00009005602
00009005603
00009005604
00009005605
12/19/2013
HCPCS Description
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
PREDNISONE, ORAL, PER 5MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
TACROLIMUS, ORAL, PER 1 MG
METHYLPREDNISOLONE ORAL, PER
METHYLPREDNISOLONE ORAL, PER
METHYLPREDNISOLONE ORAL, PER
METHYLPREDNISOLONE ORAL, PER
METHYLPREDNISOLONE ORAL, PER
METHYLPREDNISOLONE ORAL, PER
4
4
4
4
4
4
MG
MG
MG
MG
MG
MG
Earliest Start
Date
04/16/2002
10/22/2004
10/22/2004
10/22/2004
10/22/2004
10/22/2004
10/22/2004
10/22/2004
10/22/2004
10/22/2004
09/28/2004
10/26/2004
05/05/2004
01/05/2004
01/05/2004
09/28/2004
10/26/2004
06/08/2004
10/26/2004
01/05/2004
05/04/2004
05/29/2008
03/26/2004
07/23/2008
02/07/2012
02/07/2012
02/07/2012
09/23/2010
09/23/2010
07/13/2011
09/23/2010
01/01/2002
01/01/2002
02/13/2002
01/01/2004
01/01/2004
07/06/2010
08/10/2009
08/10/2009
08/10/2009
09/30/2011
09/30/2011
12/15/2006
10/01/2012
08/06/2013
01/01/2004
05/14/2010
05/14/2010
05/14/2010
09/28/2012
10/01/2007
10/01/2007
10/01/2007
10/01/2007
09/01/2004
09/01/2004
09/01/2004
09/01/2004
01/01/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
05/31/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/14/2014
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
04/30/2008
12/31/2078
12/30/2007
Page 1 of 1
HCPCS
NDC
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
J7509
00009007301
00009017601
00555030102
00555030138
00591079001
00603459315
00603459321
00781502201
00781502207
00904217519
10544032221
16590014921
18837008621
21695008021
23490191102
23490590201
33261033521
33358024121
35356019421
38779014204
38779014206
49452468601
49452468602
49452468603
49884049059
49999015321
51552060302
51991018801
51991018831
52959010000
54569032700
54569103600
54868077601
54868291300
54868291301
54868291302
54868495200
54868495201
54868662401
55045125909
55045181103
55045181108
55045351301
55289064930
55289064998
55887095321
57866403701
57866710001
58016200101
58016200401
58016471901
59746000103
59746000106
59746000204
59746000314
59746001504
59762332701
59762332702
63739016110
63739016115
63874041321
66267096121
66993084002
66993084021
66993084225
12/19/2013
HCPCS Description
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
METHYLPREDNISOLONE
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
PER
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
Earliest Start
Date
01/01/2002
01/01/2002
02/05/2002
04/10/2002
01/01/2002
01/01/2002
01/01/2002
04/04/2003
04/04/2003
01/01/2002
01/11/2008
01/01/2006
06/01/2007
01/01/2007
10/03/2006
02/07/2007
01/15/2008
07/10/2007
05/16/2008
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/03/2002
09/01/2003
03/10/2003
11/05/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
07/29/2003
10/30/2003
10/30/2003
01/01/2002
01/01/2003
12/06/2004
12/06/2004
06/23/2006
10/15/2003
01/01/2002
01/01/2002
04/15/2002
01/22/2008
10/01/2006
01/01/2002
02/16/2005
01/01/2002
01/01/2002
09/24/2007
07/20/2007
07/20/2007
01/01/2002
01/01/2002
02/27/2007
08/04/2003
01/01/2002
01/01/2002
01/21/2003
01/21/2003
04/29/2004
Latest End
Date
12/31/2078
12/31/2078
02/29/2012
07/31/2012
03/31/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/29/2008
03/31/2008
06/30/2012
12/01/2008
12/31/2078
12/31/2078
05/31/2009
11/30/2009
02/28/2010
Page 1 of 1
HCPCS
NDC
J7509
J7509
J7509
J7509
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
67253036010
67253036021
68115096021
68387017001
00093611816
00093611887
00121068705
00121068708
00121068716
00121075908
00223151201
00463607110
00591021702
00591505901
00603156756
00603156758
17317044702
17317044703
17317047708
21695036508
21695036516
23490614401
23490614402
23490614403
23490614501
23490614502
23490614503
33358029108
38739015008
38779015003
38779015004
38779015005
38779015008
38779015009
49452598001
49452598002
49452598003
49999033508
49999033524
49999092901
50383004004
50383004224
50383004248
50383017708
51552002602
51552002604
51552002605
51927114800
52959062260
53014025001
54569133500
54569482700
54569482701
54569482702
54569520400
54569520401
54569574900
54868082100
54868095400
54868172000
54868322000
54868474800
54868474900
54868474901
54868524200
12/19/2013
HCPCS Description
METHYLPREDNISOLONE ORAL, PER
METHYLPREDNISOLONE ORAL, PER
METHYLPREDNISOLONE ORAL, PER
METHYLPREDNISOLONE ORAL, PER
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
4
4
4
4
MG
MG
MG
MG
Earliest Start
Date
10/17/2005
10/17/2005
10/01/2003
03/26/2004
01/01/2002
01/01/2002
04/01/2003
04/17/2003
04/17/2003
05/02/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
11/05/2007
11/05/2007
01/01/2002
01/01/2002
01/01/2002
10/15/2007
10/15/2007
04/09/2007
10/11/2007
10/11/2007
10/11/2007
10/11/2007
10/11/2007
07/10/2007
09/24/2007
01/01/2002
01/01/2002
01/01/2002
04/25/2002
09/03/2002
01/01/2002
01/01/2002
01/01/2002
02/10/2004
05/10/2004
04/20/2007
01/22/2003
03/24/2003
03/17/2003
03/21/2005
09/01/2003
09/01/2003
09/01/2003
09/08/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
11/04/2005
04/11/2007
12/16/2003
01/01/2002
01/01/2002
02/28/2003
02/28/2003
05/25/2004
03/03/2005
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/31/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7510
J7511
J7513
J7515
J7515
J7515
J7515
J7515
J7515
J7515
J7515
J7515
J7515
J7516
J7516
J7516
J7516
J7516
J7516
J7516
J7516
J7516
J7516
J7516
J7516
J7516
J7516
J7516
J7516
J7516
J7516
J7516
J7516
J7517
J7517
J7517
J7517
55045288500
55045288508
55887037308
57866432701
58016067312
58016067324
58016067348
58016414401
58016484301
58177091005
58177091007
58177091203
58177093205
59196001024
59196001048
60432008904
60432021208
62991125701
62991125702
63629186201
65580025101
66440015008
66440015016
68115089808
68135045502
68135045503
68188048002
68188048202
68188048402
58468008001
00004050109
00074646332
00078024015
00078024061
00078024615
00172731046
00172731146
00185093230
00591222215
50111090943
60505013300
00078010901
00574086610
38779066003
38779066004
38779066005
38779066006
51552066301
51552066302
51552066304
51552066306
51927319600
55390012210
62991153301
62991153302
62991153305
63370005710
63370005715
63370005725
63370005735
63370005745
00004025901
00004025905
00004025943
00004026001
12/19/2013
HCPCS Description
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
PREDNISOLONE ORAL, PER 5 MG
LYMPHOCYTE IMMUNE GLOBULIN, ANTITHYMOCYTE GLOBULIN, RABBIT,
DACLIZUMAB, PARENTERAL, 25 MG
CYCLOSPORINE, ORAL, 25 MG
CYCLOSPORINE, ORAL, 25 MG
CYCLOSPORINE, ORAL, 25 MG
CYCLOSPORINE, ORAL, 25 MG
CYCLOSPORINE, ORAL, 25 MG
CYCLOSPORINE, ORAL, 25 MG
CYCLOSPORINE, ORAL, 25 MG
CYCLOSPORINE, ORAL, 25 MG
CYCLOSPORINE, ORAL, 25 MG
CYCLOSPORINE, ORAL, 25 MG
CYCLOSPORIN, PARENTERAL, 250 MG
CYCLOSPORIN, PARENTERAL, 250 MG
CYCLOSPORIN, PARENTERAL, 250 MG
CYCLOSPORIN, PARENTERAL, 250 MG
CYCLOSPORIN, PARENTERAL, 250 MG
CYCLOSPORIN, PARENTERAL, 250 MG
CYCLOSPORIN, PARENTERAL, 250 MG
CYCLOSPORIN, PARENTERAL, 250 MG
CYCLOSPORIN, PARENTERAL, 250 MG
CYCLOSPORIN, PARENTERAL, 250 MG
CYCLOSPORIN, PARENTERAL, 250 MG
CYCLOSPORIN, PARENTERAL, 250 MG
CYCLOSPORIN, PARENTERAL, 250 MG
CYCLOSPORIN, PARENTERAL, 250 MG
CYCLOSPORIN, PARENTERAL, 250 MG
CYCLOSPORIN, PARENTERAL, 250 MG
CYCLOSPORIN, PARENTERAL, 250 MG
CYCLOSPORIN, PARENTERAL, 250 MG
CYCLOSPORIN, PARENTERAL, 250 MG
CYCLOSPORIN, PARENTERAL, 250 MG
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
Earliest Start
Date
01/02/2006
07/05/2006
04/01/2004
04/15/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
02/01/2006
04/16/2002
04/16/2002
01/01/2002
05/25/2005
01/01/2002
01/01/2002
07/18/2002
10/25/2004
01/01/2002
09/15/2003
11/01/2004
05/09/2002
10/02/2003
10/02/2003
05/04/2004
02/01/2005
09/01/2005
04/03/2007
07/10/2006
01/04/2008
12/01/2005
01/01/2002
01/01/2002
01/01/2002
01/05/2012
01/01/2002
04/14/2005
04/14/2005
01/01/2002
12/23/2008
01/01/2002
05/17/2002
01/01/2002
11/19/2004
02/06/2002
02/06/2002
02/06/2002
02/06/2002
01/01/2002
09/01/2003
09/01/2003
09/01/2003
09/08/2003
01/01/2002
09/15/2003
09/15/2003
01/01/2008
07/08/2003
07/08/2003
07/08/2003
07/08/2003
12/19/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
11/30/2009
01/31/2010
11/30/2010
12/31/2010
12/31/2078
12/31/2078
08/31/2007
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/13/2013
12/31/2078
12/31/2078
12/31/2078
10/31/2007
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/30/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/30/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J7517
J7517
J7517
J7517
J7517
J7517
J7517
J7517
J7517
J7517
J7517
J7517
J7517
J7517
J7517
J7517
J7517
J7517
J7517
J7517
J7517
J7517
J7517
J7517
J7517
J7517
J7517
J7518
J7518
J7520
J7520
J7520
J7520
J7520
J7520
J7525
J7527
J7527
J7527
J7527
J7527
J7527
J7599
J7599
J7599
J7602
J7602
J7602
J7602
J7602
J7602
J7602
J7602
J7602
J7602
J7602
J7602
J7602
J7602
J7602
J7602
J7602
J7602
J7602
J7603
00004026043
00004026129
00054016325
00054016625
00093733405
00093733493
00093747701
00093747705
00378225001
00378447201
00378447205
00781206701
00781206705
00781206789
00781517501
00781517505
16729001901
16729009401
21695017100
49999093600
49999093630
49999093730
51079037920
67877022501
68382013005
68382013101
68382013105
00078038566
00078038666
00008103006
00008104005
00008104010
00008104105
00008104110
00008104205
00469301601
00078041420
00078041461
00078041520
00078041561
00078041720
00078041761
00469064773
00469067773
00469068773
00085133601
00182601465
00487990102
00487990130
00904765855
21695024520
23490502102
24208034720
50383074120
52959074120
54569390000
54868247201
54868340700
55045247002
55887038220
58016640401
63402051530
63874070820
68115071120
00085180601
12/19/2013
Earliest Start
Date
HCPCS Description
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
MYCOPHENOLATE MOFETIL, ORAL, 250 MG,
MYCOPHENOLATE MOFETIL, ORAL, 250 MG,
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
MYCOPHENALATE 250MG CAPSULE
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
MYCOPHENOLATE MOFETIL , ORAL, 250 MG
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
MYCOPHENOLATE MOFETIL ORAL, 250 MG
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
MYCOPHENOLIC ACID, ORAL, 180 MG
MYCOPHENOLIC ACID, ORAL, 180 MG
SIROLIMUS, ORAL, 1 MG
SIROLIMUS, ORAL, 1 MG
SIROLIMUS, ORAL, 1 MG
SIROLIMUS, ORAL, 1 MG
SIROLIMUS, ORAL, 1 MG
SIROLIMUS, ORAL, 1 MG
TACROLIMUS, PARENTERAL, 5 MG
EVEROLIMUS, ORAL, 0.25 MG
EVEROLIMUS, ORAL, 0.25 MG
EVEROLIMUS, ORAL, 0.25 MG
EVEROLIMUS, ORAL, 0.25 MG
EVEROLIMUS, ORAL, 0.25 MG
EVEROLIMUS, ORAL, 0.25 MG
IMMUNOSUPPRESSIVE DRUG, NOT OTHERWISE CLASSIFIED
IMMUNOSUPPRESSIVE DRUG, NOT OTHERWISE CLASSIFIED
IMMUNOSUPPRESSIVE DRUG, NOT OTHERWISE CLASSIFIED
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS,
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS,
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS,
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS,
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS,
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS,
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS,
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS,
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS,
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS,
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS,
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS,
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS,
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS,
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS,
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS,
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS,
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS,
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS,
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS,
INH
INH
INH
INH
INH
INH
INH
INH
INH
INH
INH
INH
INH
INH
INH
INH
INH
INH
INH
INH
01/01/2002
01/01/2002
05/04/2009
05/04/2009
05/06/2009
05/06/2009
05/05/2009
05/05/2009
05/04/2009
05/04/2009
05/04/2009
05/04/2009
05/04/2009
05/04/2009
05/04/2009
05/04/2009
05/05/2009
05/05/2009
12/15/2006
12/21/2007
04/30/2007
04/30/2007
06/12/2009
03/20/2012
05/04/2009
05/04/2009
05/04/2009
01/01/2005
01/01/2005
01/01/2002
04/09/2010
04/09/2010
02/01/2006
05/26/2006
02/01/2006
01/01/2002
01/01/2013
01/01/2013
01/01/2013
01/01/2013
01/01/2013
01/01/2013
08/06/2013
08/06/2013
08/06/2013
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/24/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/28/2014
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/29/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/30/2008
Page 1 of 1
Earliest Start
Date
Latest End
Date
38779049505 ACETYLCYSTEINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2008
12/31/2078
J7604
38779049508 ACETYLCYSTEINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2008
12/31/2078
J7604
38779049509 ACETYLCYSTEINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2008
12/31/2078
J7604
49452009701 ACETYLCYSTEINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2008
12/31/2078
J7604
49452009702 ACETYLCYSTEINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2008
12/31/2078
J7604
49452009703 ACETYLCYSTEINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2008
12/31/2078
J7604
49452009704 ACETYLCYSTEINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2008
12/31/2078
J7604
51552020104 ACETYLCYSTEINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2008
12/31/2078
J7604
51552020105 ACETYLCYSTEINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2008
12/31/2078
HCPCS
NDC
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7603
J7604
00172640544
00172640549
00472083123
00472083130
00472083160
00487950101
00487950102
00487950103
00487950125
00487950160
00487990130
00487990401
00487990402
00487990425
00591346753
00591346853
12280024125
16252009722
16252009733
16252009766
21695033225
23490502001
23490502002
23490502003
49502069203
49502069303
49502069724
49502069729
49502069730
49502069761
49999034425
54569389900
54569474800
54569544500
54868247200
54868440900
54868545900
54868570900
55045204307
55887033224
63402051124
63402051224
63402051324
66794000125
66794000130
66794000160
38779049504
J7604
12/19/2013
HCPCS Description
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ACETYLCYSTEINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/01/2008
10/31/2009
10/31/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/31/2012
01/31/2012
01/31/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/31/2011
12/31/2078
07/31/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
06/30/2009
06/30/2009
06/30/2009
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
J7604
51552020107 ACETYLCYSTEINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
J7604
51927160100 ACETYLCYSTEINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2008
12/31/2078
J7604
62991100302 ACETYLCYSTEINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2008
12/31/2078
J7604
62991100303 ACETYLCYSTEINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2008
12/31/2078
J7604
62991100304 ACETYLCYSTEINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2008
12/31/2078
J7604
63370000525 ACETYLCYSTEINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2008
12/31/2078
J7604
63370000535 ACETYLCYSTEINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2008
12/31/2078
J7604
63370000545 ACETYLCYSTEINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2008
12/31/2078
J7604
63370000550 ACETYLCYSTEINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2008
12/31/2078
J7604
63370000555 ACETYLCYSTEINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2008
12/31/2078
J7604
63370000562 ACETYLCYSTEINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2008
12/31/2078
J7605
J7605
J7606
63402091130 ARFOMOTEROL IHAL SOL, 15MCG
63402091164 ARFOMOTEROL IHAL SOL, 15MCG
49502060530 FORMOTEROL FUMARATE, INHALATION SOLUTION, FDA APPROVED FINAL
01/01/2007
01/01/2007
07/02/2012
12/31/2078
12/31/2078
12/31/2078
J7606
49502060561 FORMOTEROL FUMARATE, INHALATION SOLUTION, FDA APPROVED FINAL
10/02/2007
12/31/2078
J7608
00054302502 ACETYLCYSTEINE, INHALATION SOLUTION ADMINISTERED THROUGH DME
01/01/2002
12/31/2078
J7608
00054302602 ACETYLCYSTEINE, INHALATION SOLUTION ADMINISTERED THROUGH DME
01/01/2002
12/31/2078
J7608
00054302702 ACETYLCYSTEINE, INHALATION SOLUTION ADMINISTERED THROUGH DME
01/01/2002
12/31/2078
J7608
00054302802 ACETYLCYSTEINE, INHALATION SOLUTION ADMINISTERED THROUGH DME
01/01/2002
12/31/2078
J7608
00409330703 ACETYLCYSTEINE, INHALATION SOLUTION ADMINISTERED THROUGH DME
04/11/2005
12/31/2078
J7608
00409330803 ACETYLCYSTEINE, INHALATION SOLUTION ADMINISTERED THROUGH DME
05/25/2005
12/31/2078
J7608
00517750425 ACETYLCYSTEINE, INHALATION SOLUTION ADMINISTERED THROUGH DME
01/24/2003
12/31/2078
J7608
00517751003 ACETYLCYSTEINE, INHALATION SOLUTION ADMINISTERED THROUGH DME
01/01/2002
12/31/2078
J7608
00517760425 ACETYLCYSTEINE, INHALATION SOLUTION ADMINISTERED THROUGH DME
01/29/2003
12/31/2078
J7608
00517761003 ACETYLCYSTEINE, INHALATION SOLUTION ADMINISTERED THROUGH DME
01/01/2002
12/31/2078
J7608
00517763003 ACETYLCYSTEINE, INHALATION SOLUTION ADMINISTERED THROUGH DME
01/01/2002
12/31/2078
J7608
54868567000 ACETYLCYSTEINE, INHALATION SOLUTION ADMINISTERED THROUGH DME
08/10/2007
12/31/2078
J7608
54868567001 ACETYLCYSTEINE, INHALATION SOLUTION ADMINISTERED THROUGH DME
08/10/2007
12/31/2078
J7608
61703020331 ACETYLCYSTEINE, INHALATION SOLUTION ADMINISTERED THROUGH DME
01/01/2002
12/31/2078
J7608
61703020431 ACETYLCYSTEINE, INHALATION SOLUTION ADMINISTERED THROUGH DME
01/01/2002
12/31/2078
J7608
J7608
62991100301 ACETYLCYSTEINE, INHALATION SOLUTION, FDA-APPROVED FINAL PROD
62991100305 ACETYLCYSTEINE, INHALATION SOLUTION ADMINISTERED THROUGH DME
10/31/2011
09/15/2003
12/31/2078
12/31/2078
J7608
J7609
63323069030 ACETYLCYSTEINE, INHALATION SOLUTION, FDA-APPROVED FINAL PROD
38779018504 ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIST
09/19/2012
01/01/2007
12/31/2078
12/31/2078
J7609
38779018505 ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIST
01/01/2007
12/31/2078
12/19/2013
01/01/2008
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
J7609
38779018508 ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIST
J7609
38779018509 ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIST
01/01/2007
12/31/2078
J7609
49452022501 ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIST
01/01/2007
12/31/2078
J7609
49452022503 ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIST
01/01/2007
12/31/2078
J7609
49452022701 ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIST
01/01/2007
12/31/2078
J7609
49452022702 ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIST
01/01/2007
12/31/2078
J7609
49452022703 ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIST
01/01/2007
12/31/2078
J7609
51552004402 ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIST
01/01/2007
12/31/2078
J7609
51552004404 ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIST
01/01/2007
12/31/2078
J7609
51552004405 ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIST
01/01/2007
12/31/2078
J7609
51552004406 ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIST
01/01/2007
12/31/2078
J7609
51552004407 ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIST
01/01/2007
12/31/2078
J7609
51927157300 ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIST
01/01/2007
12/31/2078
J7609
51927285900 ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIST
01/01/2007
12/31/2078
J7609
62991100601 ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIST
01/01/2007
12/31/2078
J7609
62991100602 ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIST
01/01/2007
12/31/2078
J7609
62991100603 ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIST
01/01/2007
12/31/2078
J7609
62991100604 ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIST
01/01/2007
12/31/2078
J7609
63275999904 ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIST
01/01/2007
12/31/2078
J7609
63275999905 ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIST
01/01/2007
12/31/2078
J7609
63370001025 ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIST
01/01/2007
12/31/2078
J7609
63370001035 ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIST
01/01/2007
12/31/2078
J7609
63370001045 ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIST
01/01/2007
12/31/2078
J7609
63370001050 ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIST
01/01/2007
12/31/2078
J7611
J7611
J7611
J7611
J7611
J7611
J7611
J7611
J7611
J7611
J7611
J7611
J7611
J7611
J7611
J7611
J7611
J7611
00182601465
00487990102
00487990130
00904765855
21695024520
23490502102
24208034720
50383074120
52959074120
54569390000
54868247201
54868340700
55045247002
55887038220
58016640401
59930164702
63874070820
68115071120
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
01/01/2005
04/01/2008
04/01/2008
12/31/2078
12/31/2078
12/31/2078
02/29/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
06/30/2008
12/31/2078
12/31/2078
12/19/2013
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FINAL
FINAL
FINAL
FINAL
FINAL
FINAL
FINAL
FINAL
FINAL
FINAL
FINAL
FINAL
FINAL
FINAL
FINAL
FINAL
FINAL
FINAL
PRODUCT,
PRODUCT,
PRODUCT,
PRODUCT,
PRODUCT,
PRODUCT,
PRODUCT,
PRODUCT,
PRODUCT,
PRODUCT,
PRODUCT,
PRODUCT,
PRODUCT,
PRODUCT,
PRODUCT,
PRODUCT,
PRODUCT,
PRODUCT,
01/01/2007
12/31/2078
Page 1 of 1
HCPCS
NDC
J7612
J7612
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
00378699393
63402051530
00378699052
00378699058
00378699091
00378699152
00378699252
00378827052
00472083123
00472083130
00472083160
00487030101
00487950101
00487950102
00487950103
00487950125
00487950160
00487990401
00487990402
00487990425
00591346753
00591346853
00591379730
00591379760
00591379783
12280024125
16252009722
16252009733
16252009766
21695033225
23490502001
23490502002
23490502003
38779018504
38779018505
38779018508
38779018509
49452022501
49452022503
49452022701
49452022702
49452022703
49502069203
49502069303
49502069724
49502069729
49502069730
49502069761
49999034425
50383074225
51552004402
51552004404
51552004405
51552004406
51552004407
51927157300
51927285900
54569389900
54868247200
54868570900
55045204307
59930151701
59930151702
62991100601
62991100602
12/19/2013
HCPCS Description
LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUC
LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUC
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
Earliest Start
Date
08/28/2009
04/01/2008
10/07/2009
10/07/2009
10/07/2009
11/02/2009
11/02/2009
12/13/2012
04/01/2008
04/01/2008
04/01/2008
07/19/2010
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
11/04/2010
11/04/2010
11/04/2010
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
01/01/2005
01/01/2005
01/01/2005
01/01/2005
01/01/2005
01/01/2005
01/01/2005
01/01/2005
01/01/2005
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
01/01/2005
01/01/2005
01/01/2005
01/01/2005
01/01/2005
01/01/2005
01/01/2005
01/01/2005
04/01/2008
04/01/2008
04/01/2008
04/01/2008
01/01/2005
01/01/2005
01/01/2005
01/01/2005
Latest End
Date
12/31/2078
12/31/2078
04/30/2014
04/30/2014
01/31/2014
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/31/2012
01/31/2012
01/31/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/31/2011
12/31/2078
07/31/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/31/2008
06/30/2008
12/31/2078
12/31/2078
Page 1 of 1
Earliest Start
Date
Latest End
Date
62991254902 LEVALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMIN
01/01/2007
12/31/2078
00093672373
00093672374
00185732213
00185732230
00185732260
00378698858
00378698891
00378698893
00378967158
00487020101
00487020102
00487020106
00487020160
00591343330
00591343360
00591381730
00591381760
00781714664
16252054733
16252054766
49502067230
49502067231
49502067260
76204060005
76204060012
01/03/2008
01/03/2008
07/01/2007
07/01/2007
07/01/2007
12/28/2007
12/28/2007
12/28/2007
09/26/2013
01/01/2008
01/01/2008
01/01/2008
01/01/2008
01/02/2008
01/02/2008
05/13/2013
05/13/2013
07/30/2013
12/31/2007
12/31/2007
01/01/2006
01/01/2006
01/01/2006
01/01/2013
01/01/2013
12/31/2078
12/31/2078
12/31/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/31/2015
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
06/30/2014
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/28/2015
02/28/2015
12/31/2078
05/31/2009
12/31/2078
12/31/2078
12/31/2078
HCPCS
NDC
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7613
J7614
J7614
J7614
J7614
J7614
J7614
J7614
J7614
J7614
J7614
J7614
J7614
J7614
J7614
J7614
J7614
J7614
J7614
J7614
J7614
J7614
J7615
62991100603
62991100604
63275999904
63275999905
63370001025
63370001035
63370001045
63370001050
66794000125
66794000130
66794000160
76204020025
76204020030
76204020060
00378968044
00378968144
00378968244
00591291823
00591291923
00591292023
54569474800
54569544500
54868440900
54868545900
55887033224
62991254901
62991254902
63402051124
63402051224
63402051324
66993002127
66993002227
66993002327
76204000224
76204000324
62991254901
J7615
J7620
J7620
J7620
J7620
J7620
J7620
J7620
J7620
J7620
J7620
J7620
J7620
J7620
J7620
J7620
J7620
J7620
J7620
J7620
J7620
J7620
J7620
J7620
J7620
J7620
12/19/2013
HCPCS Description
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUC
LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUC
LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUC
LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUC
LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUC
LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUC
LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUC
LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUC
LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUC
LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUC
LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUC
LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUC
LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUC
LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUC
LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUC
LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUC
LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUC
LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUC
LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUC
LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUC
LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUC
LEVALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMIN
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
ALBUTEROL,
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
2.5
2.5
2.5
2.5
2.5
2.5
2.5
2.5
2.5
2.5
2.5
2.5
2.5
2.5
2.5
2.5
2.5
2.5
2.5
2.5
2.5
2.5
2.5
2.5
2.5
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
AND
AND
AND
AND
AND
AND
AND
AND
AND
AND
AND
AND
AND
AND
AND
AND
AND
AND
AND
AND
AND
AND
AND
AND
AND
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
UP
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
TO
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
01/01/2005
01/01/2005
01/01/2005
01/01/2005
01/01/2005
01/01/2005
01/01/2005
01/01/2005
04/01/2008
04/01/2008
04/01/2008
02/01/2012
02/01/2012
02/01/2012
03/15/2013
03/15/2013
03/15/2013
08/20/2012
08/20/2012
08/20/2012
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
01/01/2006
01/01/2006
04/01/2008
04/01/2008
04/01/2008
08/23/2012
08/23/2012
08/23/2012
02/01/2013
02/18/2013
01/01/2007
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
06/30/2009
06/30/2009
06/30/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
J7622
38779036401 BECLOMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
J7622
38779036403 BECLOMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
02/07/2002
12/31/2078
J7622
38779036406 BECLOMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
02/07/2002
12/31/2078
J7622
49452080201 BECLOMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
01/01/2002
12/31/2078
J7622
49452080202 BECLOMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
01/01/2002
12/31/2078
J7622
49452080203 BECLOMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
01/01/2002
12/31/2078
J7622
51552088301 BECLOMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
09/01/2003
12/31/2078
J7622
51552088302 BECLOMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
09/01/2003
12/31/2078
J7622
51552088309 BECLOMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
09/01/2003
12/31/2078
J7622
51927164100 BECLOMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
09/08/2003
12/31/2078
J7622
62991102001 BECLOMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
01/01/2002
12/31/2078
J7622
62991102002 BECLOMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
01/01/2002
12/31/2078
J7622
62991102003 BECLOMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
09/15/2003
12/31/2078
J7624
38779001701 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7624
38779001703 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7624
38779001704 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7624
38779001706 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7624
38779019501 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7624
38779019503 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7624
38779019506 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7624
49452107004 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7624
49452107005 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7624
49452107006 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7624
49452107501 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7624
49452107502 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7624
49452107503 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2004
12/31/2078
J7624
49452107701 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7624
49452107702 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7624
49452107704 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2004
12/31/2078
J7624
51552006401 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7624
51552006402 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
09/01/2003
12/31/2078
J7624
51927145400 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
09/08/2003
12/31/2078
J7624
51927195100 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
09/08/2003
12/31/2078
12/19/2013
02/07/2002
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
J7624
62991102301 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
J7624
62991102302 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7624
62991102303 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7624
62991102401 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7624
62991102402 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7624
62991102404 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
09/15/2003
12/31/2078
J7624
62991102405 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
09/15/2003
12/31/2078
J7624
63370002806 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
07/08/2003
12/31/2078
J7624
63370002810 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
07/08/2003
12/31/2078
J7624
63370002815 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
07/08/2003
12/31/2078
J7624
63370002825 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
07/08/2003
12/31/2078
J7624
63370002835 BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
07/08/2003
12/31/2078
J7626
J7626
J7626
J7626
J7626
J7626
J7626
J7626
J7627
00093681573
00093681673
00186198804
00186198904
00186199004
38779019804
54868562100
54868577400
38779019800
FDA-APPROVED FINAL PRODUCT,
FDA-APPROVED FINAL PRODUCT,
FDA-APPROVED FINAL PRODUCT,
FDA-APPROVED FINAL PRODUCT,
FDA-APPROVED FINAL PRODUCT,
FDA-APPROVED FINAL PRODUCT,
FDA-APPROVED FINAL PRODUCT,
FDA-APPROVED FINAL PRODUCT,
COMPOUNDED PRODUCT, ADMINIS
12/15/2009
12/15/2009
01/01/2002
01/01/2002
08/27/2007
04/19/2002
07/17/2007
06/01/2007
01/01/2006
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
J7627
38779019803 BUDESONIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2006
12/31/2078
J7627
38779019805 BUDESONIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2006
12/31/2078
J7627
38779019806 BUDESONIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2006
12/31/2078
J7627
49452129101 BUDESONIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2006
12/31/2078
J7627
49452129102 BUDESONIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2006
12/31/2078
J7627
49452129103 BUDESONIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2006
12/31/2078
J7627
51552066801 BUDESONIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2006
12/31/2078
J7627
51927283400 BUDESONIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2006
12/31/2078
J7627
62991117901 BUDESONIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2006
12/31/2078
J7627
62991117902 BUDESONIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2006
12/31/2078
J7627
62991117903 BUDESONIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2006
12/31/2078
J7627
62991117905 BUDESONIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2006
12/31/2078
J7627
63370003509 BUDESONIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2006
12/31/2078
J7627
63370003510 BUDESONIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2006
12/31/2078
J7627
63370003515 BUDESONIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2006
12/31/2078
J7627
63370003525 BUDESONIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2006
12/31/2078
12/19/2013
BUDESONIDE,
BUDESONIDE,
BUDESONIDE,
BUDESONIDE,
BUDESONIDE,
BUDESONIDE,
BUDESONIDE,
BUDESONIDE,
BUDESONIDE,
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
01/01/2002
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
J7631
00172640649 CROMOLYN SODIUM, INHALATION SOLUTION ADMINISTERED THROUGH DM
J7631
00172640659 CROMOLYN SODIUM, INHALATION SOLUTION ADMINISTERED THROUGH DM
01/01/2002
12/31/2078
J7631
49502068961 CROMOLYN SODIUM, INHALATION SOLUTION ADMINISTERED THROUGH DM
03/01/2004
11/30/2009
J7631
54868355500 CROMOLYN SODIUM, INHALATION SOLUTION ADMINISTERED THROUGH DM
03/24/2003
12/31/2078
J7631
60505080201 CROMOLYN SODIUM, INHALATION SOLUTION ADMINISTERED THROUGH DM
05/31/2002
12/31/2078
J7631
60793001012 CROMOLYN SODIUM, INHALATION SOLUTION ADMINISTERED THROUGH DM
12/15/2005
02/28/2009
J7631
60793001060 CROMOLYN SODIUM, INHALATION SOLUTION ADMINISTERED THROUGH DM
12/15/2005
02/28/2009
J7632
38779030103 CROMOLYN SODIUM, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
01/01/2008
12/31/2078
J7632
38779030104 CROMOLYN SODIUM, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
01/01/2008
12/31/2078
J7632
38779030105 CROMOLYN SODIUM, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
01/01/2008
12/31/2078
J7632
38779030108 CROMOLYN SODIUM, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
01/01/2008
12/31/2078
J7632
38779030109 CROMOLYN SODIUM, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
01/01/2008
12/31/2078
J7632
49452000601 CROMOLYN SODIUM, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
01/01/2008
12/31/2078
J7632
49452000602 CROMOLYN SODIUM, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
01/01/2008
12/31/2078
J7632
49452000603 CROMOLYN SODIUM, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
01/01/2008
12/31/2078
J7632
49452000604 CROMOLYN SODIUM, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
01/01/2008
12/31/2078
J7632
51552042302 CROMOLYN SODIUM, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
01/01/2008
12/31/2078
J7632
51552042304 CROMOLYN SODIUM, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
01/01/2008
12/31/2078
J7632
51552042305 CROMOLYN SODIUM, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
01/01/2008
12/31/2078
J7632
51552042307 CROMOLYN SODIUM, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
01/01/2008
12/31/2078
J7632
62991103801 CROMOLYN SODIUM, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
01/01/2008
12/31/2078
J7632
62991103802 CROMOLYN SODIUM, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
01/01/2008
12/31/2078
J7632
62991103803 CROMOLYN SODIUM, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
01/01/2008
12/31/2078
J7632
62991103804 CROMOLYN SODIUM, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
01/01/2008
12/31/2078
J7632
63370005015 CROMOLYN SODIUM, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
01/01/2008
12/31/2078
J7632
63370005025 CROMOLYN SODIUM, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
01/01/2008
12/31/2078
J7632
63370005035 CROMOLYN SODIUM, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
01/01/2008
12/31/2078
J7632
63370005045 CROMOLYN SODIUM, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
01/01/2008
12/31/2078
J7632
63370005050 CROMOLYN SODIUM, INHALATION SOLUTION, COMPOUNDED PRODUCT, AD
01/01/2008
12/31/2078
J7636
17317003602 ATROPINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTE
01/01/2002
12/31/2078
J7636
17317003605 ATROPINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTE
01/01/2002
12/31/2078
J7636
17317003607 ATROPINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTE
01/01/2002
12/31/2078
J7636
38779001401 ATROPINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTE
01/01/2002
12/31/2078
12/19/2013
01/01/2002
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
J7636
38779001404 ATROPINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTE
J7636
38779001405 ATROPINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTE
01/01/2002
12/31/2078
J7636
49452077001 ATROPINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTE
01/01/2002
12/31/2078
J7636
49452077002 ATROPINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTE
01/01/2002
12/31/2078
J7636
49452077003 ATROPINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTE
01/01/2002
12/31/2078
J7636
49452078001 ATROPINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTE
01/01/2002
12/31/2078
J7636
49452078002 ATROPINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTE
01/01/2002
12/31/2078
J7636
49452078003 ATROPINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTE
01/01/2002
12/31/2078
J7636
51552015602 ATROPINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTE
09/01/2003
12/31/2078
J7636
51552015604 ATROPINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTE
09/01/2003
12/31/2078
J7636
51552099902 ATROPINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTE
09/01/2003
12/31/2078
J7636
51552099904 ATROPINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTE
09/01/2003
12/31/2078
J7636
51927100100 ATROPINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTE
09/08/2003
12/31/2078
J7638
00574040810 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
02/28/2010
J7638
38779007101 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7638
38779007103 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7638
38779007104 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7638
38779007105 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
09/03/2002
12/31/2078
J7638
38779007108 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
09/03/2002
12/31/2078
J7638
38779040501 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7638
38779040503 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7638
38779040504 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7638
38779040505 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7638
38779040506 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7638
49452246501 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7638
49452246502 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7638
49452246503 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7638
49452246504 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7638
49452247001 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7638
49452247002 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7638
49452247003 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7638
49452247004 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7638
51552002501 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
12/19/2013
01/01/2002
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
J7638
51552002502 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
J7638
51552002503 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
09/01/2003
12/31/2078
J7638
51552002504 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
09/01/2003
12/31/2078
J7638
51552043001 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7638
51552043002 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
09/01/2003
12/31/2078
J7638
51927143000 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
09/08/2003
12/31/2078
J7638
62991104101 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
10/31/2011
12/31/2078
J7638
62991104102 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7638
62991104103 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7638
62991104104 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7638
62991202202 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7638
62991202203 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7638
62991202204 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7638
63370007010 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
07/08/2003
12/31/2078
J7638
63370007015 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
07/08/2003
12/31/2078
J7638
63370007020 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
07/08/2003
12/31/2078
J7638
63370007025 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
07/08/2003
12/31/2078
J7638
63370007035 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
07/08/2003
12/31/2078
J7638
63370007045 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
07/08/2003
12/31/2078
J7638
63370007050 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
07/08/2003
12/31/2078
J7639
50242010039 DORNASE ALPHA, INHALATION SOLUTION ADMINISTERED THROUGH DME,
01/01/2002
12/31/2078
J7639
50242010040 DORNASE ALPHA, INHALATION SOLUTION ADMINISTERED THROUGH DME,
01/01/2002
12/31/2078
J7640
51927364300 FORMOTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2006
12/31/2078
J7640
62991251601 FORMOTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2006
12/31/2078
J7640
62991251602 FORMOTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2006
12/31/2078
J7640
62991251603 FORMOTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2006
12/31/2078
J7640
63370006909 FORMOTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
10/24/2006
12/31/2078
J7640
63370006910 FORMOTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
10/24/2006
12/31/2078
J7641
J7641
J7641
J7641
J7641
J7641
J7641
J7641
J7641
J7641
38779040600
38779040606
38779040609
49452316201
49452316202
49452316203
51552061101
51552061102
51927179400
62991159001
01/01/2002
01/01/2002
04/26/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/08/2003
09/15/2003
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/19/2013
FLUNISOLIDE,
FLUNISOLIDE,
FLUNISOLIDE,
FLUNISOLIDE,
FLUNISOLIDE,
FLUNISOLIDE,
FLUNISOLIDE,
FLUNISOLIDE,
FLUNISOLIDE,
FLUNISOLIDE,
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
COMPOUNDED
COMPOUNDED
COMPOUNDED
COMPOUNDED
COMPOUNDED
COMPOUNDED
COMPOUNDED
COMPOUNDED
COMPOUNDED
COMPOUNDED
PRODUCT,
PRODUCT,
PRODUCT,
PRODUCT,
PRODUCT,
PRODUCT,
PRODUCT,
PRODUCT,
PRODUCT,
PRODUCT,
ADMINI
ADMINI
ADMINI
ADMINI
ADMINI
ADMINI
ADMINI
ADMINI
ADMINI
ADMINI
09/01/2003
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
J7641
J7641
J7643
62991159002 FLUNISOLIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINI
62991159003 FLUNISOLIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINI
00517460125 GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
J7643
00517460225 GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2002
12/31/2078
J7643
00517460525 GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2002
12/31/2078
J7643
00517462025 GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2002
12/31/2078
J7643
10019001602 GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
09/28/2005
04/30/2014
J7643
10019001617 GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2002
03/31/2014
J7643
10019001629 GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
05/05/2007
04/30/2014
J7643
10019001654 GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2002
01/31/2014
J7643
10019001663 GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2002
11/30/2007
J7643
10019001681 GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2002
03/31/2014
J7643
38779208703 GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
05/02/2002
12/31/2078
J7643
38779208706 GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
05/02/2002
12/31/2078
J7643
49452335801 GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2003
12/31/2078
J7643
49452335802 GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2003
12/31/2078
J7643
51552004201 GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2002
12/31/2078
J7643
51927157500 GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
09/08/2003
12/31/2078
J7643
54868323101 GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
01/01/2002
12/31/2078
J7643
60977015501 GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
02/13/2004
03/31/2014
J7643
60977015502 GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
02/13/2004
03/31/2014
J7643
60977015503 GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
02/13/2004
01/31/2014
J7643
60977015506 GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
03/02/2006
10/31/2013
J7643
60977015517 GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
05/05/2007
12/31/2078
J7643
60977015554 GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
05/05/2007
01/31/2014
J7643
60977015563 GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
05/05/2007
12/31/2078
J7643
60977015581 GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADM
05/05/2007
03/31/2014
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
00172640744
00172640749
00378698962
00378698964
00378698966
00378698993
00378797052
00472075323
00472075330
00472075360
00487980101
00487980102
00487980125
00487980130
01/01/2002
01/01/2002
10/07/2009
10/07/2009
10/07/2009
10/07/2009
04/03/2013
01/23/2004
09/11/2003
09/09/2003
01/03/2003
07/20/2005
10/11/2002
01/03/2003
04/30/2010
03/31/2010
12/31/2013
12/31/2013
09/30/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/19/2013
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FDA-APPROVED
FINAL
FINAL
FINAL
FINAL
FINAL
FINAL
FINAL
FINAL
FINAL
FINAL
FINAL
FINAL
FINAL
FINAL
09/15/2003
09/15/2003
01/01/2002
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
Earliest Start
Date
Latest End
Date
38779023004 IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2007
12/31/2078
J7645
38779023005 IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2007
12/31/2078
J7645
38779023006 IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2007
12/31/2078
J7645
49452379102 IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2007
12/31/2078
J7645
49452379103 IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2007
12/31/2078
J7645
51552039301 IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2007
12/31/2078
J7645
51552039302 IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2007
12/31/2078
HCPCS
NDC
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7644
J7645
00487980160
00591379830
00591379860
12280009430
16252009822
16252009833
16252009866
23490576101
35356012430
38779023003
38779023004
38779023005
38779023006
49452379102
49452379103
49502068526
49502068530
49502068531
49502068562
51552039301
51552039302
51552039304
51552039305
51927164800
54569491000
54868408200
54868408201
58016484901
60505080601
62991108501
62991108502
62991108503
62991108504
62991108505
62991108506
63275999801
63275999802
63275999804
63275999805
63370012010
63370012015
63370012025
63370012035
63370012050
66794000225
66794000230
66794000260
76204010025
76204010030
76204010060
38779023003
J7645
12/19/2013
HCPCS Description
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
IPRATROPIUM
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
BROMIDE,
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
SOLUTION,
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
FDA-APPROVED FINAL
COMPOUNDED PRODUCT
01/03/2003
06/24/2011
05/23/2011
03/30/2005
04/01/2006
04/01/2006
04/01/2006
04/09/2007
03/13/2008
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
04/20/2006
01/01/2005
06/01/2005
06/01/2005
01/01/2002
09/01/2003
09/01/2003
09/01/2003
09/08/2003
01/01/2002
01/01/2002
01/01/2002
02/01/2006
01/01/2002
01/01/2002
01/01/2002
09/15/2003
09/15/2003
09/15/2003
09/15/2003
12/04/2002
12/04/2002
12/04/2002
12/04/2002
07/08/2003
07/08/2003
07/08/2003
07/08/2003
07/08/2003
04/15/2002
04/15/2002
04/15/2002
02/01/2012
02/01/2012
02/01/2012
01/01/2007
12/31/2078
12/31/2078
12/31/2078
12/31/2078
11/30/2012
11/30/2012
03/31/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/31/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
06/30/2009
05/31/2009
06/30/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
J7645
51552039304 IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT
J7645
51552039305 IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2007
12/31/2078
J7645
51927164800 IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2007
12/31/2078
J7645
62991108501 IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2007
12/31/2078
J7645
62991108502 IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2007
12/31/2078
J7645
62991108503 IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2007
12/31/2078
J7645
62991108504 IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2007
12/31/2078
J7645
62991108505 IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2007
12/31/2078
J7645
62991108506 IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2007
12/31/2078
J7645
63275999801 IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2007
12/31/2078
J7645
63275999802 IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2007
12/31/2078
J7645
63275999804 IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2007
12/31/2078
J7645
63275999805 IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2007
12/31/2078
J7645
63370012010 IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2007
12/31/2078
J7645
63370012015 IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2007
12/31/2078
J7645
63370012025 IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2007
12/31/2078
J7645
63370012035 IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2007
12/31/2078
J7645
63370012050 IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2007
12/31/2078
J7659
J7659
J7659
J7659
J7660
J7660
J7660
J7669
J7669
J7669
J7669
J7669
J7669
J7669
J7669
J7669
J7669
J7669
J7669
J7669
J7669
J7669
J7669
J7669
J7669
J7669
J7669
J7669
J7669
J7669
00074141001
00409141001
00409141005
51927194000
00409141001
00409141005
51927194000
38779017101
38779017104
38779017105
38779017108
38779017109
49452455502
49452455503
49452455505
49502067624
49502067824
51552007902
51552007904
51552007905
51552007907
51927137000
52959015806
60505080701
60505080801
62991109902
62991109903
63370015320
63370015325
63370015335
02/22/2002
07/28/2005
10/26/2005
09/08/2003
01/01/2007
01/01/2007
01/01/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
02/01/2004
02/01/2004
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/08/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
07/08/2003
07/08/2003
07/08/2003
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
06/30/2009
05/31/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/19/2013
ISOPROTERENOL HCL, INHALATION SOLUTION, FDA-APPROVED FINAL P
ISOPROTERENOL HCL, INHALATION SOLUTION, FDA-APPROVED FINAL P
ISOPROTERENOL HCL, INHALATION SOLUTION, FDA-APPROVED FINAL P
ISOPROTERENOL HCL, INHALATION SOLUTION, FDA-APPROVED FINAL P
ISOPROTERENOL HCL, INHALATION SOLUTION, COMPOUNDED PRODUCT,
ISOPROTERENOL HCL, INHALATION SOLUTION, COMPOUNDED PRODUCT,
ISOPROTERENOL HCL, INHALATION SOLUTION, COMPOUNDED PRODUCT,
METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FI
METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FI
METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FI
METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FI
METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FI
METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FI
METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FI
METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FI
METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FI
METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FI
METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FI
METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FI
METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FI
METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FI
METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FI
METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FI
METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FI
METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FI
METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FI
METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FI
METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FI
METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FI
METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FI
01/01/2007
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
J7669
J7670
63370015345 METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FI
49452455502 METAPROTERENOL SULFATE, INHALATION SOLUTION, COMPOUNDED PROD
J7670
49452455503 METAPROTERENOL SULFATE, INHALATION SOLUTION, COMPOUNDED PROD
01/01/2007
12/31/2078
J7670
49452455505 METAPROTERENOL SULFATE, INHALATION SOLUTION, COMPOUNDED PROD
01/01/2007
12/31/2078
J7670
51552007902 METAPROTERENOL SULFATE, INHALATION SOLUTION, COMPOUNDED PROD
01/01/2007
12/31/2078
J7670
51552007904 METAPROTERENOL SULFATE, INHALATION SOLUTION, COMPOUNDED PROD
01/01/2007
12/31/2078
J7670
51552007905 METAPROTERENOL SULFATE, INHALATION SOLUTION, COMPOUNDED PROD
01/01/2007
12/31/2078
J7670
51552007907 METAPROTERENOL SULFATE, INHALATION SOLUTION, COMPOUNDED PROD
01/01/2007
12/31/2078
J7670
51927137000 METAPROTERENOL SULFATE, INHALATION SOLUTION, COMPOUNDED PROD
01/01/2007
12/31/2078
J7670
62991109902 METAPROTERENOL SULFATE, INHALATION SOLUTION, COMPOUNDED PROD
01/01/2007
12/31/2078
J7670
62991109903 METAPROTERENOL SULFATE, INHALATION SOLUTION, COMPOUNDED PROD
01/01/2007
12/31/2078
J7670
63370015320 METAPROTERENOL SULFATE, INHALATION SOLUTION, COMPOUNDED PROD
01/01/2007
12/31/2078
J7670
63370015325 METAPROTERENOL SULFATE, INHALATION SOLUTION, COMPOUNDED PROD
01/01/2007
12/31/2078
J7670
63370015335 METAPROTERENOL SULFATE, INHALATION SOLUTION, COMPOUNDED PROD
01/01/2007
12/31/2078
J7670
63370015345 METAPROTERENOL SULFATE, INHALATION SOLUTION, COMPOUNDED PROD
01/01/2007
12/31/2078
J7674
64281010006 METHACHOLINE CHLORIDE ADMINISTERED AS INHALATION SOLUTION TH
01/01/2005
12/31/2078
J7674
64281010012 METHACHOLINE CHLORIDE ADMINISTERED AS INHALATION SOLUTION TH
01/01/2005
12/31/2078
J7676
00074454801 PENTAMIDINE ISETHIONATE, INHALATION SOLUTION, COMPOUNDED PRO
01/01/2008
12/31/2078
J7676
63323011310 PENTAMIDINE ISETHIONATE, INHALATION SOLUTION, COMPOUNDED PRO
01/01/2008
12/31/2078
J7681
38779038101 TERBUTALINE SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2002
12/31/2078
J7681
38779038103 TERBUTALINE SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT
09/03/2002
12/31/2078
J7681
38779038104 TERBUTALINE SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2002
12/31/2078
J7681
38779038105 TERBUTALINE SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2002
12/31/2078
J7681
49452763101 TERBUTALINE SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT
05/09/2002
12/31/2078
J7681
49452763102 TERBUTALINE SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT
05/09/2002
12/31/2078
J7681
49452763105 TERBUTALINE SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT
05/09/2002
12/31/2078
J7681
51552044603 TERBUTALINE SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT
09/01/2003
12/31/2078
J7681
51552044604 TERBUTALINE SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT
09/01/2003
12/31/2078
J7681
51927276500 TERBUTALINE SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT
09/08/2003
12/31/2078
J7681
62991115201 TERBUTALINE SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2002
12/31/2078
J7681
62991115202 TERBUTALINE SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT
01/01/2002
12/31/2078
J7681
63370025015 TERBUTALINE SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT
07/08/2003
12/31/2078
J7681
63370025020 TERBUTALINE SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT
07/08/2003
12/31/2078
12/19/2013
07/08/2003
01/01/2007
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
J7681
63370025025 TERBUTALINE SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT
J7681
63370025035 TERBUTALINE SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT
07/08/2003
12/31/2078
J7682
J7682
J7682
J7682
J7682
J7682
J7682
J7682
J7682
J7682
J7682
J7682
J7682
J7682
J7682
J7682
J7682
J7682
J7682
J7682
J7682
J7682
J7682
J7682
J7682
J7682
J7682
J7682
J7682
J7684
00078049471
10122082056
38779031901
38779031903
38779031904
38779031905
38779031906
39822041201
39822041206
49452782301
49452782302
51552078901
51552078902
51552078904
51552078905
51927237500
53905006501
53905006504
62991135101
62991135102
62991135103
62991135104
62991135105
63323030351
63323030355
63370027510
63370027515
63370027525
63370027535
00574045005
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT,
TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
04/01/2008
09/20/2013
01/01/2002
01/01/2002
05/13/2002
05/13/2002
01/01/2002
01/01/2002
01/01/2002
11/15/2004
11/15/2004
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/08/2003
01/01/2002
06/17/2005
01/01/2002
01/01/2002
01/01/2002
09/15/2003
09/15/2003
06/21/2004
12/17/2004
07/08/2003
07/08/2003
07/08/2003
07/08/2003
01/01/2002
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
10/31/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
J7684
17317071901 TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7684
17317071907 TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7684
38779001101 TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7684
38779001103 TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7684
38779001104 TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7684
38779001105 TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7684
38779005101 TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7684
38779005103 TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7684
38779005104 TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
04/30/2002
12/31/2078
J7684
38779005105 TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
04/30/2002
12/31/2078
J7684
39822530005 TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
02/28/2013
J7684
49452789002 TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7684
49452789003 TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7684
49452790001 TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7684
49452790002 TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
12/19/2013
07/08/2003
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
J7684
49452790003 TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
J7684
49452790004 TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7684
51552003301 TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7684
51552003302 TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
09/01/2003
12/31/2078
J7684
51552003303 TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
09/01/2003
12/31/2078
J7684
51552003305 TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
09/01/2003
12/31/2078
J7684
51552076801 TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
09/01/2003
12/31/2078
J7684
51927132600 TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
09/08/2003
12/31/2078
J7684
51927257500 TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
09/08/2003
12/31/2078
J7684
62991115601 TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7684
62991115602 TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7684
62991115603 TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMI
01/01/2002
12/31/2078
J7685
38779031901 TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2007
12/31/2078
J7685
38779031903 TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2007
12/31/2078
J7685
38779031904 TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2007
12/31/2078
J7685
38779031905 TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2007
12/31/2078
J7685
38779031906 TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2007
12/31/2078
J7685
39822041201 TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2007
12/31/2078
J7685
39822041206 TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2007
12/31/2078
J7685
49452782301 TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2007
12/31/2078
J7685
49452782302 TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2007
12/31/2078
J7685
51552078901 TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2007
12/31/2078
J7685
51552078902 TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2007
12/31/2078
J7685
51552078904 TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2007
12/31/2078
J7685
51552078905 TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2007
12/31/2078
J7685
51927237500 TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2007
12/31/2078
J7685
62991135101 TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2007
12/31/2078
J7685
62991135102 TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2007
12/31/2078
J7685
62991135103 TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2007
12/31/2078
J7685
62991135104 TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2007
12/31/2078
J7685
62991135105 TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2007
12/31/2078
J7685
63323030351 TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2007
12/31/2078
J7685
63323030355 TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2007
12/31/2078
12/19/2013
01/01/2002
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
J7685
63370027510 TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
J7685
63370027515 TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2007
12/31/2078
J7685
63370027525 TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2007
12/31/2078
J7685
63370027535 TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINIS
01/01/2007
12/31/2078
J7686
J7686
J7686
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
66302020601
66302020602
66302020603
00074454801
38779030103
38779030104
38779030105
38779030108
38779030109
38779049504
38779049505
38779049508
38779049509
38779063204
38779063205
38779063208
38779063209
49452000601
49452000602
49452000603
49452000604
49452009701
49452009702
49452009703
49452009704
49452326101
49452326102
49452326103
49502064115
51552020104
51552020105
51552020107
51552042302
51552042304
51552042305
51552042307
51552077501
51552077502
51552077504
51552077505
51927160100
51927161000
62991100302
62991100303
62991100304
62991100305
62991103801
62991103802
62991103803
62991103804
62991107201
62991107202
62991107203
63323011310
63370000525
63370000535
63370000545
63370000550
08/14/2009
08/14/2009
08/14/2009
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
09/01/2003
09/01/2003
09/01/2003
09/01/2003
01/01/2007
09/08/2003
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
09/01/2002
09/01/2002
09/01/2002
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/19/2013
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
INHALATION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
SOLUTION
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
ADMINISTERED
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
THROUGH
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
DME
01/01/2007
12/31/2078
Page 1 of 1
Earliest Start
Date
Latest End
Date
00053759610 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
03/01/2006
05/06/2013
J7799
00053759615 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
03/01/2006
12/31/2078
J7799
00053759620 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
03/01/2006
06/08/2013
J7799
00053759625 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
03/01/2006
12/31/2078
J7799
00074177510 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
06/01/2007
J7799
00074490234 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
10/01/2007
J7799
00074564125 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00074564425 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00074751716 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
09/01/2007
J7799
00264112701 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264112950 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
09/30/2010
J7799
00264120755 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
06/30/2010
J7799
00264121710 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264122200 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264124055 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264125055 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
07/31/2010
J7799
00264125155 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264126055 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
07/31/2010
J7799
00264127050 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264128050 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264128055 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
09/30/2014
J7799
00264128155 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264129050 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
05/31/2013
J7799
00264129055 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
HCPCS
NDC
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7699
J7799
63370000555
63370000562
63370005015
63370005025
63370005035
63370005045
63370005050
63370009815
63370009825
63370009835
63370009850
63370009855
63402091130
63402091164
68115065160
00053759603
J7799
12/19/2013
HCPCS Description
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
NOC
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
DRUGS,
INHALATION SOLUTION ADMINISTERED THROUGH DME
INHALATION SOLUTION ADMINISTERED THROUGH DME
INHALATION SOLUTION ADMINISTERED THROUGH DME
INHALATION SOLUTION ADMINISTERED THROUGH DME
INHALATION SOLUTION ADMINISTERED THROUGH DME
INHALATION SOLUTION ADMINISTERED THROUGH DME
INHALATION SOLUTION ADMINISTERED THROUGH DME
INHALATION SOLUTION ADMINISTERED THROUGH DME
INHALATION SOLUTION ADMINISTERED THROUGH DME
INHALATION SOLUTION ADMINISTERED THROUGH DME
INHALATION SOLUTION ADMINISTERED THROUGH DME
INHALATION SOLUTION ADMINISTERED THROUGH DME
INHALATION SOLUTION ADMINISTERED THROUGH DME
INHALATION SOLUTION ADMINISTERED THROUGH DME
INHALATION SOLUTION ADMINISTERED THROUGH DME
OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
07/08/2003
07/08/2003
07/08/2003
07/08/2003
07/08/2003
04/04/2007
01/31/2007
04/19/2004
03/01/2006
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
J7799
00264222055 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
J7799
00264230350 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264402155 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
09/30/2015
J7799
00264752000 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264752010 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264757810 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264757820 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264760500 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264760510 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
02/28/2014
J7799
00264760800 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264760810 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264760820 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264760830 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264761200 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264761210 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264761220 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264761400 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264761410 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264761600 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264761610 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264761620 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264762200 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264762320 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264780200 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264780210 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264780510 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00264780610 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00338001204 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
10/31/2009
J7799
00338002302 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00338002303 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00338002304 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00338002313 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
04/30/2008
J7799
00338002334 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
12/19/2013
01/01/2002
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
J7799
00338003003 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
J7799
00338003106 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00338003113 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
01/31/2008
J7799
00338003134 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
01/31/2008
J7799
00338003603 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
10/31/2009
J7799
00338003804 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
10/31/2009
J7799
00338004303 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00338004304 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00338005403 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00338005603 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00338007303 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
07/31/2011
J7799
00338007304 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00338007702 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00338007703 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00338007704 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00338008102 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
05/31/2007
J7799
00338008103 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00338008104 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
04/30/2007
J7799
00338008502 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00338008503 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00338008504 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00338035104 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00338035303 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00338035304 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00338035503 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00338035702 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00338035703 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00338064002 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
06/30/2009
J7799
00338071113 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
04/30/2008
J7799
00338071134 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
01/31/2008
J7799
00338071313 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2007
J7799
00338071334 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00338071513 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
08/31/2007
12/19/2013
01/01/2002
09/30/2009
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
J7799
00338071534 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
J7799
00338071906 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00338071913 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00338087302 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
06/30/2010
J7799
00409113002 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
05/13/2005
12/31/2078
J7799
00409114102 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
04/13/2005
12/31/2078
J7799
00409150805 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
08/31/2005
07/01/2011
J7799
00409153405 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
02/24/2006
07/01/2011
J7799
00409153503 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
09/08/2005
10/01/2011
J7799
00409158603 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
03/24/2006
12/31/2078
J7799
00409177510 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
02/20/2006
12/31/2078
J7799
00409408902 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
05/18/2005
11/01/2012
J7799
00409421902 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
03/30/2005
12/31/2078
J7799
00409486202 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
03/09/2005
12/31/2078
J7799
00409486203 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
04/04/2005
10/01/2011
J7799
00409490234 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
12/08/2005
12/31/2078
J7799
00409664802 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
03/29/2005
12/31/2078
J7799
00409665773 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
10/14/2005
12/31/2078
J7799
00409666075 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
07/26/2005
12/31/2078
J7799
00409711907 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
05/27/2006
10/01/2011
J7799
00409712007 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
07/06/2005
12/31/2078
J7799
00409713202 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
05/26/2006
12/31/2078
J7799
00409713266 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
09/12/2005
12/31/2078
J7799
00409713267 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
11/14/2005
12/31/2078
J7799
00409751716 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
12/07/2005
12/31/2078
J7799
00409771209 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
08/19/2005
12/31/2078
J7799
00409771309 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
04/07/2006
12/31/2078
J7799
00409771403 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
08/30/2005
12/31/2078
J7799
00409771502 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
11/14/2005
12/31/2078
J7799
00409771503 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
09/16/2005
12/31/2078
J7799
00409773020 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
07/27/2005
12/31/2078
J7799
00409773036 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
07/11/2005
12/31/2078
J7799
00409773037 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
09/16/2005
12/31/2078
12/19/2013
01/01/2002
09/30/2007
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
J7799
00409791819 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
J7799
00409792402 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
07/28/2005
12/31/2078
J7799
00409792403 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
07/28/2005
12/31/2078
J7799
00409792409 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
12/21/2005
12/31/2078
J7799
00409792502 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
06/29/2005
04/01/2012
J7799
00409792503 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
09/16/2005
12/31/2078
J7799
00409792509 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
03/17/2006
12/31/2078
J7799
00409792602 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
08/30/2005
12/31/2078
J7799
00409792603 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
06/07/2005
12/31/2078
J7799
00409792609 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
08/25/2005
12/31/2078
J7799
00409792630 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
04/14/2006
12/31/2078
J7799
00409792648 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
04/14/2006
12/31/2078
J7799
00409793002 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
07/05/2005
12/31/2078
J7799
00409793003 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/12/2005
12/31/2078
J7799
00409793009 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
03/16/2005
12/31/2078
J7799
00409793519 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
09/12/2005
12/31/2078
J7799
00409793619 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
06/24/2005
12/31/2078
J7799
00409793629 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
10/28/2005
12/31/2078
J7799
00409793719 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
08/24/2005
12/31/2078
J7799
00409793819 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
09/29/2005
12/31/2078
J7799
00409798502 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
04/06/2005
12/31/2078
J7799
00409798503 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
04/06/2005
12/31/2078
J7799
00409798509 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
11/24/2004
12/31/2078
J7799
00409800415 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
08/01/2005
12/31/2078
J7799
00469325010 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
05/03/2005
12/31/2078
J7799
00517290025 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
01/31/2013
J7799
00517293025 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
00548100100 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
05/31/2012
J7799
00548101500 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
05/31/2009
J7799
00548200100 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
08/31/2012
J7799
00548330100 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
09/30/2014
J7799
00548331500 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
06/30/2012
J7799
15927322000 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
09/08/2003
12/31/2078
12/19/2013
07/08/2005
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
J7799
17317041702 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
J7799
17317041703 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
17317041705 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
38779024704 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
38779024705 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
38779043604 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
08/21/2002
12/31/2078
J7799
38779043605 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
08/21/2002
12/31/2078
J7799
38779206503 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
05/02/2002
12/31/2078
J7799
38779206506 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
05/02/2002
12/31/2078
J7799
44206045101 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
04/01/2010
12/31/2078
J7799
44206045202 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
04/01/2010
12/31/2078
J7799
44206045404 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
04/01/2010
12/31/2078
J7799
49452274001 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
49452529001 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
49452529002 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
49452529003 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
51552023202 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
09/01/2003
12/31/2078
J7799
51552023204 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
09/01/2003
12/31/2078
J7799
51552023205 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
09/01/2003
12/31/2078
J7799
51552052605 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
09/01/2003
12/31/2078
J7799
51927122500 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
09/08/2003
12/31/2078
J7799
51927171500 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
09/08/2003
12/31/2078
J7799
54868308900 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
12/11/2006
12/31/2078
J7799
54868308901 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
12/05/2007
12/31/2078
J7799
54868370300 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
54868572700 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
12/12/2006
12/31/2078
J7799
63323008861 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
63323008863 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
63323013920 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
63323013940 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
63323018730 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
01/01/2002
12/31/2078
J7799
63370008807 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
12/19/2003
12/31/2078
J7799
63370008815 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
12/19/2003
12/31/2078
12/19/2013
01/01/2002
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
J7799
63370008825 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
00182709611
00182709911
00182710011
00182710111
00574722612
00574723412
00574723612
00713013512
00713052612
00713053612
16590019312
16590019412
21695064912
23490617401
23490618001
23490618201
23490618202
23490618203
33358030102
33358030112
35356003912
45802075830
45802075930
49999033912
49999034012
52959023712
52959029100
52959035506
52959035512
52959056101
52959056104
52959056201
52959056206
54569035301
54569035302
54569472000
54569472002
54569574400
54569574401
54569574500
54569574501
54569574502
54868060101
54868060102
54868062200
54868062202
54868161302
54868193200
54868193201
54868193202
54868311200
54868311201
54868468600
54868468601
54868479402
55045174902
55045240002
55045301102
55045301103
55289011902
55289011906
55289041404
55289041406
12/19/2013
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
ANTIEMETIC
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
RECTAL/SUPPOSITORY,
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
NOT
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
OTHERWISE
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
SPECIFIED
Earliest Start
Date
Latest End
Date
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
02/01/2006
02/01/2006
11/12/2007
02/07/2007
02/07/2007
02/07/2007
02/07/2007
11/30/2007
07/10/2007
07/10/2007
10/19/2007
01/01/2006
01/01/2006
09/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
09/11/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
04/26/2006
08/08/2007
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
02/28/2010
03/31/2009
03/31/2011
12/31/2009
12/31/2078
07/31/2014
07/31/2014
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/19/2003
12/31/2078
Page 1 of 1
HCPCS
NDC
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8498
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
55289092802
55289092804
55289092806
55289092879
55289094002
55289094006
55887022012
55887062103
55887062112
58016301803
58016306601
58016306701
58016322201
58016500901
58016650601
63874080612
66336015003
66336015006
68115029912
68115069112
00093894001
00093894005
00093894093
00093894301
00093894305
00093894701
00093894705
00172426760
00172426770
00172426860
00172426870
00173094555
00173094955
00173095396
00173099155
00173099156
00182266689
00182266789
00182820089
00228260511
00228260550
00228260611
00228260650
00228260711
00228260750
00378025301
00378030201
00472008216
00591033501
00591033601
00591269201
00904578961
00904579061
00904579961
13411018201
13411018203
13411018206
13411018209
13411018210
13411018301
13411018303
13411018306
13411018309
13411018310
16477051008
12/19/2013
HCPCS Description
ANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT OTHERWISE SPECIFIED
ANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT OTHERWISE SPECIFIED
ANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT OTHERWISE SPECIFIED
ANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT OTHERWISE SPECIFIED
ANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT OTHERWISE SPECIFIED
ANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT OTHERWISE SPECIFIED
ANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT OTHERWISE SPECIFIED
ANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT OTHERWISE SPECIFIED
ANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT OTHERWISE SPECIFIED
ANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT OTHERWISE SPECIFIED
ANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT OTHERWISE SPECIFIED
ANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT OTHERWISE SPECIFIED
ANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT OTHERWISE SPECIFIED
ANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT OTHERWISE SPECIFIED
ANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT OTHERWISE SPECIFIED
ANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT OTHERWISE SPECIFIED
ANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT OTHERWISE SPECIFIED
ANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT OTHERWISE SPECIFIED
ANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT OTHERWISE SPECIFIED
ANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT OTHERWISE SPECIFIED
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
Earliest Start
Date
03/01/2006
05/09/2006
01/01/2006
01/01/2006
03/01/2006
05/09/2006
04/01/2007
01/01/2006
04/01/2007
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/15/2006
01/01/2006
04/20/2007
04/13/2006
01/01/2006
01/01/2002
01/01/2002
11/30/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
10/22/2003
07/02/2003
01/01/2003
01/03/2007
01/08/2007
01/12/2007
08/23/2006
08/23/2006
08/23/2006
08/23/2006
08/23/2006
08/23/2006
08/23/2006
08/23/2006
08/23/2006
08/23/2006
04/30/2008
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
04/30/2014
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/03/2008
12/31/2078
12/31/2078
12/31/2078
03/31/2007
12/31/2078
03/31/2007
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
10/31/2012
10/31/2012
05/31/2012
12/31/2078
12/31/2078
07/31/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
16590000330
16590000360
16590037020
16590037030
16590037040
21695001020
21695001025
21695001030
21695001060
21695001130
23490501101
23490501201
23490501202
23490501203
23490501204
23490501301
23490501302
23490501303
23490501304
23490501501
23490501502
33358000925
33358001015
33358001028
33358001030
33358001060
33358001125
33358001130
33358001135
49884056501
49884056601
49884056701
49999008600
49999008625
49999008630
49999008690
49999023135
49999038510
49999038515
49999038525
49999038540
50383081016
51079087601
51079087620
51079087701
51079087720
51079087801
51079087820
51655029651
51655029654
51655029676
51655030051
51655030054
51655030076
52959033000
52959033025
52959033050
52959051725
52959051730
52959051735
52959054401
52959054410
52959054412
52959054415
52959054421
12/19/2013
HCPCS Description
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
Earliest Start
Date
02/01/2006
02/01/2006
06/01/2006
06/01/2006
06/01/2006
11/30/2006
05/19/2008
02/01/2007
11/30/2006
05/19/2008
10/11/2007
02/07/2007
02/07/2007
02/07/2007
02/07/2007
02/07/2007
02/07/2007
02/07/2007
10/11/2007
02/07/2007
10/11/2007
07/10/2007
07/10/2007
07/10/2007
07/10/2007
07/10/2007
07/10/2007
07/10/2007
07/10/2007
01/01/2002
01/01/2002
01/01/2002
09/01/2006
07/29/2002
07/13/2005
07/13/2005
06/02/2005
06/09/2004
06/09/2004
06/09/2004
06/02/2005
06/13/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
06/22/2005
06/22/2005
06/22/2005
06/22/2005
06/22/2005
06/22/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/31/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2011
12/31/2011
02/29/2012
02/29/2012
12/31/2011
12/31/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
52959054425
52959054430
52959054440
52959054450
52959067830
54569448200
54569448201
54569448204
54569448206
54569472400
54569476501
54569476502
54569476503
54569476504
54569476505
54569476506
54569476509
54868016302
54868218400
54868218402
54868218403
54868218404
54868302500
54868399600
54868399601
54868399602
54868399603
54868399604
54868399605
54868399700
54868399701
54868399702
54868399703
54868399704
54868399705
54868399800
54868399801
54868399802
54868399803
54868399804
54868399805
54868399806
54868399807
54868399808
55045256500
55045256502
55045256504
55045256505
55045256508
55045257100
55045257102
55045257104
55045257105
55045257106
55045257108
55045264800
55045264802
55045264803
55045264805
55045264806
55289000610
55289000625
55289000635
55289000650
55289027310
12/19/2013
HCPCS Description
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
Earliest Start
Date
01/01/2002
01/01/2002
08/24/2007
01/01/2002
10/07/2003
01/01/2002
01/01/2002
09/11/2002
04/26/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
06/01/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
06/17/2004
08/06/2007
01/01/2002
06/12/2003
09/25/2003
10/20/2003
11/03/2003
08/01/2005
01/01/2002
01/01/2002
03/05/2003
12/08/2003
01/28/2004
06/09/2004
07/06/2004
07/23/2004
04/22/2005
01/01/2005
12/06/2004
01/01/2005
01/01/2005
01/01/2005
01/01/2005
01/01/2005
01/01/2003
01/01/2005
03/01/2005
01/01/2005
01/01/2005
07/01/2003
01/01/2005
01/01/2005
01/01/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
55289027325
55289027330
55289027335
55289027350
55289046205
55289046212
55289046215
55289046221
55289046225
55289046230
55289046235
55289046260
55289056415
55289056420
55289056448
55289062910
55289062930
55289062950
55289069112
55289069115
55289069125
55887024615
55887024621
55887024625
55887024630
55887024640
55887024650
55887024660
55887085325
55887085330
55887085335
55887085350
55887085360
55887085390
55887097730
55887097740
57866695002
57866695003
58016011100
58016011115
58016011120
58016011125
58016011130
58016011160
58016011190
58016011200
58016011220
58016011230
58016011260
58016011290
58016062700
58016062720
58016062730
58016062760
58016062790
58864019125
58864019135
58864060201
58864060230
58864087635
60429071150
60429071350
60505004206
60505530601
60505530608
12/19/2013
HCPCS Description
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
Earliest Start
Date
01/01/2002
08/01/2006
01/01/2002
01/01/2002
01/15/2004
01/01/2002
01/01/2002
08/17/2006
01/01/2002
01/01/2002
04/21/2008
03/01/2006
01/01/2002
01/01/2002
01/01/2002
08/26/2002
06/05/2007
04/23/2008
01/01/2002
01/01/2002
01/01/2002
04/01/2007
02/01/2005
02/01/2005
02/01/2005
04/01/2007
02/01/2005
03/23/2007
04/01/2004
04/01/2004
04/01/2007
04/01/2007
04/01/2004
04/01/2004
04/01/2007
11/29/2005
04/15/2002
04/15/2002
09/01/2006
09/01/2006
09/01/2006
09/01/2006
09/01/2006
09/01/2006
09/01/2006
05/31/2005
05/31/2005
05/31/2005
08/09/2002
05/31/2005
01/29/2002
01/29/2002
01/29/2002
01/29/2002
01/29/2002
03/01/2004
03/01/2004
06/01/2004
03/02/2004
01/01/2005
01/01/2002
01/01/2002
03/01/2006
03/01/2006
05/21/2007
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
60505530701
60505530705
62033020410
62033020414
63304050401
63304050501
63304065201
63304065205
63629167601
63629167602
63629167603
63629167701
63629167702
63629167703
63629167801
63629167802
63629167803
63739031410
63739031415
63739031510
63739031515
63739031610
63739031615
63874040401
63874040410
63874040414
63874040415
63874040420
63874040424
63874040425
63874040430
63874040435
63874040440
63874040450
63874040460
63874040501
63874040510
63874040520
63874040525
63874040530
63874040535
63874050001
63874050015
63874050020
63874050021
63874050025
63874050030
63874050040
63874050060
66267000625
66267000640
66267000650
66267000715
66267000721
66267000725
66267000730
66267039930
66336064225
66336064230
66336064240
66336064250
66336073515
66336073525
66336073540
66336086250
12/19/2013
HCPCS Description
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
NON
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
Earliest Start
Date
03/01/2006
05/21/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
11/01/2004
11/01/2004
11/01/2004
11/01/2004
11/01/2004
11/01/2004
11/01/2004
11/01/2004
11/01/2004
02/27/2007
06/09/2004
02/27/2007
06/09/2004
02/27/2007
06/09/2004
01/23/2002
01/23/2002
01/23/2002
01/23/2002
01/23/2002
01/23/2002
01/23/2002
01/23/2002
01/15/2006
01/23/2002
01/23/2002
01/23/2002
01/15/2006
01/15/2006
01/15/2006
01/15/2006
01/15/2006
01/15/2006
03/15/2006
01/23/2002
03/15/2006
03/15/2006
03/15/2006
03/15/2006
03/15/2006
03/15/2006
04/08/2002
08/01/2002
04/08/2002
04/08/2002
04/08/2002
04/08/2002
04/08/2002
03/15/2005
10/22/2004
06/22/2005
10/22/2004
01/07/2008
10/22/2004
10/22/2004
10/22/2004
05/01/2006
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/01/2010
12/31/2078
05/01/2010
12/31/2078
08/01/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8499
J8501
J8501
J8501
J8501
J8501
J8501
J8501
J8501
J8501
J8501
J8501
J8501
J8501
J8501
J8501
J8501
J8510
J8515
J8515
J8515
J8515
J8515
J8520
J8520
J8520
J8520
J8520
J8521
J8521
J8521
J8521
J8521
J8521
J8521
J8521
J8521
J8521
J8521
J8521
J8530
J8530
J8530
J8530
J8530
J8530
J8530
J8530
67253010010
67253010011
67253010110
67253010111
67253010210
67253010250
68115000510
68115000525
68115000530
68115000540
68115000610
68115000615
68115000621
68115000625
68115000630
68115000660
68115000730
68115000740
00006046102
00006046105
00006046106
00006046130
00006046205
00006046206
00006046230
00006046405
00006046410
00006386203
52959074801
54569574100
54868523100
54868523101
54868523102
54868532500
00173071325
00093542088
16252053608
49884067314
59762010001
68084024521
00004110020
54868414300
54868414301
54868414302
54868414303
00004110150
54569571700
54868526000
54868526001
54868526002
54868526003
54868526004
54868526005
54868526006
54868526007
54868526008
54868526009
00015050301
00015050401
00054412925
00054413025
00054808925
00054813025
54868500500
54868500501
12/19/2013
HCPCS Description
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC,
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC,
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC,
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC,
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC,
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC,
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC,
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC,
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC,
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC,
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC,
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC,
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC,
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC,
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC,
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC,
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC,
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC,
APREPITANT, ORAL, 5 MG
APREPITANT, ORAL, 5 MG
APREPITANT, ORAL, 5 MG
APREPITANT, ORAL, 5 MG
APREPITANT, ORAL, 5 MG
APREPITANT, ORAL, 5 MG
APREPITANT, ORAL, 5 MG
APREPITANT, ORAL, 5 MG
APREPITANT, ORAL, 5 MG
APREPITANT, ORAL, 5 MG
APREPITANT, ORAL, 5 MG
APREPITANT, ORAL, 5 MG
APREPITANT, ORAL, 5 MG
APREPITANT, ORAL, 5 MG
APREPITANT, ORAL, 5 MG
APREPITANT, ORAL, 5 MG
BUSULFAN, 2 MG, ORAL
CABERGOLINE, ORAL, 0.25 MG
CABERGOLINE, ORAL, 0.25 MG
CABERGOLINE, ORAL, 0.25 MG
CABERGOLINE, ORAL, 0.25 MG
CABERGOLINE, ORAL, 0.25 MG
CAPECITABINE, 150 MG, ORAL
CAPECITABINE, ORAL, 150 MG
CAPECITABINE, ORAL, 150 MG
CAPECITABINE, ORAL, 150 MG
CAPECITABINE, ORAL, 150 MG
CAPECITABINE, 500 MG, ORAL
CAPECITABINE, ORAL, 500 MG
CAPECITABINE, ORAL, 500 MG
CAPECITABINE, ORAL, 500 MG
CAPECITABINE, ORAL, 500 MG
CAPECITABINE, ORAL, 500 MG
CAPECITABINE, ORAL, 500 MG
CAPECITABINE, ORAL, 500 MG
CAPECITABINE, ORAL, 500 MG
CAPECITABINE, ORAL, 500 MG
CAPECITABINE, ORAL, 500 MG
CAPECITABINE, ORAL, 500 MG
CYCLOPHOSPHAMIDE, 25 MG, ORAL
CYCLOPHOSPHAMIDE, 25 MG, ORAL
CYCLOPHOSPHAMIDE, 25 MG, ORAL
CYCLOPHOSPHAMIDE, 50 MG, ORAL
CYCLOPHOSPHAMIDE, 25 MG, ORAL
CYCLOPHOSPHAMIDE, 25 MG, ORAL
CYCLOPHOSPHAMIDE, 25 MG, ORAL
CYCLOPHOSPHAMIDE, 25 MG, ORAL
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
Earliest Start
Date
10/01/2003
07/15/2003
10/01/2003
07/15/2003
07/15/2003
07/15/2003
01/20/2005
04/19/2004
05/01/2005
01/20/2005
01/20/2005
03/17/2004
01/20/2005
01/05/2004
03/17/2004
04/19/2004
03/29/2004
05/01/2005
01/29/2008
01/01/2005
07/01/2006
01/01/2005
01/01/2005
07/01/2006
01/01/2005
07/24/2006
07/24/2006
01/01/2005
08/22/2007
10/24/2005
06/29/2005
08/03/2006
03/04/2008
06/24/2005
01/01/2000
03/07/2007
05/01/2008
01/01/2006
01/01/2006
06/03/2008
10/01/2003
02/10/2005
08/08/2007
10/19/2005
05/19/2006
10/01/2003
07/15/2005
06/28/2005
06/29/2005
06/29/2005
10/07/2005
01/12/2006
01/12/2006
01/11/2006
01/12/2006
01/20/2006
08/16/2006
01/01/1994
01/01/1994
03/28/2000
03/28/2000
03/28/2000
03/28/2000
01/18/2006
04/13/2006
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/31/2014
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/14/2009
02/14/2009
12/31/2078
12/31/2078
11/30/2005
08/31/2005
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J8530
J8530
J8530
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
54868521800
54868521801
54868521802
00006006368
00054317644
00054317757
00054317763
00054417925
00054418025
00054418125
00054418225
00054418325
00054418425
00054817425
00054817525
00054817625
00054817925
00054818025
00054818125
00095008635
00095008651
18837003730
21695038204
23490540401
23490540701
23490540702
35356035930
49999005906
52959039212
52959039221
52959039228
52959054704
52959054710
52959054711
52959054712
52959054716
52959054720
52959054730
52959054750
54569032200
54569032203
54569032404
54569033601
54569572900
54868021800
54868021801
54868021803
54868021804
54868021805
54868021806
54868021807
54868021808
54868021809
54868091600
54868174400
54868315700
54868315701
54868533400
54868533401
55045130801
55045130802
55045130803
55045130806
55045130807
55045130808
12/19/2013
HCPCS Description
CYCLOPHOSPHAMIDE, 25 MG, ORAL
CYCLOPHOSPHAMIDE, 25 MG, ORAL
CYCLOPHOSPHAMIDE, 25 MG, ORAL
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
DEXAMETHASONE, ORAL, 0.25 MG
Earliest Start
Date
02/10/2005
12/22/2005
12/22/2005
01/01/2006
01/01/2006
07/31/2008
09/30/1990
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
09/01/2006
01/01/2006
09/01/2006
02/01/2007
02/07/2007
02/07/2007
11/30/2007
08/08/2008
01/01/2006
01/01/2006
01/01/2006
01/01/2006
05/16/2007
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
09/11/2006
04/03/2008
01/01/2006
01/01/2006
01/01/2006
05/10/2007
01/01/2006
08/31/2007
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8540
J8560
J8560
J8560
J8561
J8561
J8561
55045130809
55045197005
55045266502
55289058204
55289058210
55887016530
55887016560
55887016590
55887037712
58016029000
58016029002
58016029003
58016029012
58016029015
58016029020
58016029030
58016029073
58016029089
58016029160
58016029300
58016029306
58016029312
58016029315
58016029320
58016029330
58016035020
58016078100
58016078108
58016078110
58016078112
58016078114
58016078115
58016078120
58016078121
58016078124
58016078128
58016078130
58016078140
58016078150
58468021802
60432046608
63874044401
63874044412
63874044415
63874044420
63874044421
63874044430
66267006612
66336047906
66336047915
66336055012
68115009612
68115009614
68115009630
68115009704
68115009715
68115009720
68115009730
68115043510
00378326694
54868535501
54868535502
00078041420
00078041461
00078041520
12/19/2013
HCPCS Description
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
DEXAMETHASONE, ORAL, 0.25
ETOPOSIDE, 50 MG, ORAL
ETOPOSIDE, 50 MG, ORAL
ETOPOSIDE, 50 MG, ORAL
EVEROLIMUS, ORAL, 0.25 MG
EVEROLIMUS, ORAL, 0.25 MG
EVEROLIMUS, ORAL, 0.25 MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
Earliest Start
Date
01/01/2006
01/01/2006
01/01/2006
10/01/2007
04/10/2008
04/01/2007
04/01/2007
04/01/2007
03/23/2007
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2007
01/01/2006
01/01/2007
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2007
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
04/01/2010
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
10/19/2001
01/30/2006
01/30/2006
01/01/2012
01/01/2012
01/01/2012
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J8561
J8561
J8561
J8565
J8600
J8600
J8600
J8600
J8600
J8600
J8600
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8610
J8650
J8700
J8700
J8700
J8700
J8700
J8700
J8700
J8700
00078041561
00078041720
00078041761
00310048230
00173004535
54868433900
54868433901
54868433902
54868433903
54868433904
59572030250
00054455015
00054455025
00054855025
00378001401
00378001450
00555057202
00555057235
23490588900
49999038024
51079067001
51079067005
51285036601
51285036701
51285036801
51285036901
51552105401
51552105409
51927156500
52959024400
54569181808
54868382600
54868382601
54868382602
54868382603
54868382604
54868382605
54868382606
54868382607
54868382608
54868382609
55289092430
60429008036
63370015410
63370015415
63370015425
63629147201
63629147202
67253032010
67253032036
67253058042
67253058043
67253058044
67253058045
67253058046
68115063200
00187024701
00085124803
00085136601
00085136602
00085141701
00085142501
00085142502
00085143001
00085143002
12/19/2013
HCPCS Description
EVEROLIMUS, ORAL, 0.25 MG
EVEROLIMUS, ORAL, 0.25 MG
EVEROLIMUS, ORAL, 0.25 MG
GEFITINIB, ORAL, 250 MG
MELPHALAN, 2 MG, ORAL
MELPHALAN, 2 MG, ORAL
MELPHALAN, 2 MG, ORAL
MELPHALAN, 2 MG, ORAL
MELPHALAN, 2 MG, ORAL
MELPHALAN, 2 MG, ORAL
MELPHALAN, 2 MG, ORAL
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE,2. 5 MG
METHOTREXATE, 2.5 MG
METHOTREXATE, 2.5 MG
METHOTREXATE, 2.5 MG
METHOTREXATE; ORAL, 2.5 MG
METHOTREXATE; ORAL, 2.5 MG
METHOTREXATE; ORAL, 2.5 MG
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE; ORAL, 2.5 MG
METHOTREXATE; ORAL, 2.5 MG
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE; ORAL, 2.5 MG
METHOTREXATE; ORAL, 2.5 MG
METHOTREXATE; ORAL, 2.5 MG
METHOTREXATE; ORAL, 2.5 MG
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE; ORAL, 2.5 MG
METHOTREXATE, 2.5 MG, ORAL
MTX 2.5MG ORAL
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE, 2.5 MG, ORAL
METHOTREXATE, 2.5 MG, ORAL
NABILONE, ORAL, 1 MG
TEMODAR, 5 MG, ORAL
TEMODAR, 5 MG, ORAL
TEMODAR, 5 MG, ORAL
TEMODAR, 5 MG, ORAL
TEMODAR, 5 MG, ORAL
TEMODAR, 5 MG, ORAL
TEMODAR, 5 MG, ORAL
TEMODAR, 5 MG, ORAL
Earliest Start
Date
01/01/2012
01/01/2012
01/01/2012
01/01/2005
01/01/1994
08/16/2005
11/22/2005
02/03/2006
04/03/2006
02/05/2008
04/22/2004
09/27/1994
09/27/1994
09/27/1994
01/01/1994
02/23/1998
01/01/1994
01/01/1994
11/30/2007
06/09/2004
01/01/1994
01/01/1994
03/09/2006
03/09/2006
12/01/2005
12/01/2005
09/01/2003
09/01/2003
09/08/2003
10/02/2000
10/20/2000
12/04/2002
12/04/2002
12/09/2002
08/25/2003
08/25/2003
07/20/2004
11/22/2004
11/04/2005
06/29/2010
09/13/2010
11/01/2005
05/25/2010
07/08/2003
07/08/2003
07/08/2003
11/01/2004
02/01/2009
12/30/2005
07/01/2009
07/01/2003
07/01/2003
07/01/2003
07/01/2003
07/01/2003
04/19/2004
01/01/2007
04/09/2007
04/09/2007
04/09/2007
04/09/2007
04/09/2007
04/09/2007
04/09/2007
04/09/2007
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
04/30/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J8700
J8700
J8700
J8700
J8700
J8700
J8700
J8700
J8700
J8700
J8700
J8700
J8700
J8700
J8700
J8700
J8700
J8700
J8700
J8700
J8705
J8705
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
00085151901
00085151902
00085300401
00085300402
54868414200
54868414201
54868414202
54868414203
54868414204
54868414205
54868414206
54868534800
54868534801
54868535000
54868535001
54868535002
54868535003
54868535004
54868535400
54868535500
00007420511
00007420711
00003083050
00003633517
00003633617
00003633717
00007420511
00007420711
00009766304
00015050842
00015303020
00015303120
00015303220
00015303410
00024582005
00024582020
00054354258
00054458111
00054458127
00054460325
00054460425
00054483121
00054483126
00054483413
00054483422
00054860325
00054860425
00054883125
00054883425
00093078201
00093078205
00093078210
00093078256
00093078405
00093078406
00093078410
00093078486
00093551006
00093963487
00121477610
00172496058
00172496070
00172565649
00172565658
00172565670
12/19/2013
Earliest Start
Date
HCPCS Description
TEMODAR, 5 MG, ORAL
TEMODAR, 5 MG, ORAL
TEMODAR, 5 MG, ORAL
TEMODAR, 5 MG, ORAL
TEMODAR, 5 MG, ORAL
TEMODAR, 5 MG, ORAL
TEMODAR, 5 MG, ORAL
TEMODAR, 5 MG, ORAL
TEMODAR, 5 MG, ORAL
TEMODAR, 5 MG, ORAL
TEMODAR, 5 MG, ORAL
TEMODAR, 5 MG, ORAL
TEMODAR, 5 MG, ORAL
TEMODAR, 5 MG, ORAL
TEMODAR, 5 MG, ORAL
TEMODAR, 5 MG, ORAL
TEMODAR, 5 MG, ORAL
TEMODAR, 5 MG, ORAL
TEMODAR, 5 MG, ORAL
TEMODAR, 5 MG, ORAL
TOPOTECAN, ORAL, 0.25 MG
TOPOTECAN, ORAL, 0.25 MG
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
PRESCRIPTION DRUG, ORAL,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
04/09/2007
04/09/2007
01/30/2008
01/30/2008
06/29/2005
08/03/2006
01/26/2006
03/16/2006
03/23/2006
03/23/2006
05/16/2006
10/20/2005
04/13/2006
10/31/2007
10/20/2005
11/22/2005
02/08/2006
03/23/2006
04/13/2006
12/20/2005
07/01/2009
07/01/2009
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/16/2008
09/16/2008
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
11/12/2009
11/12/2009
04/11/2002
02/19/2004
02/19/2004
01/01/2002
01/01/2002
02/21/2003
02/21/2003
02/21/2003
02/21/2003
01/01/2002
01/01/2002
02/21/2003
02/21/2003
02/20/2003
01/09/2008
01/09/2008
02/20/2003
01/09/2008
02/20/2003
01/09/2008
02/20/2003
04/27/2005
08/13/2003
07/07/2006
01/01/2002
01/01/2002
02/20/2003
02/20/2003
02/20/2003
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
04/15/2015
04/15/2015
06/30/2013
10/14/2008
12/31/2078
10/31/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/31/2008
03/31/2008
11/30/2008
11/30/2008
12/31/2078
12/31/2078
03/31/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/31/2012
12/31/2078
12/31/2078
12/31/2078
03/31/2009
04/30/2009
12/31/2078
Page 1 of 1
HCPCS
NDC
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
00172565680
00172565746
00172565760
00172565770
00172565780
00173063535
00182186489
00185112505
00185112518
00185112588
00310020130
00310020137
00378014405
00378014491
00378027401
00378027493
00378354725
00378354752
00555044609
00555044663
00555060602
00555060702
00555060704
00555087004
00555087063
00555088202
00555090401
00555090414
00904357161
12280034630
13632012301
49884028901
49884029001
49884029004
49884029005
49884072401
49884075305
49884075313
49884090738
49884090761
49884092202
49884092204
49999098630
51079043401
51079043420
51079043501
51079043519
51079043520
52959092830
54482005301
54569376501
54569571500
54569571600
54569573100
54569573200
54569585700
54868112600
54868112601
54868112602
54868112603
54868112604
54868112605
54868136600
54868136700
54868162900
12/19/2013
HCPCS Description
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
DRUG,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
CHEMOTHERAPEUTIC,
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
NOS
Earliest Start
Date
02/20/2003
02/11/2004
02/20/2003
02/20/2003
04/28/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
05/02/2008
02/20/2003
02/20/2003
02/20/2003
02/20/2003
07/01/2005
07/01/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/09/2008
07/10/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/26/2006
01/26/2006
01/01/2002
05/01/2004
02/09/2004
11/18/2004
06/14/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
05/15/2008
01/01/2002
10/20/2005
07/15/2005
07/15/2005
08/03/2005
08/03/2005
11/06/2006
08/11/2003
11/22/2005
11/22/2005
11/22/2005
05/23/2006
10/17/2006
04/06/2006
08/08/2003
10/03/2005
Latest End
Date
12/31/2078
12/31/2078
05/31/2009
05/31/2009
05/31/2009
06/30/2014
02/28/2010
08/31/2011
07/31/2011
12/31/2078
12/31/2078
07/29/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
04/30/2011
11/30/2010
12/31/2078
12/31/2078
12/31/2015
12/31/2078
08/31/2011
12/31/2078
11/30/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/31/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J8999
J9000
J9000
J9000
J9000
J9000
J9000
J9000
J9000
J9000
J9000
J9000
J9000
54868162901
54868162902
54868300401
54868300402
54868300403
54868300404
54868300405
54868309901
54868428700
54868428701
54868428702
54868428703
54868428704
54868462800
54868477300
54868477301
54868477302
54868477303
54868500000
54868526100
54868528200
54868528201
54868538900
54868538901
57844052206
57866443601
57866482201
58016017000
58016017030
58016017060
58016017090
58016017099
60432012608
60432012616
60505036801
63629126201
63739016501
63739016503
63739016510
63739016515
63739026910
63739026915
66105083201
66105083203
66105083206
66105083209
66105083210
68094051859
68094051861
68094051862
68094052859
68094052861
68094052862
00069303020
00069303120
00069303220
00069303320
00069303420
00703504001
00703504303
00703504601
10019092001
10019092102
25021020705
25021020725
12/19/2013
HCPCS Description
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
Earliest Start
Date
10/03/2005
07/06/2007
01/01/2002
01/01/2002
02/02/2006
04/10/2006
04/13/2006
01/01/2002
01/17/2005
01/17/2005
02/14/2005
09/22/2005
01/18/2008
06/12/2002
04/10/2003
08/06/2003
07/07/2005
07/14/2005
02/19/2004
06/29/2005
05/23/2005
05/23/2005
09/01/2005
12/14/2005
05/14/2004
04/15/2002
04/15/2002
02/01/2006
02/01/2006
02/01/2006
02/01/2006
02/01/2006
11/17/2004
12/01/2006
06/23/2006
11/01/2004
01/01/2002
01/01/2002
02/27/2007
06/09/2004
02/27/2007
02/15/2005
09/13/2006
09/13/2006
09/13/2006
09/13/2006
09/13/2006
07/01/2007
11/28/2006
11/28/2006
07/01/2007
02/26/2004
02/26/2004
05/19/2011
05/19/2011
05/19/2011
05/19/2011
05/19/2011
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
11/01/2013
11/01/2013
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/31/2007
01/31/2007
12/31/2078
07/01/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/17/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/30/2007
06/30/2008
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J9000
J9000
J9000
J9000
J9000
J9000
J9000
J9000
J9000
J9000
J9000
J9000
J9000
J9000
J9000
J9000
J9000
J9000
J9001
J9001
J9001
J9002
J9002
J9002
J9010
J9010
J9015
J9015
J9015
J9017
J9017
J9017
J9017
J9017
J9017
J9017
J9017
J9019
J9019
J9020
J9020
J9025
J9025
J9027
J9027
J9031
J9031
J9031
J9033
J9035
J9035
J9040
J9040
J9040
J9040
J9040
J9040
J9040
J9040
J9040
J9040
J9040
J9041
J9042
J9043
25021020751
55390023110
55390023210
55390023301
55390023510
55390023610
55390023701
55390023801
55390024110
55390024301
55390024510
55390024610
55390024701
55390024801
63323010161
63323088305
63323088310
63323088330
17314960001
17314960002
59676096001
17314960001
17314960002
59676096001
50419035703
58468035703
00078049561
53905099101
54868559600
10106006101
10106006104
10106006201
10106006204
49452073501
49452073502
51927144100
63459060010
57902024901
57902024905
57902024901
57902024905
59572010201
67211010201
58468010001
58468010002
00052060202
00052060302
49281088001
63459039120
50242006001
50242006101
00015301020
00015306301
00703315401
00703315491
00703315501
00703315591
55390000501
55390000601
61703032322
61703033218
63323013610
63020004901
51144005001
00024582411
12/19/2013
HCPCS Description
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, ALL LIPID FORMULATIONS
INJECTION, DOXORUBICIN HYDROCHLORIDE, ALL LIPID FORMULATIONS
DOXORUBICIN, PER 10MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, LIPOSOMAL DOXIL, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, LIPOSOMAL DOXIL, 10 MG
INJECTION, DOXORUBICIN HYDROCHLORIDE, LIPOSOMAL DOXIL, 10 MG
INJECTION, ALEMTUZUMAB, 10 MG
ALEMTUZUMAB, PER 10MG
INJECTION, ALDESLEUKIN, PER SINGLE USE VIAL
INJECTION, ALDESLEUKIN, PER SINGLE USE VIAL
INJECTION, ALDESLEUKIN, PER SINGLE USE VIAL
INJECTION, ARSENIC TRIOXIDE, 1 MG
INJECTION, ARSENIC TRIOXIDE, 1 MG
INJECTION, ARSENIC TRIOXIDE, 1 MG
INJECTION, ARSENIC TRIOXIDE, 1 MG
INJECTION, ARSENIC TRIOXIDE, 1 MG
INJECTION, ARSENIC TRIOXIDE, 1 MG
INJECTION, ARSENIC TRIOXIDE, 1 MG
INJECTION, ARSENIC TRIOXIDE, 1 MG
INJECTION, ASPARAGINASE, 1,000 UNITS
INJECTION, ASPARAGINASE, 1,000 UNITS
INJECTION, ASPARAGINASE, 10,000 UNITS
INJECTION, ASPARAGINASE, 10,000 UNITS
AZACITADINE, PER 1 MG, INJECTION
INJECTION, AZACITIDINE, 1 MG
INJECTION, CLOFARABINE, 1 MG
INJECTION, CLOFARABINE, 1 MG
BCG (INTRAVESICAL) PER INSTILLATION
BCG (INTRAVESICAL) PER INSTILLATION
BCG (INTRAVESICAL) PER INSTILLATION
BENDAMUSTINE HCL, PER 1MG
INJECTION, BEVACIZUMAB, 10 MG
INJECTION, BEVACIZUMAB, 10 MG
INJECTION, BLEOMYCIN SULFATE, 15 UNITS
INJECTION, BLEOMYCIN SULFATE, 15 UNITS
INJECTION, BLEOMYCIN SULFATE, 15 UNITS
INJECTION, BLEOMYCIN SULFATE, 15 UNITS
INJECTION, BLEOMYCIN SULFATE, 15 UNITS
INJECTION, BLEOMYCIN SULFATE, 15 UNITS
INJECTION, BLEOMYCIN SULFATE, 15 UNITS
INJECTION, BLEOMYCIN SULFATE, 15 UNITS
INJECTION, BLEOMYCIN SULFATE, 15 UNITS
INJECTION, BLEOMYCIN SULFATE, 15 UNITS
BLEOMYCIN PER 15 UNITS
INJECTION, BORTEZOMIB, 0.1 MG
INJECTION, BRENTUXIMAB VEDOTIN, 1MG
INJECTION, CABAZITAXEL, 1MG
Earliest Start
Date
11/01/2013
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
08/06/2007
08/06/2007
08/06/2007
08/06/2007
01/01/2002
01/01/2002
07/01/2011
01/01/2012
01/01/2012
07/01/2011
01/28/2005
01/25/2005
12/12/2007
01/01/2002
05/22/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
11/15/2004
11/15/2004
12/04/2003
07/15/2006
01/01/2013
01/01/2013
11/21/2011
11/21/2011
01/01/2010
01/01/2006
01/01/2006
01/01/2006
01/01/2002
01/01/2002
01/01/2002
03/31/2008
01/01/2005
01/01/2005
01/01/2002
01/01/2002
01/01/2002
02/20/2002
01/01/2002
02/20/2002
03/10/2003
03/10/2003
01/01/2002
01/01/2002
02/16/2009
01/01/2005
01/01/2013
01/01/2012
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
11/30/2012
12/31/2078
12/31/2078
12/31/2078
06/30/2014
05/31/2014
09/30/2012
01/31/2013
01/31/2013
11/30/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
06/01/2012
06/01/2012
12/31/2078
06/01/2012
06/01/2012
12/31/2078
09/30/2011
12/31/2078
03/31/2012
12/31/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/31/2009
02/28/2009
12/31/2078
04/30/2010
12/31/2078
01/31/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
J9045
00015321030
00015321130
00015321230
00015321330
00015321430
00015321530
00015321630
00409112910
00409112911
00409112912
00591333626
00591333712
00591333889
00591345460
00703324411
00703324611
00703324811
00703324911
00703326401
00703326601
00703326801
00703326871
00703327401
00703327601
00703327801
00703424401
00703424601
00703424801
10019091501
10019091701
10139006005
10139006015
10139006045
15210006112
15210006312
15210006612
15210006712
50111096576
50111096676
50111096776
55390015001
55390015101
55390015201
55390015301
55390015401
55390015501
55390015601
55390022001
55390022101
55390022201
61703033918
61703033922
61703033950
61703033956
61703036018
61703036022
61703036050
63323016610
63323016721
63323016800
63323017245
63323017260
67817006112
67817006312
67817006612
12/19/2013
HCPCS Description
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
INJECTION,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
CARBOPLATIN,
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
Earliest Start
Date
08/21/2003
08/21/2003
08/21/2003
01/01/2002
01/01/2002
01/01/2002
02/25/2004
12/11/2006
12/11/2006
12/11/2006
01/19/2007
01/19/2007
01/19/2007
01/19/2007
06/24/2004
06/24/2004
06/24/2004
11/17/2005
06/24/2004
06/24/2004
06/24/2004
05/01/2006
05/01/2006
05/01/2006
05/01/2006
05/01/2006
05/01/2006
02/01/2006
10/15/2004
10/15/2004
07/09/2007
07/09/2007
07/09/2007
01/15/2007
01/15/2007
01/15/2007
01/15/2007
02/01/2005
02/01/2005
02/01/2005
01/17/2006
01/17/2006
01/17/2006
10/15/2004
10/15/2004
10/15/2004
03/01/2006
11/19/2004
11/19/2004
11/19/2004
04/14/2004
04/14/2004
04/14/2004
02/09/2005
06/28/2006
06/28/2006
06/28/2006
04/01/2004
04/01/2004
04/01/2004
04/28/2006
04/07/2006
10/14/2004
10/14/2004
10/14/2004
Latest End
Date
09/30/2007
06/30/2007
09/30/2007
03/31/2008
05/14/2008
04/30/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/31/2009
03/30/2009
04/30/2009
03/31/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/31/2008
05/31/2008
04/30/2008
09/30/2007
05/31/2009
02/28/2010
08/31/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2006
03/31/2007
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
10/31/2010
10/31/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J9045
J9050
J9050
J9055
J9055
J9060
J9060
J9060
J9060
J9060
J9060
J9060
J9060
J9062
J9062
J9062
J9062
J9062
J9062
J9062
J9062
J9062
J9062
J9062
J9065
J9065
J9065
J9065
J9065
J9070
J9070
J9070
J9070
J9080
J9080
J9080
J9080
J9090
J9090
J9090
J9090
J9090
J9091
J9091
J9091
J9091
J9091
J9092
J9092
J9092
J9092
J9092
J9093
J9094
J9095
J9095
J9096
J9096
J9096
J9096
J9096
J9097
J9098
J9100
J9100
67817006712
00015301238
00015301260
66733094823
66733095823
00703574711
00703574811
49452207801
55390041450
55390041499
63323010351
63323010364
63323010365
00703574711
00703574811
55390009901
55390011250
55390011299
55390018701
55390041450
55390041499
63323010351
63323010364
63323010365
00069020101
55390011501
55390012401
59676020101
63323014010
00015050641
10019095501
10019095601
10019095701
00015050641
10019095501
10019095601
10019095701
00015050241
00015050641
10019095501
10019095601
10019095701
00015050541
00015050641
10019095501
10019095601
10019095701
00015050641
10019095501
10019095601
10019095701
10019095711
00015050641
00015050641
00015050241
00015050641
00015050541
00015050641
38779050603
38779050604
38779050605
00015050641
57665033101
55390013110
55390013210
12/19/2013
Earliest Start
Date
HCPCS Description
INJECTION, CARBOPLATIN, 50 MG
INJECTION, CARMUSTINE, 100 MG
INJECTION, CARMUSTINE, 100 MG
INJECTION, CETUXIMAB, 10 MG
INJECTION, CETUXIMAB, 10 MG
CISPLATIN PWD OR SOLN, PER 10MG
INJECTION, CISPLATIN, POWDER OR SOLUTION,
CISPLATIN, POWDER OR S0LUTION, PER 10 MG
INJECTION, CISPLATIN, POWDER OR SOLUTION,
INJECTION, CISPLATIN, POWDER OR SOLUTION,
INJECTION, CISPLATIN, POWDER OR SOLUTION,
INJECTION, CISPLATIN, POWDER OR SOLUTION,
CISPLATIN PWD OR SOLN, PER 10MG
CISPLATIN 50MG INJ
CISPLATIN 50MG INJ
CISPLATIN 50MG INJ
CISPLATIN 50MG INJ
CISPLATIN 50MG INJ
CISPLATIN 50MG INJ
CISPLATIN 50MG INJ
CISPLATIN 50MG INJ
CISPLATIN 50MG INJ
CISPLATIN 50MG INJ
CISPLATIN 50MG INJ
INJECTION, CLADRIBINE, PER 1 MG
INJECTION, CLADRIBINE, PER 1 MG
INJECTION, CLADRIBINE, PER 1 MG
INJECTION, CLADRIBINE, PER 1 MG
INJECTION, CLADRIBINE, PER 1 MG
CYCLOPHOSPHAMIDE, 100MG
CYCLOPHOSPHAMIDE 100MG
CYCLOPHOSPHAMIDE 100MG
CYCLOPHOSPHAMIDE 100MG INJ
CYCLOPHOSPHAMIDE, 200 MG
CYCLOPHOSPHAMIDE 200 MG
CYCLOPHOSPHAMIDE 200 MG
CYCLOPHOSPHAMIDE 200 MG
CYCLOPHOSPHAMIDE 500MG
CYCLOPHOSPHAMIDE, 500 MG
CYCLOPHOSPHAMIDE, 500 MG
CYCLOPHOSPHAMIDE 500MG
CYCLOPHOSPHAMIDE 500MG
CYCLOPHOSPHAMIDE 1GM
CYCLOPHOSPHAMIDE, 1 GM
CYCLOPHOSPHAMIDE 1000MG
CYCLOPHOSPHAMIDE, 1.0 GRAM
CYCLOPHOSPHAMIDE 1.0 GM INJ
CYCLOPHOSPHAMIDE, 2 GM
CYCLOPHOSPHAMIDE 2.0 GM INJ
CYCLOPHOSPHAMIDE 2.0 GM INJ
CYCLOPHOSPHAMIDE, 2.0 GRAM
CYCLOPHOSPHAMIDE, 2.0 GRAM
CYCLOPHOSPHAMIDE, 100MG
CYCLOPHOSPHAMIDE, 200MG
CYCLOPHOSPHAMIDE, LYOPHILIZED, 500 MG
CYCLOPHOSPHAMIDE, 500 MG
CYCLOPHOSPHAMIDE, LYOPHILIZED, 1.0 GRAM
1 GM
CYCLOPHOSPHAMIDE, LYOPHILIZED, 1.0 GRAM
CYCLOPHOSPHAMIDE, LYOPHILIZED, 1.0 GRAM
CYCLOPHOSPHAMIDE, LYOPHILIZED, 1.0 GRAM
CYCLOPHOSPHAMIDE, LYOPHILIZED, 2.0 GRAM
INJECTION, CYTARABINE LIPOSOME, 10 MG
INJECTION, CYTARABINE, 100 MG
CYTARABINE, 100MG
10 MG
10
10
10
10
MG
MG
MG
MG
10/14/2004
01/01/2002
04/07/2008
01/01/2005
05/03/2007
12/31/1999
06/01/2000
01/30/2002
10/09/2001
10/09/2001
11/15/1999
11/15/1999
12/31/1999
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/14/2013
01/01/2002
01/01/2002
01/01/2002
09/13/2004
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2007
01/01/2006
04/30/2004
01/01/2006
01/01/2006
01/01/2007
01/01/2006
01/01/2006
04/30/2004
01/01/2006
01/01/2006
01/01/2006
01/01/2006
04/30/2004
04/30/2004
01/01/2006
01/01/2006
05/15/2004
01/01/2006
05/15/2004
01/01/2006
01/01/2002
01/01/2002
01/01/2002
05/15/2004
01/01/2004
01/01/2002
07/01/1996
Latest End
Date
12/31/2078
09/30/2009
09/30/2015
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2012
12/31/2078
10/01/2012
12/31/2078
08/31/2010
12/31/2078
12/31/2078
12/31/2078
08/31/2010
12/31/2078
12/31/2078
12/31/2078
10/31/2010
08/31/2010
12/31/2078
12/31/2078
12/31/2078
11/30/2010
08/31/2010
12/31/2078
12/31/2078
12/31/2078
08/31/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/31/2010
08/31/2010
10/31/2010
08/31/2010
11/30/2010
08/31/2010
12/31/2078
12/31/2078
12/31/2078
08/31/2010
12/31/2078
12/31/2078
11/30/2012
Page 1 of 1
HCPCS
NDC
J9100
J9100
J9100
J9100
J9110
J9110
J9110
J9110
J9110
J9110
J9110
J9110
J9110
J9110
J9110
J9110
J9110
J9120
J9130
J9130
J9140
J9140
J9140
J9140
J9140
J9140
J9140
J9140
J9140
J9150
J9150
J9150
J9150
J9150
J9150
J9150
J9150
J9151
J9155
J9155
J9160
J9160
J9170
J9170
J9170
J9171
J9171
J9171
J9171
J9171
J9171
J9171
J9171
J9171
J9171
J9171
J9171
J9175
J9178
J9178
J9178
J9178
J9178
J9178
J9178
55390013301
55390080610
61703030538
61703031922
55390013110
55390013210
55390013301
55390013401
55390080710
55390080801
55390080901
61703030346
61703030350
61703030425
61703030436
61703031922
63323012020
67386081155
61703032722
63323012710
00026815120
00703507501
00703507503
51927236200
55390009010
55390033910
61703032722
63323012812
63323012820
00703523313
55390010801
55390010810
55390014210
55390028110
55390080510
63323011908
63323012404
61958030101
55566830101
55566840101
62856060301
64365050301
00075800120
00075800180
16729022850
00075800120
00075800180
00075800301
00075800404
00409020102
00409020110
00409020120
00955102001
00955102104
16729012049
16729022850
66758005001
67871000710
00009509101
00009509301
00591346983
00591347057
00703306711
00703306911
10139006101
12/19/2013
HCPCS Description
CYTARABINE, PER 100MG INJ
INJECTION, CYTARABINE, 100 MG
INJECTION, CYTARABINE, 100 MG
CYTARABINE, 100MG
CYTARABINE, 500MG
INJECTION, CYTARABINE, 500 MG
INJECTION, CYTARABINE, 500 MG
INJECTION, CYTARABINE, 500 MG
INJECTION, CYTARABINE, 500 MG
INJECTION, CYTARABINE, 500 MG
INJECTION, CYTARABINE, 500 MG
INJECTION, CYTARABINE, 500 MG
INJECTION, CYTARABINE, 500 MG
INJECTION, CYTARABINE, 500 MG
INJECTION, CYTARABINE, 500 MG
INJECTION, CYTARABINE, 500 MG
INJECTION, CYTARABINE, 500 MG
INJECTION, DACTINOMYCIN, 0.5 MG
DACARBAZINE 100MG
DACARBAZINE, 100 MG
DACARBAZINE, 200 MG
DACARBAZINE, 200 MG
DACARBAZINE, 200 MG
DACARBAZINE, 200 MG
DACARBAZINE, 200 MG
DACARBAZINE, 200 MG
DACARBAZINE, 200 MG
DACARBAZINE, 200 MG
DACARBAZINE, 200 MG
INJECTION, DAUNORUBICIN, 10 MG
INJECTION, DAUNORUBICIN, 10 MG
INJECTION, DAUNORUBICIN, 10 MG
INJECTION, DAUNORUBICIN, 10 MG
INJECTION, DAUNORUBICIN, 10 MG
INJECTION, DAUNORUBICIN, 10 MG
INJECTION, DAUNORUBICIN, 10 MG
INJECTION, DAUNORUBICIN, 10 MG
INJECTION, DAUNORUBICIN CITRATE, LIPOSOMAL FORMULATION, 10 M
INJECTION, DEGARELIX, 1MG
INJECTION, DEGARELIX, 1MG
INJECTION, DENILEUKIN DIFTITOX, 300 MICROGRAMS
INJECTION, DENILEUKIN DIFTITOX, 300 MICROGRAMS
INJECTION, DOCETAXEL, 20 MG
INJECTION, DOCETAXEL, 20 MG
DOCETAXEL, PER 20MG
INJECTION, DOCETAXEL, 1 MG
INJECTION, DOCETAXEL, 1 MG
DOCETAXEL, PER 1MG
DOCETAXEL, PER 1MG
DOCETAXEL, PER 1MG
DOCETAXEL, PER 1MG
DOCETAXEL, PER 1MG
DOCETAXEL, PER 1MG
INJECTION, DOCETAXEL, 1 MG
DOCETAXEL, PER 1MG
DOCETAXEL, PER 1MG
DOCETAXEL, PER 1MG
INJECTION, ELLIOTTS' B SOLUTION, 1 ML
INJECTION, EPIRUBICIN HCL, 2 MG
INJECTION, EPIRUBICIN HCL, 2 MG
INJECTION, EPIRUBICIN HCL, 2 MG
INJECTION, EPIRUBICIN HCL, 2 MG
INJECTION, EPIRUBICIN HCL, 2 MG
INJECTION, EPIRUBICIN HCL, 2 MG
INJECTION, EPIRUBICIN HCL, 2 MG
Earliest Start
Date
01/01/2011
01/01/2002
05/01/2003
07/01/1996
01/01/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
05/01/2003
01/01/2002
01/01/2002
05/01/2003
01/01/2002
03/05/2004
01/21/2006
01/01/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/08/2003
01/01/2002
03/05/2008
09/23/2002
01/01/2002
01/01/2002
01/27/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
02/18/2004
01/01/2002
01/01/2012
01/01/2012
01/17/2008
01/01/2002
01/01/2002
01/01/2002
06/30/2011
01/01/2010
01/01/2010
10/11/2010
10/11/2010
03/17/2011
03/17/2011
03/17/2011
03/14/2011
03/14/2011
06/30/2011
06/30/2011
08/05/2011
01/01/2006
01/01/2004
01/01/2004
10/23/2007
10/23/2007
08/09/2007
08/09/2007
11/30/2007
Latest End
Date
12/31/2078
07/31/2013
12/31/2078
12/31/2078
12/31/2078
11/30/2012
12/31/2078
12/31/2078
03/31/2013
08/31/2014
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
06/30/2006
12/31/2078
12/31/2078
12/31/2078
11/30/2012
02/29/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
10/31/2012
12/31/2078
04/30/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/01/2009
05/31/2012
06/30/2013
12/31/2078
05/31/2012
06/30/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J9178
J9178
J9178
J9178
J9178
J9178
J9178
J9178
J9178
J9178
J9178
J9178
J9178
J9178
J9178
J9178
J9178
J9178
J9178
J9178
J9179
J9181
J9181
J9181
J9181
J9181
J9181
J9181
J9181
J9181
J9181
J9181
J9181
J9181
J9181
J9181
J9181
J9181
J9182
J9182
J9182
J9182
J9182
J9182
J9182
J9182
J9182
J9182
J9185
J9185
J9185
J9185
J9185
J9185
J9185
J9190
J9190
J9190
J9190
J9190
J9190
J9190
J9190
J9190
J9190
10139006125
10518010410
10518010411
25021020325
55390020701
55390020801
59762509101
59762509301
61703034735
61703034859
61703035901
61703035902
61703035959
61703035991
61703035992
61703035993
63323015100
63323015105
63323015125
63323015175
62856038901
00015340420
00703565301
00703565601
00703565701
10019093001
10019093002
16729011431
51927277200
55390029101
55390029201
55390029301
55390049101
55390049201
55390049301
63323010405
63323010425
63323010450
00703565301
00703565601
00703565701
38779078403
38779078406
51927277200
55390029101
55390029301
63323010405
63323010450
00703485211
00703485281
00703585401
50419051106
63323019002
63323019606
66758004601
00187395364
00703301513
00703301812
00703301912
10139006301
10139006311
10139006312
10139006350
38779002501
38779002504
12/19/2013
HCPCS Description
INJECTION, EPIRUBICIN HCL, 2 MG
INJECTION, EPIRUBICIN HCL, 2 MG
INJECTION, EPIRUBICIN HCL, 2 MG
EPIRUBICIN PER 2MG
INJECTION, EPIRUBICIN HCL, 2 MG
INJECTION, EPIRUBICIN HCL, 2 MG
INJECTION, EPIRUBICIN HCL, 2 MG
INJECTION, EPIRUBICIN HCL, 2 MG
INJECTION, EPIRUBICIN HCL, 2 MG
INJECTION, EPIRUBICIN HCL, 2 MG
INJECTION, EPIRUBICIN HCL, 2 MG
INJECTION, EPIRUBICIN HCL, 2 MG
INJECTION, EPIRUBICIN HCL, 2 MG
INJECTION, EPIRUBICIN HCL, 2 MG
INJECTION, EPIRUBICIN HCL, 2 MG
INJECTION, EPIRUBICIN HCL, 2 MG
INJECTION, EPIRUBICIN HCL, 2 MG
INJECTION, EPIRUBICIN HCL, 2 MG
INJECTION, EPIRUBICIN HCL, 2 MG
INJECTION, EPIRUBICIN HCL, 2 MG
INJECTION, ERIBULIN MESYLATE, 0.1 MG
INJECTION, ETOPOSIDE, 10 MG
INJECTION, ETOPOSIDE, 10 MG
INJECTION, ETOPOSIDE, 10 MG
INJECTION, ETOPOSIDE, 10 MG
INJECTION, ETOPOSIDE, 10 MG
INJECTION, ETOPOSIDE, 10 MG
INJECTION, ETOPOSIDE, 10 MG
INJECTION, ETOPOSIDE, 10 MG
INJECTION, ETOPOSIDE, 10 MG
INJECTION, ETOPOSIDE, 10 MG
INJECTION, ETOPOSIDE, 10 MG
INJECTION, ETOPOSIDE, 10 MG
INJECTION, ETOPOSIDE, 10 MG
INJECTION, ETOPOSIDE, 10 MG
INJECTION, ETOPOSIDE, 10 MG
INJECTION, ETOPOSIDE, 10 MG
INJECTION, ETOPOSIDE, 10 MG
ETOPOSIDE 100MG
ETOPOSIDE 100MG
ETOPOSIDE 100MG
ETOPOSIDE, 100 MG
ETOPOSIDE, 100 MG
ETOPOSIDE, 100 MG
ETOPOSIDE 100MG
ETOPOSIDE 100MG
ETOPOSIDE 100MG
ETOPOSIDE 100MG
INJECTION, FLUDARABINE PHOSPHATE, 50
INJECTION, FLUDARABINE PHOSPHATE, 50
INJECTION, FLUDARABINE PHOSPHATE, 50
INJECTION, FLUDARABINE PHOSPHATE, 50
INJECTION, FLUDARABINE PHOSPHATE, 50
INJECTION, FLUDARABINE PHOSPHATE, 50
INJECTION, FLUDARABINE PHOSPHATE, 50
INJECTION, FLUOROURACIL, 500 MG
INJECTION, FLUOROURACIL, 500 MG
INJECTION, FLUOROURACIL, 500 MG
INJECTION, FLUOROURACIL, 500 MG
INJECTION, FLUOROURACIL, 500 MG
INJECTION, FLUOROURACIL, 500 MG
INJECTION, FLUOROURACIL, 500 MG
INJECTION, FLUOROURACIL, 500 MG
INJECTION, FLUOROURACIL, 500 MG
INJECTION, FLUOROURACIL, 500 MG
MG
MG
MG
MG
MG
MG
MG
Earliest Start
Date
11/30/2007
08/24/2007
08/24/2007
08/24/2009
08/07/2007
08/07/2007
08/08/2007
08/08/2007
11/06/2006
11/06/2006
04/10/2008
04/10/2008
08/08/2007
03/13/2008
03/13/2008
08/08/2007
12/07/2007
12/07/2007
12/07/2007
12/07/2007
01/01/2012
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
03/22/2011
01/01/2009
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2007
01/01/2007
01/01/2006
04/25/2002
04/25/2002
09/08/2003
01/01/2007
01/01/2007
01/01/2006
01/01/2007
05/02/2007
08/03/2006
09/12/2003
01/01/2002
10/31/2007
12/07/2007
10/12/2007
01/01/2002
09/02/2003
09/02/2003
09/02/2003
07/02/2007
06/11/2007
06/11/2007
06/07/2007
01/01/2002
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/28/2011
10/31/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/31/2013
05/31/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
06/30/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J9190
J9190
J9190
J9190
J9190
J9190
J9190
J9190
J9190
J9190
J9190
J9190
J9190
J9190
J9190
J9190
J9190
J9190
J9190
J9190
J9190
J9200
J9200
J9200
J9200
J9201
J9201
J9201
J9201
J9201
J9201
J9201
J9201
J9201
J9202
J9202
J9206
J9206
J9206
J9206
J9206
J9206
J9206
J9206
J9206
J9206
J9206
J9206
J9206
J9206
J9206
J9206
J9206
J9206
J9206
J9206
J9206
J9206
J9206
J9206
J9206
J9206
J9206
J9207
J9208
38779002505
49452317501
49452317502
49452317503
49452317504
51552073301
51552073302
51552073304
51552073305
51927108500
62991148601
62991148602
62991148603
63323011710
63323011720
63323011751
63323011761
63370009515
63370009525
63370009535
66758004403
55390013501
55390043501
61703033109
63323014507
00002750101
00002750201
00409018101
00409018601
00781328275
00781328379
63323010210
63323010213
63323012550
00310095036
00310095130
00009752901
00009752902
00009752903
00009752904
00009752905
00591318902
00591318926
00703443211
00703443411
00781306672
00781306675
10019093401
10019093402
10019093417
10019093479
10518010310
10518010311
18111000202
18111000203
59762752901
59762752902
61703034909
61703034916
61703034936
63323019302
63323019305
66758004802
00015191012
00015055605
12/19/2013
HCPCS Description
INJECTION, FLUOROURACIL, 500 MG
INJECTION, FLUOROURACIL, 500 MG
INJECTION, FLUOROURACIL, 500 MG
INJECTION, FLUOROURACIL, 500 MG
INJECTION, FLUOROURACIL, 500 MG
INJECTION, FLUOROURACIL, 500 MG
INJECTION, FLUOROURACIL, 500 MG
INJECTION, FLUOROURACIL, 500 MG
INJECTION, FLUOROURACIL, 500 MG
INJECTION, FLUOROURACIL, 500 MG
INJECTION, FLUOROURACIL, 500 MG
INJECTION, FLUOROURACIL, 500 MG
INJECTION, FLUOROURACIL, 500 MG
5FU PER 500MG
INJECTION, FLUOROURACIL, 500 MG
INJECTION, FLUOROURACIL, 500 MG
INJECTION, FLUOROURACIL, 500 MG
INJECTION, FLUOROURACIL, 500 MG
INJECTION, FLUOROURACIL, 500 MG
INJECTION, FLUOROURACIL, 500 MG
500MG INJ FLUOROURACIL
INJECTION, FLOXURIDINE, 500 MG
INJECTION, FLOXURIDINE, 500 MG
INJECTION, FLOXURIDINE, 500 MG
INJECTION, FLOXURIDINE, 500 MG
INJECTION, GEMCITABINE HYDROCHLORIDE,
INJECTION, GEMCITABINE HYDROCHLORIDE,
GEMICITABINE, 200MG
GEMICITABINE, 200MG
INJECTION, GEMCITABINE HYDROCHLORIDE,
INJECTION, GEMCITABINE HYDROCHLORIDE,
GEMICITABINE, 200MG
GEMICITABINE, 200MG
GEMICITABINE, 200MG
GOSERELIN ACETATE IMPLANT, PER 3.6 MG
GOSERELIN ACETATE IMPLANT, PER 3.6 MG
INJECTION, IRINOTECAN, 20 MG
INJECTION, IRINOTECAN, 20 MG
INJECTION, IRINOTECAN, 20 MG
INJECTION, IRINOTECAN, 20 MG
IRINOTECAN, PER 20MG
INJECTION, IRINOTECAN, 20 MG
INJECTION, IRINOTECAN, 20 MG
INJECTION, IRINOTECAN, 20 MG
INJECTION, IRINOTECAN, 20 MG
INJECTION, IRINOTECAN, 20 MG
INJECTION, IRINOTECAN, 20 MG
INJECTION, IRINOTECAN, 20 MG
INJECTION, IRINOTECAN, 20 MG
INJECTION, IRINOTECAN, 20 MG
INJECTION, IRINOTECAN, 20 MG
INJECTION, IRINOTECAN, 20 MG
INJECTION, IRINOTECAN, 20 MG
INJECTION, IRINOTECAN, 20 MG
INJECTION, IRINOTECAN, 20 MG
INJECTION, IRINOTECAN, 20 MG
INJECTION, IRINOTECAN, 20 MG
INJECTION, IRINOTECAN, 20 MG
IRINOTECAN, 20 MG
INJECTION, IRINOTECAN, 20 MG
INJECTION, IRINOTECAN, 20 MG
INJECTION, IRINOTECAN, 20 MG
IRINOTECAN, 20 MG/ML
IXABEPILONE, PER 1MG
INJECTION, IFOSFAMIDE, 1 GRAM
200 MG
200 MG
200 MG
200 MG
Earliest Start
Date
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2004
09/01/2003
09/01/2003
09/01/2003
09/01/2003
09/08/2003
08/17/2011
09/15/2003
09/15/2003
12/21/1998
01/01/2002
01/01/2002
01/01/2002
07/08/2003
07/08/2003
07/08/2003
07/01/2009
01/01/2002
01/01/2002
09/23/2002
01/01/2002
01/01/2002
01/01/2002
08/26/2011
08/26/2011
11/15/2010
11/15/2010
01/25/2011
01/25/2011
01/25/2011
05/05/2003
05/05/2003
01/01/2002
01/01/2002
10/01/2010
10/01/2010
07/26/1996
03/04/2008
03/04/2008
02/28/2008
02/28/2008
02/27/2008
02/27/2008
02/21/2008
02/21/2008
02/21/2008
02/21/2008
02/27/2008
02/27/2008
02/28/2008
02/28/2008
02/27/2008
02/27/2008
02/27/2008
02/27/2008
02/27/2008
02/05/2008
02/05/2008
12/23/2009
01/01/2009
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/31/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
05/31/2014
05/31/2014
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/01/2013
06/01/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2009
12/31/2009
12/31/2078
12/31/2078
06/30/2011
10/31/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/30/2010
12/31/2078
12/31/2078
02/01/2011
01/01/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/31/2011
Page 1 of 1
HCPCS
NDC
J9208
J9208
J9208
J9208
J9208
J9208
J9208
J9208
J9208
J9209
J9209
J9209
J9209
J9209
J9209
J9209
J9209
J9209
J9209
J9209
J9209
J9211
J9211
J9211
J9211
J9211
J9211
J9211
J9211
J9211
J9211
J9211
J9211
J9212
J9212
J9212
J9212
J9212
J9212
J9213
J9213
J9213
J9213
J9213
J9213
J9214
J9214
J9214
J9214
J9214
J9214
J9214
J9214
J9214
J9214
J9215
J9216
J9217
J9217
J9217
J9217
J9217
J9217
J9217
J9217
00015055741
00703342711
00703342911
10019092501
10019092582
10019092602
10019092616
63323014210
63323014212
00015356302
00015356303
00703480503
10019095301
10019095302
10019095362
55390004501
55390026601
55390034701
63323073310
63323073311
63323073312
00013257691
00013258691
00013259691
00703415411
00703415511
00703415611
55390021501
55390021601
55390021701
59762257601
59762258601
59762259601
00187200601
00187200605
00187200702
00187200706
64116003106
64116003906
00004201507
00004201509
00004201607
00004201609
00004201707
00004201709
00085053901
00085057102
00085111001
00085113301
00085116801
00085117902
00085123501
00085124201
00085125401
54868334100
54746000101
64116001112
00024022205
00024060545
00024061030
00024079375
00074334603
00074364203
00074366303
00074368303
12/19/2013
HCPCS Description
INJECTION, IFOSFAMIDE, 1 GRAM
INJECTION, IFOSFAMIDE, 1 GRAM
INJECTION, IFOSFAMIDE, 1 GRAM
INJECTION, IFOSFAMIDE, 1 GRAM
INJECTION, IFOSFAMIDE, 1 GRAM
INJECTION, IFOSFAMIDE, 1 GRAM
INJECTION, IFOSFAMIDE, 1 GRAM
INJECTION, IFOSFAMIDE, 1 GRAM
INJECTION, IFOSFAMIDE, 1 GRAM
INJECTION, MESNA, 200 MG
INJECTION, MESNA, 200 MG
INJECTION, MESNA, 200 MG
INJECTION, MESNA, 200 MG
INJECTION, MESNA, 200 MG
INJECTION, MESNA, 200 MG
INJECTION, MESNA, 200 MG
INJECTION, MESNA, 200 MG
INJECTION, MESNA, 200 MG
INJECTION, MESNA, 200 MG
INJECTION, MESNA, 200 MG
INJECTION, MESNA, 200 MG
INJECTION, IDARUBICIN HYDROCHLORIDE, 5 MG
INJECTION, IDARUBICIN HYDROCHLORIDE, 5 MG
INJECTION, IDARUBICIN HYDROCHLORIDE, 5 MG
INJECTION, IDARUBICIN HYDROCHLORIDE, 5 MG
INJECTION, IDARUBICIN HYDROCHLORIDE, 5 MG
INJECTION, IDARUBICIN HYDROCHLORIDE, 5 MG
INJECTION, IDARUBICIN HYDROCHLORIDE, 5 MG
INJECTION, IDARUBICIN HYDROCHLORIDE, 5 MG
INJECTION, IDARUBICIN HYDROCHLORIDE, 5 MG
INJECTION, IDARUBICIN HYDROCHLORIDE, 5 MG
INJECTION, IDARUBICIN HYDROCHLORIDE, 5 MG
INJECTION, IDARUBICIN HYDROCHLORIDE, 5 MG
INJECTION, INTERFERON ALFACON-1, RECOMBINANT, 1 MICROGRAM
INJECTION, INTERFERON ALFACON-1, RECOMBINANT, 1 MICROGRAM
INJECTION, INTERFERON ALFACON-1, RECOMBINANT, 1 MICROGRAM
INJECTION, INTERFERON ALFACON-1, RECOMBINANT, 1 MICROGRAM
INJECTION, INTERFERON ALFACON-1, RECOMBINANT, 1 MICROGRAM
INJECTION, INTERFERON ALFACON-1, RECOMBINANT, 1 MICROGRAM
INJECTION, INTERFERON, ALFA-2A, RECOMBINANT, 3 MILLION UNITS
INJECTION, INTERFERON, ALFA-2A, RECOMBINANT, 3 MILLION UNITS
INJECTION, INTERFERON, ALFA-2A, RECOMBINANT, 3 MILLION UNITS
INJECTION, INTERFERON, ALFA-2A, RECOMBINANT, 3 MILLION UNITS
INJECTION, INTERFERON, ALFA-2A, RECOMBINANT, 3 MILLION UNITS
INJECTION, INTERFERON, ALFA-2A, RECOMBINANT, 3 MILLION UNITS
INJECTION, INTERFERON, ALFA-2B, RECOMBINANT, 1 MILLION UNITS
INJECTION, INTERFERON, ALFA-2B, RECOMBINANT, 1 MILLION UNITS
INJECTION, INTERFERON, ALFA-2B, RECOMBINANT, 1 MILLION UNITS
INJECTION, INTERFERON, ALFA-2B, RECOMBINANT, 1 MILLION UNITS
INTERFERON, ALFA-2B, RECOMBINANT, 1 MILLION UNITS
INJECTION, INTERFERON, ALFA-2B, RECOMBINANT, 1 MILLION UNITS
INJECTION, INTERFERON, ALFA-2B, RECOMBINANT, 1 MILLION UNITS
INJECTION, INTERFERON, ALFA-2B, RECOMBINANT, 1 MILLION UNITS
INJECTION, INTERFERON, ALFA-2B, RECOMBINANT, 1 MILLION UNITS
INJECTION, INTERFERON, ALFA-2B, RECOMBINANT, 1 MILLION UNITS
INJECTION, INTERFERON, ALFA-N3, (HUMAN LEUKOCYTE DERIVED), 2
INJECTION, INTERFERON, GAMMA 1-B, 3 MILLION UNITS
LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG
LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG
LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG
LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG
LEUPROLIDE ACETATE DEPOT, 7.5 MG
LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG
LEUPROLIDE PER 7.5MG DEPOT SUSP
LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG
Earliest Start
Date
01/01/2002
07/26/2007
07/26/2007
09/12/2005
05/05/2007
09/12/2005
05/05/2007
07/25/2002
11/18/2002
01/01/2002
01/01/2002
02/22/2002
03/15/2004
03/15/2004
05/05/2007
02/24/2004
09/21/2005
03/05/2008
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/24/2002
09/24/2002
09/24/2002
08/07/2007
08/07/2007
08/07/2007
08/27/2007
08/27/2007
08/27/2007
01/18/2008
01/18/2008
01/18/2008
01/18/2008
04/18/2003
04/18/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
07/02/2003
01/01/2002
01/01/2002
11/01/2003
02/18/2005
03/04/2003
07/25/2003
01/01/2010
09/30/1998
09/30/1998
04/01/2009
Latest End
Date
10/31/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
11/30/2010
11/30/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/31/2012
07/31/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/30/2011
12/31/2078
04/30/2012
06/30/2012
09/30/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/31/2009
02/28/2009
12/31/2078
10/31/2008
12/31/2078
10/31/2008
12/31/2078
10/31/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/31/2007
09/12/2012
09/12/2012
09/12/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J9217
J9217
J9217
J9217
J9217
J9217
J9217
J9217
J9218
J9218
J9218
J9218
J9218
J9218
J9218
J9219
J9225
J9225
J9225
J9226
J9226
J9228
J9228
J9230
00300210801
00300228201
00300244001
00300334601
00300364201
00300366301
00300368301
54868556800
00185740085
00300361224
00300361228
00406805003
00703401418
00703401419
49884036826
00026971101
55592050001
67979000201
67979050001
67979000201
67979050001
00003232711
00003232822
67386091151
LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG
LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG
LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG
LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG
LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG
LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG
LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG
LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG
LEUPROLIDE ACETATE, PER 1 MG
LEUPROLIDE ACETATE, PER 1 MG
LEUPROLIDE ACETATE, PER 1 MG
LEUPROLIDE ACETATE, PER 1 MG
LEUPROLIDE ACETATE, PER 1 MG
LEUPROLIDE ACETATE, PER 1 MG
LEUPROLIDE ACETATE, PER 1 MG
LEUPROLIDE ACETATE IMPLANT, 65 MG
HISTRELIN IMPLANT, 50 MG
HISTRELIN IMPLANT, 50 MG
HISTRELIN IMPLANT, 50 MG
HISTRELIN IMPLANT (SUPPRELIN LA), 50 MG
HISTRELIN IMPLANT (SUPPRELIN LA), 50 MG
IPILMUMAB INJ, PER 1MG
IPILMUMAB INJ, PER 1MG
INJECTION, MECHLORETHAMINE HYDROCHLORIDE, (NITROGEN MUSTARD)
J9245
J9245
J9250
J9250
J9250
J9250
J9250
J9250
J9250
J9250
J9250
J9250
J9250
J9250
J9250
J9250
J9250
J9250
J9250
J9250
J9250
J9250
J9250
J9260
J9260
J9260
J9260
J9260
J9260
J9260
J9260
J9260
J9261
J9261
J9263
J9263
J9263
J9263
J9263
J9263
00173013093
59572030101
10139006202
10139006210
10139006240
54868017300
54868017301
54868471600
54868479600
54868480900
55390003110
55390003210
55390003310
55390003410
61703035038
61703040841
63323012102
63323012104
63323012108
63323012110
63323012140
63323012302
63323012310
55390003110
55390003210
55390003410
55390014301
61703035038
61703040841
63323012250
63323012302
63323012310
00007440101
00007440106
00024059010
00024059120
00024059240
00703398501
00703398601
61703036318
INJECTION, MELPHALAN HYDROCHLORIDE, 50 MG
INJECTION, MELPHALAN HYDROCHLORIDE, 50 MG
METHOTREXATE SODIUM, 5 MG
METHOTREXATE SODIUM, 5 MG
METHOTREXATE SODIUM, 5 MG
METHOTREXATE SODIUM, 5 MG
METHOTREXATE SODIUM, 5 MG
METHOTREXATE SODIUM, 5 MG
METHOTREXATE SODIUM, 5 MG
METHOTREXATE SODIUM, 5 MG
METHOTREXATE SODIUM, 5 MG
METHOTREXATE SODIUM, 5 MG
METHOTREXATE SODIUM, 5 MG
METHOTREXATE SODIUM, 5 MG
METHOTREXATE SODIUM, 5 MG
METHOTREXATE SODIUM, 5 MG
METHOTREXATE SODIUM, 5 MG
METHOTREXATE SODIUM, 5 MG
METHOTREXATE SODIUM, 5 MG
METHOTREXATE SODIUM, 5 MG
METHOTREXATE SODIUM, 5 MG
METHOTREXATE SODIUM, 5 MG
METHOTREXATE SODIUM, 5 MG
METHOTREXATE SODIUM, 50 MG
METHOTREXATE SODIUM, 50 MG
METHOTREXATE SODIUM, 50 MG
METHOTREXATE SODIUM, 50 MG
METHOTREXATE SODIUM, 50 MG
METHOTREXATE SODIUM, 50 MG
METHOTREXATE SODIUM, 50 MG
METHOTREXATE SODIUM, 50 MG
METHOTREXATE SODIUM, 50 MG
INJECTION, NELARABINE, 50 MG
INJECTION, NELARABINE, 50 MG
INJECTION, OXALIPLATIN, 0.5 MG
INJECTION, OXALIPLATIN, 0.5 MG
INJECTION, OXALIPLATIN, 0.5 MG
OXALIPLATIN INJ, 0.5MG
OXALIPLATIN INJ, 0.5MG
OXALIPLATIN INJ, 0.5MG
12/19/2013
HCPCS Description
Earliest Start
Date
Latest End
Date
01/01/2002
03/15/2004
07/02/2007
06/07/2007
06/07/2007
03/26/2003
04/06/2005
12/16/2002
05/21/2003
06/03/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
06/27/2005
04/09/2004
01/01/2002
01/01/2002
01/01/2002
01/01/2002
03/08/2002
01/01/2002
01/01/2002
09/07/2005
05/01/1996
09/07/2005
09/07/2005
01/01/2007
02/26/2001
01/01/2002
01/01/2007
01/01/2007
04/02/2008
01/01/2007
06/08/2005
06/08/2005
08/20/2007
01/01/2010
08/11/2009
08/10/2009
05/31/2012
03/31/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/31/2013
12/31/2078
12/31/2078
12/31/2078
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
04/12/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
04/27/2006
01/01/2002
01/01/2006
06/18/2007
07/25/2007
01/01/2008
01/01/2008
01/01/2012
01/01/2012
01/21/2006
02/01/2011
08/01/2011
11/01/2010
07/01/2011
08/01/2011
10/01/2011
07/01/2011
12/31/2078
12/31/2012
11/01/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/31/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J9263
J9263
J9264
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9265
J9266
J9266
J9268
J9268
J9268
J9280
J9280
J9280
J9290
J9290
J9290
J9290
J9290
J9290
J9290
J9290
J9290
J9291
J9291
J9291
J9291
J9293
J9293
J9293
J9293
J9293
61703036322
63323065020
68817013450
00015347530
00015347630
00015347911
00172375377
00172375396
00172375473
00172375494
00172375675
00172375695
00555198414
00555198514
00703476601
00703476701
00703476801
10518010207
10518010208
10518010209
55390011405
55390011420
55390011450
55390030405
55390030420
55390030450
55390031405
55390031420
55390031450
55390051405
55390051420
55390051450
61703034209
61703034222
61703034250
63323076350
66758004301
66758004302
66758004303
54482030101
57665000202
00409080101
55390024401
62701080001
16729010811
16729011505
55390025201
00015300220
38779055307
38779055309
49452478502
51927364200
55390025201
55390045201
62701001101
63323019140
00015305920
55390025201
55390025301
55390045301
00703468001
00703468091
00703468501
00703468591
00703468601
12/19/2013
HCPCS Description
INJECTION, OXALIPLATIN, 0.5 MG
OXALIPLATIN INJ, 0.5MG
INJECTION, PACLITAXEL PROTEIN-BOUND PARTICLES, 1 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
PACLITAXIL, 6MG/ML
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PACLITAXEL, 30 MG
INJECTION, PEGASPARGASE, PER SINGLE DOSE VIAL
INJECTION, PEGASPARGASE, PER SINGLE DOSE VIAL
INJECTION, PENTOSTATIN, 10 MG
INJECTION, PENTOSTATIN, 10 MG
INJECTION, PENTOSTATIN, 10 MG
MITOMYCIN PER 5MG
MITOMYCIN PER 5MG
MITOMYCIN, PER 5MG
MITOMYCIN, 20 MG
MITOMYCIN, 20 MG
MITOMYCIN, 20 MG
MITOMYCIN, 20 MG
MITOMYCIN, 20 MG
MITOMYCIN, 20 MG
MITOMYCIN, 20 MG
MITOMYCIN, 20 MG
MITOMYCIN, 20 MG
MITOMYCIN, 40 MG
MITOMYCIN 40 MG INJ
MITOMYCIN, 40 MG
MITOMYCIN, 40 MG
INJECTION, MITOXANTRONE HYDROCHLORIDE, PER 5 MG
INJECTION, MITOXANTRONE HYDROCHLORIDE, PER 5 MG
INJECTION, MITOXANTRONE HYDROCHLORIDE, PER 5 MG
INJECTION, MITOXANTRONE HYDROCHLORIDE, PER 5 MG
INJECTION, MITOXANTRONE HYDROCHLORIDE, PER 5 MG
Earliest Start
Date
08/10/2009
06/14/2010
01/01/2006
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/24/2002
01/01/2002
01/24/2002
01/01/2002
01/24/2002
06/03/2008
06/03/2008
09/24/2008
09/15/2000
09/16/2009
04/19/2007
04/19/2007
04/19/2007
01/01/2002
01/01/2002
01/01/2002
12/04/2006
12/04/2006
12/04/2006
01/14/2004
01/14/2004
01/14/2004
01/25/2005
01/25/2005
01/25/2005
04/21/2004
04/21/2004
04/21/2004
05/04/2007
01/11/2008
01/11/2008
01/11/2008
03/08/2012
04/01/2002
07/20/2007
08/08/2007
01/01/2002
06/09/2009
06/18/2009
05/01/1996
01/01/2002
05/24/2002
05/29/2002
11/15/2004
08/19/2004
01/01/2002
01/01/2002
01/01/2002
02/04/2002
01/01/2002
01/01/2006
01/01/2002
01/01/2002
04/11/2006
11/06/2006
04/11/2006
11/06/2006
04/11/2006
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
06/30/2010
07/31/2010
07/31/2010
06/30/2010
08/31/2008
07/31/2010
12/31/2078
05/31/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/28/2011
11/30/2009
07/30/2010
12/31/2078
12/31/2078
12/31/2078
11/30/2012
04/30/2013
04/30/2013
03/31/2012
06/30/2012
12/31/2012
10/31/2009
12/31/2009
12/31/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/06/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/31/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
10/31/2012
12/31/2078
12/31/2078
12/31/2078
04/30/2009
12/31/2078
Page 1 of 1
HCPCS
NDC
J9293
J9293
J9293
J9293
J9293
J9293
J9293
J9293
J9293
J9293
J9293
J9293
J9293
J9293
J9293
J9293
J9300
J9302
J9302
J9303
J9303
J9303
J9305
J9305
J9307
J9310
J9310
J9315
J9320
J9328
J9330
J9340
J9340
J9340
J9340
J9350
J9350
J9350
J9351
J9351
J9351
J9351
J9351
J9355
J9355
J9357
J9357
J9360
J9360
J9370
J9370
J9370
J9370
J9375
J9390
J9390
J9390
J9390
J9390
J9390
J9390
J9390
J9390
J9390
J9390
00703468691
15210040335
15210040336
15210040337
44087152001
44087152501
44087153001
55390008301
55390008401
55390008501
61703034318
61703034365
61703034366
63323013210
63323013212
63323013215
00008451001
00173082101
00173082133
55513095401
55513095501
55513095601
00002762301
00002764001
48818000101
50242005121
50242005306
59572098301
00703463601
00085138101
00008117901
00703430102
00703430301
51927276200
55390003010
00007420101
00007420105
55390037010
00409030201
25021020606
55390037010
63323076210
63323076217
50242005656
50242013468
67979000101
67979000102
55390009110
63323027810
00703440211
00703441211
61703030906
61703030916
00703441211
00703418201
00703418281
00703418291
00703418301
00703418381
00703418391
10019097001
10019097002
55390006901
55390007001
55390026701
12/19/2013
HCPCS Description
INJECTION, MITOXANTRONE HYDROCHLORIDE, PER
INJECTION, MITOXANTRONE HYDROCHLORIDE, PER
INJECTION, MITOXANTRONE HYDROCHLORIDE, PER
INJECTION, MITOXANTRONE HYDROCHLORIDE, PER
INJECTION, MITOXANTRONE HYDROCHLORIDE, PER
INJECTION, MITOXANTRONE HYDROCHLORIDE, PER
INJECTION, MITOXANTRONE HYDROCHLORIDE, PER
INJECTION, MITOXANTRONE HYDROCHLORIDE, PER
INJECTION, MITOXANTRONE HYDROCHLORIDE, PER
INJECTION, MITOXANTRONE HYDROCHLORIDE, PER
INJECTION, MITOXANTRONE HYDROCHLORIDE, PER
INJECTION, MITOXANTRONE HYDROCHLORIDE, PER
INJECTION, MITOXANTRONE HYDROCHLORIDE, PER
INJECTION, MITOXANTRONE HYDROCHLORIDE, PER
INJECTION, MITOXANTRONE HYDROCHLORIDE, PER
INJECTION, MITOXANTRONE HYDROCHLORIDE, PER
INJECTION, GEMTUZUMAB OZOGAMICIN, 5 MG
INJECTION, OFATUMUMAB, 10 MG
INJECTION, OFATUMUMAB, 10 MG
INJECTION, PANITUMUMAB, 10 MG
INJECTION, PANITUMUMAB, 10 MG
INJECTION, PANITUMUMAB, 10 MG
INJECTION, PEMETREXED, 10 MG
INJECTION, PEMETREXED, 10 MG
INJECTION, PRALATREXATE, 1 MG
INJECTION, RITUXIMAB, 100 MG
INJECTION, RITUXIMAB, 100 MG
INJECTION, ROMIDEPSIN, 1 MG
INJECTION, STREPTOZOCIN, 1 GRAM
INJECTION, TEMOZOLOMIDE, 1 MG
INJECTION, TEMSIROLIMUS, 1 MG
INJECTION, THIOTEPA, 15 MG
INJECTION, THIOTEPA, 15 MG
INJECTION, THIOTEPA, 15 MG
INJECTION, THIOTEPA, 15 MG
INJECTION, TOPOTECAN, 4 MG
INJECTION, TOPOTECAN, 4 MG
INJECTION, TOPOTECAN, 4 MG
TOPOTECAN, PER 0.1MG
INJECTION, TOPOTECAN, 0.1 MG
INJECTION, TOPOTECAN, 0.1 MG
INJECTION, TOPOTECAN, 0.1 MG
INJECTION, TOPOTECAN, 0.1 MG
TRASTUZUMAB, 10MG (HERCEPTIN)
INJECTION, TRASTUZUMAB, 10 MG
INJECTION, VALRUBICIN, INTRAVESICAL, 200 MG
INJECTION, VALRUBICIN, INTRAVESICAL, 200 MG
INJECTION, VINBLASTINE SULFATE, 1 MG
INJECTION, VINBLASTINE SULFATE, 1 MG
VINCRISTINE SULFATE, 1 MG
VINCRISTINE SULFATE, 1 MG
VINCRISTINE SULFATE, 1 MG
VINCRISTINE SULFATE, 1 MG
VINCRISTINE SULFATE, 2MG
INJECTION, VINORELBINE TARTRATE, 10 MG
INJECTION, VINORELBINE TARTRATE, 10 MG
INJECTION, VINORELBINE TARTRATE, 10 MG
INJECTION, VINORELBINE TARTRATE, 10 MG
INJECTION, VINORELBINE TARTRATE, 10 MG
INJECTION, VINORELBINE TARTRATE, 10 MG
INJECTION, VINORELBINE TARTRATE, 10 MG
INJECTION, VINORELBINE TARTRATE, 10 MG
INJECTION, VINORELBINE TARTRATE, 10 MG
INJECTION, VINORELBINE TARTRATE, 10 MG
INJECTION, VINORELBINE TARTRATE, 10 MG
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
MG
Earliest Start
Date
11/06/2006
08/14/2006
07/31/2006
08/14/2006
06/11/2003
06/11/2003
06/11/2003
04/11/2006
04/11/2006
04/11/2006
04/11/2006
04/11/2006
04/11/2006
03/17/2006
03/17/2006
03/17/2006
01/01/2002
01/01/2012
01/01/2012
01/01/2008
01/01/2008
01/01/2008
01/01/2005
01/07/2008
10/05/2009
01/01/2002
01/01/2002
01/01/2012
12/03/2003
01/01/2012
06/27/2007
01/01/2002
01/01/2002
09/08/2003
01/01/2002
01/01/2002
01/01/2002
04/18/2011
02/21/2011
12/02/2010
04/18/2011
11/29/2010
11/29/2010
01/01/2006
09/01/2003
10/31/2007
10/31/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2007
02/10/2003
05/01/2006
05/01/2006
02/10/2003
05/01/2006
05/01/2006
12/01/2003
12/01/2003
02/03/2004
02/03/2004
09/21/2005
Latest End
Date
11/30/2008
12/31/2078
12/31/2078
12/31/2078
11/30/2013
12/31/2007
12/31/2007
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/28/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/30/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
05/31/2012
12/31/2078
12/31/2078
12/31/2012
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
J9390
J9390
J9390
J9390
J9390
J9390
J9390
J9390
J9390
J9390
J9390
J9390
J9390
J9395
J9395
J9395
J9600
J9999
J9999
J9999
J9999
J9999
J9999
J9999
J9999
J9999
J9999
J9999
J9999
P9047
Q0138
Q0138
Q0139
Q0139
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
55390026801
60831308601
60831308602
61703034106
61703034109
63323014801
63323014805
64370053201
64370053202
64370308601
64370308602
66758004501
66758004502
00310072010
00310072025
00310072050
58914015575
00015355427
00015355626
00015356415
00703410048
00703410058
00703410068
00703410948
00703410958
00703410968
55390010601
59730560101
67286005308
00944049301
59338077501
59338077510
59338077501
59338077510
00069305107
00069305175
00069306030
00069306075
00069306086
00069307030
00069307075
00069307086
00069308030
00069311019
00069312019
00069313019
00069314019
00069417021
00093714609
00093714618
00093714656
00093714756
00093714823
00093714994
00093716933
00093716956
00185720370
00185720670
00185720969
00185721268
00378153383
00378153459
00378153593
00781149631
00781149668
12/19/2013
Earliest Start
Date
HCPCS Description
INJECTION, VINORELBINE TARTRATE, 10 MG
INJECTION, VINORELBINE TARTRATE, 10 MG
INJECTION, VINORELBINE TARTRATE, 10 MG
INJECTION, VINORELBINE TARTRATE, 10 MG
INJECTION, VINORELBINE TARTRATE, 10 MG
INJECTION, VINORELBINE TARTRATE, 10 MG
INJECTION, VINORELBINE TARTRATE, 10 MG
INJECTION, VINORELBINE TARTRATE, 10 MG
INJECTION, VINORELBINE TARTRATE, 10 MG
INJECTION, VINORELBINE TARTRATE, 10 MG
INJECTION, VINORELBINE TARTRATE, 10 MG
INJECTION, VINORELBINE TARTRATE, 10 MG
INJECTION, VINORELBINE TARTRATE, 10 MG
FULVESTRANT, PER 25MG
INJECTION, FULVESTRANT, 25 MG
INJECTION, FULVESTRANT, 25 MG
INJECTION, PORFIMER SODIUM, 75 MG
NOT OTHERWISE CLASSIFIED, ANTINEOPLASTIC DRUGS
NOT OTHERWISE CLASSIFIED, ANTINEOPLASTIC DRUGS
NOT OTHERWISE CLASSIFIED, ANTINEOPLASTIC DRUGS
NOT OTHERWISE CLASSIFIED, ANTINEOPLASTIC DRUGS
NOT OTHERWISE CLASSIFIED, ANTINEOPLASTIC DRUGS
NOT OTHERWISE CLASSIFIED, ANTINEOPLASTIC DRUGS
NOT OTHERWISE CLASSIFIED, ANTINEOPLASTIC DRUGS
NOT OTHERWISE CLASSIFIED, ANTINEOPLASTIC DRUGS
NOT OTHERWISE CLASSIFIED, ANTINEOPLASTIC DRUGS
NOT OTHERWISE CLASSIFIED, ANTINEOPLASTIC DRUGS
NOT OTHERWISE CLASSIFIED, ANTINEOPLASTIC DRUGS
NOT OTHERWISE CLASSIFIED, ANTINEOPLASTIC DRUGS
HUMAN ALBUMIN 25%, PER 50 ML
FERUMOXYTROL, PER 1MG (NON ESRD)
FERUMOXYTROL, PER 1MG (NON ESRD)
FERUMOXYTROL, PER 1MG (ESRD)
FERUMOXYTROL, PER 1MG (ESRD)
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROYMCIN ORAL, 1GM
AZITHROMYCIN ORAL PER 1GM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER,
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
1
1
1
1
1
1
1
1
1
1
1
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
09/21/2005
12/19/2005
12/19/2005
09/07/2005
11/07/2005
06/22/2005
06/22/2005
06/23/2008
06/23/2008
03/26/2007
03/26/2007
03/05/2008
03/05/2008
10/01/2007
01/01/2004
01/01/2004
01/01/2002
01/01/2002
01/01/2002
01/01/2002
04/08/2002
04/08/2002
04/08/2002
05/01/2006
05/01/2006
05/01/2006
09/01/2004
01/01/2002
06/10/2004
09/30/1990
01/01/2010
01/01/2010
01/01/2010
01/01/2010
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
08/06/2002
08/06/2002
10/21/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
07/11/2005
12/06/2005
11/14/2005
11/14/2005
11/14/2005
01/01/2009
09/22/2008
11/14/2005
11/14/2005
09/21/2006
09/21/2006
09/21/2006
09/21/2006
06/05/2007
06/05/2007
06/05/2007
01/09/2006
11/14/2005
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
06/01/2011
07/01/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2010
12/31/2078
12/31/2078
06/30/2009
06/30/2009
03/31/2009
12/31/2078
12/31/2078
12/31/2078
04/30/2009
10/31/2009
10/31/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
06/28/2013
12/31/2078
06/28/2013
06/28/2013
08/31/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
00781149669
00781149731
00781194131
00781194133
12280005730
12280010930
12280026806
12280026903
13411013101
13411013103
13411013106
13411013109
13411013115
16590024806
16590036206
18837033806
21695001206
23490690401
23490690500
23490690501
23490690502
23490775801
23490776001
23490776002
33358004006
33358004110
33358036701
33358036703
33358036804
33358036830
33358036850
35356001703
35356004415
35356012815
49999009604
49999009606
49999026015
49999058215
49999078606
50111076728
50111078710
50111078752
50111078766
50111078810
50111078852
50111078867
50111078910
50111079120
50111079222
50111079320
51079059101
51079059120
52959031315
52959050506
52959065703
52959065706
52959083806
52959092703
52959093230
54569423000
54569423100
54569423200
54569441700
54569449700
54569452200
12/19/2013
HCPCS Description
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
Earliest Start
Date
11/14/2005
11/14/2005
11/16/2005
11/16/2005
03/21/2005
03/24/2005
03/08/2006
03/08/2006
08/23/2006
06/01/2005
08/23/2006
08/23/2006
08/23/2006
02/01/2006
12/01/2006
04/15/2008
07/19/2007
11/12/2007
04/09/2007
10/11/2007
10/11/2007
02/07/2007
02/07/2007
04/09/2007
07/10/2007
07/10/2007
07/10/2007
07/10/2007
07/10/2007
07/10/2007
07/10/2007
09/14/2007
10/26/2007
03/13/2008
01/27/2006
08/08/2002
07/01/2003
01/27/2006
01/11/2006
07/06/2006
12/15/2005
08/10/2006
12/15/2005
12/15/2005
08/10/2006
12/15/2005
12/15/2005
07/06/2006
07/06/2006
07/06/2006
06/25/2007
06/25/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2006
11/22/2005
04/24/2008
05/23/2008
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
02/29/2012
06/30/2011
03/31/2012
12/31/2078
01/31/2012
12/31/2078
01/31/2012
09/30/2011
02/29/2012
02/29/2012
02/29/2012
07/31/2011
07/31/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
54569452201
54569452202
54569456700
54569544800
54569575400
54569575500
54569575600
54569577100
54569580400
54569580600
54569580700
54569580800
54569580900
54569581000
54868324400
54868364800
54868407600
54868407800
54868407801
54868407802
54868418300
54868464400
54868464401
54868464402
54868540400
54868547100
54868547800
54868547801
54868547802
54868548700
54868548701
54868564700
54868564800
54868564801
54868564802
55045237205
55045237305
55045237306
55045237308
55045249206
55045344206
55045369301
55045369803
55045372501
55045372602
55045372701
55289027402
55289027403
55289031004
55289031006
55289031014
55289096404
55289096414
55887003315
55887031130
55887078506
55887093306
57866044607
57866313601
57866435601
58016008600
58016008630
58016008660
58016008690
58016039100
12/19/2013
HCPCS Description
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
AZITHROMYCIN
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
DIHYDRATE,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
CAPSULES/POWDER,
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
GRAM
Earliest Start
Date
01/01/2002
08/26/2002
01/01/2002
09/09/2002
11/24/2005
11/24/2005
11/24/2005
02/14/2006
06/30/2006
07/24/2006
07/24/2006
07/24/2006
07/24/2006
07/25/2006
06/08/2004
11/16/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
07/26/2002
02/21/2005
06/01/2005
09/02/2005
11/16/2005
11/23/2005
12/13/2005
02/07/2006
12/13/2005
08/10/2007
08/01/2006
08/01/2006
08/01/2006
08/03/2006
01/19/2005
01/19/2005
01/01/2003
01/19/2005
07/03/2006
12/05/2005
12/06/2006
12/26/2006
12/26/2006
12/26/2006
12/26/2006
10/16/2007
04/02/2008
01/01/2002
01/15/2004
01/01/2002
11/01/2005
02/01/2006
04/01/2008
01/01/2007
06/01/2007
01/01/2002
04/15/2002
05/01/2006
03/28/2006
02/01/2006
02/01/2006
02/01/2006
02/01/2006
01/15/2004
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0144
Q0162
Q0162
58016039101
58016039106
58016039110
58016039115
58016039118
58016039120
58016039128
58016039130
58016039160
58016039190
58016481401
58864065504
58864065506
58864065514
58864065530
58864079106
59762305101
59762305102
59762306001
59762306002
59762306003
59762307001
59762307002
59762308001
59762311001
59762312001
59762313001
59762314001
63874024600
63874024604
63874024606
63874024610
63874024615
64679096101
64679096104
64679096105
64679096201
64679096401
64679096403
64679096405
66105050701
66105050703
66105050706
66105050709
66105050710
66105065301
66105065303
66105065305
66105065306
66105065319
66105067001
66105067003
66105067005
66105067006
66105067018
66267092806
66336040005
66336046644
68115036404
68115036450
68115054150
68115093106
68387056506
00093723656
00143242330
12/19/2013
HCPCS Description
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
Earliest Start
Date
04/03/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/15/2004
01/15/2004
12/20/2005
07/01/2005
09/10/2003
02/01/2005
06/01/2006
07/01/2004
07/07/2006
07/07/2006
11/14/2005
11/14/2005
11/14/2005
11/14/2005
11/14/2005
11/14/2005
07/07/2006
07/07/2006
07/07/2006
07/07/2006
03/15/2006
03/15/2006
03/15/2006
03/15/2006
03/15/2006
02/11/2008
02/14/2008
02/11/2008
02/11/2008
02/11/2008
02/14/2008
02/11/2008
08/22/2006
01/01/2006
08/22/2006
08/22/2006
08/22/2006
09/13/2006
09/13/2006
09/13/2006
09/13/2006
09/13/2006
09/13/2006
09/13/2006
09/13/2006
09/13/2006
09/13/2006
01/01/2002
12/03/2007
10/22/2004
10/26/2004
05/04/2005
05/04/2005
01/05/2004
05/01/2006
01/01/2012
01/01/2012
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
00173044600
00173044604
00173044700
00173044702
00173044704
00173048900
00173056900
00173057000
00378031553
00378031593
00378034453
00378034493
00378773293
00378773493
00378773497
00490007500
00490007530
00490007560
00490007590
00781168131
33358036902
33358037002
45802012714
45802012765
45802020514
45802020565
45963053930
49999078330
51079052401
51079052420
51079052501
51079052520
51672409103
52152053830
52152053930
54569587300
54868350800
54868350801
54868350802
54868350900
54868350901
54868350902
54868350903
54868508900
54868508901
54868508902
54868508903
54868508904
54868508905
54868573800
54868574900
54868574901
54868580100
54868580101
54868588700
55045372903
55045381501
55111015313
55111015330
55111015413
55111015430
55111015611
55289055903
55289055905
55289055906
12/19/2013
HCPCS Description
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
ONDANSETRON
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
ANTI-EMETI
Earliest Start
Date
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
08/29/2011
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
07/10/2012
07/10/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
07/31/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/31/2011
12/31/2078
07/31/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
10/01/2008
10/01/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/31/2013
03/31/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
08/31/2013
12/31/2078
08/31/2013
12/31/2078
08/31/2011
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
Earliest Start
Date
Latest End
Date
00071084018 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
04/01/1997
Q0163
00071219517 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
11/18/2003
04/01/1998
Q0163
00071233317 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
11/17/2003
04/01/1997
Q0163
00113037926 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/14/2004
12/31/2078
Q0163
00113043162 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/14/2004
12/31/2078
Q0163
00113046262 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/14/2004
12/31/2078
Q0163
00113047962 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/14/2004
12/31/2078
Q0163
00113047978 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/14/2004
12/31/2078
Q0163
00121048905 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
00121048910 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
00121048920 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
00182049210 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
07/31/2011
Q0163
00182113193 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/03/2002
07/07/2008
Q0163
00182200137 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
04/30/2011
Q0163
00182209116 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
01/31/2010
Q0163
00182209201 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
06/30/2012
Q0163
00182209216 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
03/31/2012
Q0163
00182616837 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
07/31/2011
Q0163
00182616840 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
09/30/2011
HCPCS
NDC
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0162
Q0163
58016008400
58016008410
58016008430
58016008460
58016008490
58016082600
58016082630
58016082660
58016082690
60505038105
62756013001
62756013101
62756024064
62756035664
62756035666
63304045830
63304045930
65862018730
65862018830
66336026803
66336079303
68462010530
68462010630
68462015713
68462015811
68462015813
00071084013
Q0163
12/19/2013
HCPCS Description
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2012
01/01/2002
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
04/01/1997
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
Q0163
00185064801 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
Q0163
00185064810 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
00185064901 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
00185064910 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
00501243104 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
08/02/2006
12/31/2078
Q0163
00536077085 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
00536077097 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
00536359401 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
00536359701 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
00536377206 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
00555005902 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
07/31/2014
Q0163
00555005905 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
07/31/2014
Q0163
00603024018 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
04/30/2009
Q0163
00603024118 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
06/05/2007
12/31/2078
Q0163
00603082354 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
00603082358 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
00603082381 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
07/25/2002
12/31/2078
Q0163
00603082394 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
00603086054 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
00603333721 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
12/16/2002
05/31/2009
Q0163
00603333732 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
05/31/2009
Q0163
00603333821 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
12/16/2002
09/30/2008
Q0163
00603333832 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
09/30/2008
Q0163
00603333921 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/24/2007
12/31/2078
Q0163
00603333932 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
06/05/2007
12/31/2078
Q0163
00603334021 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
04/03/2007
12/31/2078
Q0163
00603334032 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
04/03/2007
12/31/2078
Q0163
00677185601 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/29/2003
05/31/2009
Q0163
00677185610 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/29/2003
05/31/2009
Q0163
00677185701 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
02/14/2003
09/30/2008
Q0163
00677185710 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
02/14/2003
10/31/2008
Q0163
00677185801 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/28/2003
09/30/2008
Q0163
00761091420 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
12/19/2013
01/01/2002
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
Q0163
00904122800 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
Q0163
00904122820 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
00904203524 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
00904203559 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
00904205661 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
00904427451 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
00904517416 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
00904530660 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
00904530661 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/12/2003
12/31/2078
Q0163
00904530680 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
00904530760 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
00904530780 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
00904555159 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
08/13/2002
12/31/2078
Q0163
00927022124 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
00927061634 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
00927061712 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
10135014901 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
10135014910 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
10135014924 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
10135014961 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
11/01/2002
12/31/2078
Q0163
10135015101 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
10135015110 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
10135015124 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
10135015150 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
10135015152 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
10135015157 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
10135015601 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
11/01/2002
12/31/2078
Q0163
10135015610 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
11/01/2002
12/31/2078
Q0163
10135015613 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
10135016613 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
10158004201 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2012
Q0163
10158004302 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2012
Q0163
10158004304 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2012
12/19/2013
01/01/2002
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
Q0163
10158004306 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
Q0163
10267083501 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
10267083504 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
10267083601 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
10267083604 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
10892011265 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
10956075024 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
11/02/2004
12/31/2078
Q0163
10956075048 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
11/02/2004
12/31/2078
Q0163
10956075124 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
11/02/2004
12/31/2078
Q0163
10956075148 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
11/02/2004
12/31/2078
Q0163
11822052710 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/02/2006
12/31/2078
Q0163
11845089601 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
12280006824 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
07/12/2005
12/31/2078
Q0163
12280006830 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
03/21/2005
12/31/2078
Q0163
12280018500 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
06/22/2005
12/31/2078
Q0163
12547017021 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
12547017031 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
12547017033 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
12547017055 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
12547017136 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
12547017137 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
11/17/2003
12/31/2078
Q0163
12547017238 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
12810037926 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
16590007820 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
02/01/2006
12/31/2078
Q0163
16590007920 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
02/01/2006
12/31/2078
Q0163
17714002001 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
17714002010 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
17714002101 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
17714002110 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
17714004201 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
17714004224 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
18837004330 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
11/01/2007
12/31/2078
Q0163
18837021330 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
10/26/2006
12/31/2078
12/19/2013
01/01/2002
12/31/2012
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
Q0163
18837021398 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
Q0163
18837029930 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
02/01/2008
12/31/2078
Q0163
18864021103 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
19458507601 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
19458507602 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
19458916302 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
20254020706 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
20254020710 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
20254020806 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
20254020810 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
21695030430 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
02/01/2007
12/31/2078
Q0163
21695030490 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
09/17/2007
12/31/2078
Q0163
21695050030 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
04/15/2008
12/31/2078
Q0163
23490545501 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
11/30/2007
12/31/2078
Q0163
23490545700 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
11/30/2007
12/31/2078
Q0163
23490545701 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
02/07/2007
12/31/2078
Q0163
23490545702 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
02/07/2007
12/31/2078
Q0163
23490545703 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
02/07/2007
12/31/2078
Q0163
23490545704 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
02/07/2007
12/31/2078
Q0163
23490545705 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
02/07/2007
12/31/2078
Q0163
23490545901 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
02/07/2007
12/31/2078
Q0163
23490545902 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
02/07/2007
12/31/2078
Q0163
23490545903 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
02/07/2007
12/31/2078
Q0163
23490545904 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
02/07/2007
12/31/2078
Q0163
24385037926 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
24385040673 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
24385043126 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
08/03/2009
12/31/2078
Q0163
24385046262 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
24385046278 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
24385047962 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
24385047978 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
30103032254 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
30103072254 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
12/19/2013
10/26/2006
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
Q0163
33358011030 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
Q0163
33358011120 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
07/10/2007
12/31/2078
Q0163
33358011130 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
07/10/2007
12/31/2078
Q0163
37205027062 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
37205027078 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
37205027762 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
37205027778 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
37205056526 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
37205056534 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
41280022059 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
43292055631 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
43292055705 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
43292055719 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
43292055765 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
43292055778 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
47682018232 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2007
12/31/2078
Q0163
47682018247 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
47682018264 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2007
12/31/2078
Q0163
47682084787 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2007
12/31/2078
Q0163
47682085887 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2007
12/31/2078
Q0163
49348004404 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/21/2011
Q0163
49348004410 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
10/27/2011
Q0163
49348004534 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
49348020537 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
49348028208 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
49348056404 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
10/27/2011
Q0163
49483006101 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
49483006110 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
49614014662 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
10/13/2003
12/31/2078
Q0163
49614037926 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2004
12/31/2078
Q0163
49999000300 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
08/12/2004
12/31/2078
Q0163
49999000306 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
07/11/2002
12/31/2078
Q0163
49999000315 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
07/11/2002
12/31/2078
12/19/2013
07/10/2007
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
Q0163
49999000320 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
Q0163
49999000321 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
10/15/2004
12/31/2078
Q0163
49999000324 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
08/08/2002
12/31/2078
Q0163
49999000330 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
07/11/2002
12/31/2078
Q0163
49999000340 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
08/08/2002
12/31/2078
Q0163
49999000360 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
06/02/2005
12/31/2078
Q0163
49999009104 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/07/2003
12/31/2078
Q0163
49999009115 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
03/26/2003
12/31/2078
Q0163
49999009120 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
09/03/2002
12/31/2078
Q0163
49999009130 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/07/2003
12/31/2078
Q0163
49999009160 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/07/2003
12/31/2078
Q0163
49999024704 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/07/2003
12/31/2078
Q0163
50332013208 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
06/01/2007
12/31/2078
Q0163
50486061616 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
12/04/2002
12/31/2078
Q0163
50486061632 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
12/04/2002
12/31/2078
Q0163
50580084310 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
03/26/2004
12/31/2078
Q0163
50580084313 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
04/08/2004
12/31/2078
Q0163
50580084324 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
50580084325 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
07/08/2002
12/31/2078
Q0163
50580084348 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
50580084372 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
51079006601 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
05/31/2013
Q0163
51079006619 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
09/30/2009
Q0163
51079006620 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
05/31/2013
Q0163
51079096701 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
51079096717 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
51079096719 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
11/30/2012
Q0163
51079096720 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
11/30/2012
Q0163
51655008824 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
51655008852 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
51655011324 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
51655011325 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
51655011327 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
12/19/2013
02/24/2005
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
Q0163
51655011380 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
Q0163
51655013354 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
06/22/2005
12/31/2078
Q0163
52297026867 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
06/15/2002
Q0163
52297037926 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2003
Q0163
52297046262 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2003
Q0163
52297052162 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2003
Q0163
52297094810 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2003
Q0163
52959004300 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
06/17/2003
12/31/2078
Q0163
52959004304 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
52959004310 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
52959004315 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
52959004320 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
52959004324 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/12/2003
12/31/2078
Q0163
52959004330 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
52959004350 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
52959004360 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
52959005306 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
52959005310 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
52959005312 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
52959005315 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
52959005320 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
52959005330 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
52959005352 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/24/2005
12/31/2078
Q0163
52959012303 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
52959012306 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
53100012822 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
53100012832 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
53100012851 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
53100012875 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
54569023900 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
54569023901 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
54569023902 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
54569023903 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
12/19/2013
06/22/2005
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
Q0163
54569023908 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
Q0163
54569024100 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
54569024102 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
54569024103 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
54569024105 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
54569350400 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
54569350401 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
54569419700 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
54838013540 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
54838013570 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
54838013580 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
54838015440 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
54838015470 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
54838015480 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
54868002600 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
54868002601 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
54868002604 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
54868002605 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
54868002606 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
54868002607 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
06/29/2006
12/31/2078
Q0163
54868105000 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
54868105001 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
54868105003 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
54868105004 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
54868105005 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
54868105006 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
04/15/2002
12/31/2078
Q0163
54868122700 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
02/23/2006
12/31/2078
Q0163
54868122702 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
10/22/2002
12/31/2078
Q0163
55045112400 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/01/2004
12/31/2078
Q0163
55045112401 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
12/06/2004
12/31/2078
Q0163
55045112402 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
12/06/2004
12/31/2078
Q0163
55045112403 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
12/06/2004
12/31/2078
Q0163
55045112404 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
12/06/2004
12/31/2078
12/19/2013
01/01/2002
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
Q0163
55045112405 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
Q0163
55045112406 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
12/06/2004
12/31/2078
Q0163
55045112407 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
12/06/2004
12/31/2078
Q0163
55045112408 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2003
12/31/2078
Q0163
55045112409 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
12/06/2004
12/31/2078
Q0163
55045112500 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
12/06/2004
12/31/2078
Q0163
55045112501 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
07/01/2004
12/31/2078
Q0163
55045112502 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
02/01/2004
12/31/2078
Q0163
55045112503 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
12/06/2004
12/31/2078
Q0163
55045112504 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2003
12/31/2078
Q0163
55045112505 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/02/2004
12/31/2078
Q0163
55045112506 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2003
12/31/2078
Q0163
55045112508 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2003
12/31/2078
Q0163
55045112509 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
02/01/2004
12/31/2078
Q0163
55045125202 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2003
12/31/2078
Q0163
55045278106 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
07/01/2004
12/31/2078
Q0163
55289010001 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
55289010010 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
55289010015 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
55289010020 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
55289010030 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
55289010040 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
09/09/2002
12/31/2078
Q0163
55289047901 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
55289047910 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
55289047912 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
07/01/2006
12/31/2078
Q0163
55289047915 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
55289047920 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
55289047924 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
55289047930 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
55887088520 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
55887088530 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
04/01/2004
12/31/2078
Q0163
55887097320 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
55887097328 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
04/01/2004
12/31/2078
12/19/2013
01/01/2003
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
Q0163
55887097330 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
Q0163
55966011501 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
55966099805 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
57866359401 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
04/15/2002
12/31/2078
Q0163
57866359402 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
04/15/2002
12/31/2078
Q0163
57866359405 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
04/15/2002
12/31/2078
Q0163
57866359406 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
04/15/2002
12/31/2078
Q0163
57866376201 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
04/15/2002
12/31/2078
Q0163
57866376202 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
04/15/2002
12/31/2078
Q0163
57866376204 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
04/15/2002
12/31/2078
Q0163
57866376205 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
03/22/2006
12/31/2078
Q0163
57896078101 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
08/01/2002
12/31/2078
Q0163
57896078201 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
08/01/2002
12/31/2078
Q0163
58016040800 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
58016040806 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
58016040809 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
58016040810 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
58016040812 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
58016040814 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
58016040815 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
58016040820 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
58016040821 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
58016040824 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2007
12/31/2078
Q0163
58016040825 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2007
12/31/2078
Q0163
58016040828 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
58016040830 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
58016040840 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
58016040860 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
58016040900 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
58016040910 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
58016040912 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
58016040915 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
58016040920 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
12/19/2013
04/01/2004
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
Q0163
58016040921 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
Q0163
58016040924 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
03/26/2002
12/31/2078
Q0163
58016040930 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
58016040940 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2007
12/31/2078
Q0163
58016040960 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
08/01/2006
12/31/2078
Q0163
58016040990 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
08/01/2006
12/31/2078
Q0163
58864016230 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
58864016256 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
03/01/2004
12/31/2078
Q0163
58864016330 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
59390006535 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
59390006546 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
59390006547 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
59618019933 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
59618020006 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
59741011904 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
59741011908 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
59741011916 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
59741011920 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
60242020201 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
07/06/2007
12/31/2078
Q0163
60242020210 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
07/06/2007
12/31/2078
Q0163
60432003304 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
05/31/2008
Q0163
60432003308 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
05/31/2008
Q0163
60432003316 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
09/30/2008
Q0163
60760033030 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
63629134301 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
11/01/2004
12/31/2078
Q0163
63629134302 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
11/01/2004
12/31/2078
Q0163
63629134303 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
11/01/2004
12/31/2078
Q0163
63629134304 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
11/01/2004
12/31/2078
Q0163
63629134901 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
11/01/2004
12/31/2078
Q0163
63629134902 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
11/01/2004
12/31/2078
Q0163
63629134903 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
11/01/2004
12/31/2078
Q0163
63868008701 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
63868008724 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
12/19/2013
01/01/2007
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
Q0163
63868050001 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
Q0163
63868061132 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
63868061232 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
04/01/2006
12/31/2078
Q0163
63868075124 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
04/15/2003
12/31/2078
Q0163
63868078924 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
11/01/2003
12/31/2078
Q0163
63868082354 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
63868099524 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
09/12/2003
12/31/2078
Q0163
63874000501 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
63874000502 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
63874000506 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/10/2004
12/31/2078
Q0163
63874000509 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/10/2004
12/31/2078
Q0163
63874000510 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/10/2004
12/31/2078
Q0163
63874000512 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/10/2004
12/31/2078
Q0163
63874000514 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/10/2004
12/31/2078
Q0163
63874000515 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
63874000520 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
63874000521 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/10/2004
12/31/2078
Q0163
63874000524 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/10/2004
12/31/2078
Q0163
63874000525 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/10/2004
12/31/2078
Q0163
63874000528 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/10/2004
12/31/2078
Q0163
63874000530 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
63874000540 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/10/2004
12/31/2078
Q0163
63874000545 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/10/2004
12/31/2078
Q0163
63874000560 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/10/2004
12/31/2078
Q0163
63874000590 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/10/2004
12/31/2078
Q0163
63874000601 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
63874000602 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
63874000607 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/10/2004
12/31/2078
Q0163
63874000610 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/10/2004
12/31/2078
Q0163
63874000612 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/10/2004
12/31/2078
Q0163
63874000614 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/10/2004
12/31/2078
Q0163
63874000615 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
63874000620 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
12/19/2013
01/01/2002
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
Q0163
63874000625 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
Q0163
63874000628 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/10/2004
12/31/2078
Q0163
63874000630 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
63874000660 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/10/2004
12/31/2078
Q0163
65162015610 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
09/01/2004
12/31/2078
Q0163
65162015611 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
09/01/2004
12/31/2078
Q0163
65162051610 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
09/01/2004
03/31/2011
Q0163
65162051611 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
09/01/2004
02/28/2011
Q0163
65162051810 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
09/01/2004
01/31/2011
Q0163
65162051811 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
09/01/2004
04/30/2011
Q0163
66267008015 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
66267008020 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
04/05/2002
12/31/2078
Q0163
66267008030 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
66267008060 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
66267008115 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
66267008120 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
04/05/2002
12/31/2078
Q0163
66267008130 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
66267008160 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
09/04/2002
12/31/2078
Q0163
66267097704 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
66336004506 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
10/22/2004
12/31/2078
Q0163
66336004515 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
10/22/2004
12/31/2078
Q0163
66336004520 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
04/01/2010
12/31/2078
Q0163
66336004530 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
11/23/2003
12/31/2078
Q0163
66336004560 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
11/23/2003
12/31/2078
Q0163
66336004590 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
04/01/2010
12/31/2078
Q0163
66336058915 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
66336058920 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
10/22/2004
12/31/2078
Q0163
66336058930 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
10/22/2004
12/31/2078
Q0163
66336058960 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
10/22/2004
12/31/2078
Q0163
66375010702 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
66375010802 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
68115011600 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
03/17/2004
12/31/2078
Q0163
68115011610 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
03/17/2004
12/31/2078
12/19/2013
05/10/2004
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
Q0163
68115011612 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
Q0163
68115011615 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
10/01/2003
12/31/2078
Q0163
68115011620 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
03/17/2004
12/31/2078
Q0163
68115011624 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
10/26/2004
12/31/2078
Q0163
68115011630 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
10/01/2003
12/31/2078
Q0163
68115011660 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
03/17/2004
12/31/2078
Q0163
68115011706 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
03/29/2004
12/31/2078
Q0163
68115011715 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
10/01/2003
12/31/2078
Q0163
68115011720 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/05/2004
12/31/2078
Q0163
68115011730 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
10/01/2003
12/31/2078
Q0163
68115097604 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/20/2004
12/31/2078
Q0163
68387054130 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
05/01/2006
12/31/2078
Q0163
74300000133 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
74300000610 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
74300000611 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0163
75137021215 DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRE
01/01/2002
12/31/2078
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
00093964301
00182821089
00378510501
00555052102
00781502001
21695057130
23490651201
23490651202
33358029920
33358029930
49884054901
51079054101
51079054119
51079054120
51655009387
51991019601
54569035000
54569035005
54868472100
54868472101
54868472102
54868472103
55045169602
55289056810
55289056812
55289056830
55887039530
57866629901
57866629902
58016032600
58016032612
58016032630
58016032660
58016032690
01/01/2002
01/01/2002
01/01/2002
04/29/2004
01/01/2002
08/22/2008
02/07/2007
02/07/2007
07/10/2007
07/10/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
06/22/2005
10/23/2002
06/26/2002
01/01/2002
02/10/2003
04/08/2003
06/09/2005
06/04/2007
12/06/2004
07/01/2005
10/01/2002
11/15/2007
04/01/2004
04/15/2002
10/01/2003
03/01/2007
09/15/2003
03/01/2007
03/01/2007
03/01/2007
12/31/2078
10/11/2007
12/31/2078
03/31/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/31/2008
12/31/2078
12/31/2078
01/31/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/19/2013
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
PRESCRIP
05/01/2005
12/31/2078
Page 1 of 1
HCPCS
NDC
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0164
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
58864070201
58864070215
59746011306
59746011310
63629184101
66336043406
66336043410
66993080502
68115030010
00093965201
00172369160
00182821189
00378511001
00555052202
00555052204
00781502101
16590032710
21695057230
23490650903
33358030010
33358030020
33358030030
33358030060
35356032500
38779018004
38779018005
38779018008
49452605301
49452605302
49452605303
49452605305
49452605904
49884055001
51079054201
51079054220
51552007405
51552007409
51655029489
51927213400
51927348900
51991019701
52959039115
52959047602
52959047610
52959047615
52959047620
52959047624
52959047630
52959047660
54569035101
54569035500
54569035502
54868108200
54868108201
54868108202
54868108203
54868108204
54868108205
54868108206
54888108203
55045112602
55045112603
55045112604
55045112606
55045112607
12/19/2013
HCPCS Description
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
PROCHLORPERAZINE
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
MALEATE,
5 MG, ORAL, FDA APPROVED PRESCRIP
5 MG, ORAL, FDA APPROVED PRESCRIP
5 MG, ORAL, FDA APPROVED PRESCRIP
5 MG, ORAL, FDA APPROVED PRESCRIP
5 MG, ORAL, FDA APPROVED PRESCRIP
5 MG, ORAL, FDA APPROVED PRESCRIP
5 MG, ORAL, FDA APPROVED PRESCRIP
5 MG, ORAL, FDA APPROVED PRESCRIP
5 MG, ORAL, FDA APPROVED PRESCRIP
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
10 MG, ORAL, FDA APPROVED PRESCRI
Earliest Start
Date
06/15/2006
03/01/2004
01/01/2002
01/01/2002
11/01/2004
10/22/2004
08/18/2005
02/14/2003
01/05/2004
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/07/2002
07/11/2002
01/01/2002
04/01/2007
07/24/2007
11/30/2007
07/10/2007
07/10/2007
07/10/2007
07/10/2007
08/01/2008
03/08/2002
01/01/2002
01/01/2002
02/13/2002
02/13/2002
02/13/2002
04/01/2005
02/13/2002
01/01/2002
01/01/2002
01/01/2002
09/01/2003
09/01/2003
06/22/2005
09/08/2003
09/08/2003
10/23/2002
01/01/2002
08/09/2005
01/01/2002
01/01/2002
01/01/2002
10/27/2004
11/22/2004
11/22/2004
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/29/2004
06/03/2005
08/24/2007
02/10/2005
06/09/2005
04/16/2007
10/20/2004
04/01/2005
07/01/2003
01/01/2003
11/10/2005
07/01/2005
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2009
12/31/2078
12/31/2078
10/17/2007
09/22/2007
12/31/2078
12/31/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
Earliest Start
Date
Latest End
Date
00004024133 GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIP
01/01/2002
12/31/2078
Q0166
00093748512 GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIP
01/02/2008
12/31/2078
Q0166
00093748520 GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIP
01/02/2008
12/31/2078
Q0166
00378100394 GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIP
01/30/2007
11/30/2012
Q0166
00555057651 GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIP
03/17/2008
12/31/2078
Q0166
00555057693 GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIP
03/17/2008
12/31/2078
Q0166
16714022130 GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIP
05/15/2008
12/31/2020
Q0166
16714022132 GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIP
05/15/2008
12/31/2020
Q0166
51079047201 GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIP
03/03/2008
11/30/2012
HCPCS
NDC
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0165
Q0166
55045112608
55289022404
55289022406
55289022412
55887061930
57866629801
58016070600
58016070602
58016070603
58016070608
58016070630
58016070660
58016070690
58864064442
59746011506
59746011510
62991112202
62991112204
63370019825
63370019835
63370019845
63629133501
63629133502
63629133503
63874049001
63874049006
63874049008
63874049010
63874049012
63874049015
63874049020
63874049028
63874049030
63874049060
66336092115
66336092160
66993081002
66993081005
68115029800
68115029804
68115029812
68115029815
68115029830
68115029860
68115029890
00004024126
Q0166
12/19/2013
HCPCS Description
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
PROCHLORPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRI
GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIP
07/01/2003
05/21/2002
03/07/2008
04/02/2008
04/01/2004
04/15/2002
09/23/2004
09/23/2004
09/23/2004
01/01/2007
09/23/2004
09/23/2004
09/23/2004
03/01/2004
01/01/2002
01/01/2002
01/01/2002
09/15/2003
12/19/2003
12/19/2003
12/19/2003
11/01/2004
11/01/2004
11/01/2004
05/10/2004
05/10/2004
05/10/2004
05/10/2004
05/10/2004
05/10/2004
05/10/2004
05/10/2004
05/10/2004
05/10/2004
12/03/2007
05/29/2008
02/14/2003
02/14/2003
07/27/2006
07/27/2006
05/11/2004
07/27/2006
07/27/2006
07/01/2005
07/27/2006
01/01/2002
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
09/30/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
Q0166
51079047205 GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIP
Q0166
54868413900 GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIP
06/03/2005
12/31/2078
Q0166
54868413901 GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIP
06/28/2005
12/31/2078
Q0166
54868413902 GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIP
09/07/2005
12/31/2078
Q0166
54868413903 GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIP
10/14/2005
12/31/2078
Q0166
54868413904 GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIP
09/22/2005
12/31/2078
Q0166
54868413905 GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIP
01/05/2006
12/31/2078
Q0166
54868413906 GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIP
06/07/2006
12/31/2078
Q0166
63717080130 GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIP
03/03/2008
12/31/2078
Q0166
64720019802 GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIP
12/29/2007
11/30/2011
Q0166
64720019898 GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIP
12/29/2007
11/30/2011
Q0166
67253041712 GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIP
05/15/2008
12/31/2078
Q0166
67253041722 GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIP
05/15/2008
12/31/2078
Q0167
Q0167
Q0167
Q0167
Q0167
Q0168
Q0168
Q0168
Q0168
Q0168
Q0168
Q0168
Q0168
Q0168
Q0168
Q0168
Q0169
Q0169
Q0169
Q0169
Q0169
Q0169
Q0169
Q0169
Q0169
Q0169
Q0169
Q0169
Q0169
Q0169
Q0169
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
00051002121
54569578900
54868308400
54868308401
54868308402
00051002221
00051002321
54868318900
54868318901
54868318902
54868318903
58016095100
58016095130
58016095160
58016095190
68115069225
00115104001
00406204001
00603543721
10702000201
33358041830
49999090220
52959091430
54868072100
55289094802
63629159101
63629159102
63629159103
63629159104
68382004001
68382004010
00115104101
00115104103
00115104201
00406204101
00406204110
00406204201
00463615610
00591530701
00591530710
01/01/2002
04/26/2006
01/01/2002
02/11/2004
01/27/2006
08/14/2006
01/01/2002
06/07/2005
01/30/2006
02/07/2006
06/06/2006
04/01/2004
04/01/2004
04/01/2004
04/01/2004
03/29/2004
02/12/2008
09/12/2006
08/25/2006
05/10/2007
07/24/2007
01/11/2007
11/26/2007
01/01/2002
05/09/2006
11/01/2004
11/01/2004
11/01/2004
11/01/2004
12/01/2005
02/27/2007
02/12/2008
04/01/2008
05/20/2008
09/12/2006
07/15/2007
09/12/2006
01/01/2002
04/15/2002
04/15/2002
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/19/2013
DRONABINOL, 2.5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
DRONABINOL, 2.5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
DRONABINOL, 2.5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
DRONABINOL, 2.5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
DRONABINOL, 2.5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
DRONABINOL, 5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
DRONABINOL, 5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
DRONABINOL, 5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
DRONABINOL, 5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
DRONABINOL, 5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
DRONABINOL, 5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
DRONABINOL, 5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
DRONABINOL, 5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
DRONABINOL, 5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
DRONABINOL, 5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
DRONABINOL, 5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETI
PROMETHAZINE HYDROCHLORIDE, 12.5 MG, ORAL, FDA APPROVED PRES
PROMETHAZINE HYDROCHLORIDE, 12.5 MG, ORAL, FDA APPROVED PRES
PROMETHAZINE HYDROCHLORIDE, 12.5 MG, ORAL, FDA APPROVED PRES
PROMETHAZINE HYDROCHLORIDE, 12.5 MG, ORAL, FDA APPROVED PRES
PROMETHAZINE HYDROCHLORIDE, 12.5 MG, ORAL, FDA APPROVED PRES
PROMETHAZINE HYDROCHLORIDE, 12.5 MG, ORAL, FDA APPROVED PRES
PROMETHAZINE HYDROCHLORIDE, 12.5 MG, ORAL, FDA APPROVED PRES
PROMETHAZINE HYDROCHLORIDE, 12.5 MG, ORAL, FDA APPROVED PRES
PROMETHAZINE HYDROCHLORIDE, 12.5 MG, ORAL, FDA APPROVED PRES
PROMETHAZINE HYDROCHLORIDE, 12.5 MG, ORAL, FDA APPROVED PRES
PROMETHAZINE HYDROCHLORIDE, 12.5 MG, ORAL, FDA APPROVED PRES
PROMETHAZINE HYDROCHLORIDE, 12.5 MG, ORAL, FDA APPROVED PRES
PROMETHAZINE HYDROCHLORIDE, 12.5 MG, ORAL, FDA APPROVED PRES
PROMETHAZINE HYDROCHLORIDE, 12.5 MG, ORAL, FDA APPROVED PRES
PROMETHAZINE HYDROCHLORIDE, 12.5 MG, ORAL, FDA APPROVED PRES
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
03/03/2008
11/30/2012
Page 1 of 1
HCPCS
NDC
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
00591531901
00603158454
00603158458
00603543821
00603543832
00603543921
00781183001
00781183010
00781183201
00904584061
10544034320
10544034330
10702000301
10702000310
10702000401
16590019110
16590019115
16590019120
16590019130
16590019160
16590019190
18837012710
18837012730
18837012745
18837012760
18837012790
21695045310
21695045315
21695045320
21695045325
21695070304
23490618301
23490618302
23490618303
23490618304
23490618306
23490618307
23490618308
23490618701
33358030208
33358030210
33358030230
33358030260
49999009005
49999009010
49999009012
49999009015
49999009020
49999009030
49999009060
49999026204
49999059430
49999059490
50383080116
51079089501
51079089520
51655008427
51655008453
52959080404
52959080408
54569104600
54569175400
54569175401
54569175405
54569175406
12/19/2013
HCPCS Description
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
Earliest Start
Date
04/15/2002
05/12/2006
05/12/2006
08/25/2006
08/25/2006
08/25/2006
01/01/2002
01/01/2002
01/01/2002
05/06/2008
01/11/2008
01/21/2008
01/16/2007
01/16/2007
01/16/2007
04/01/2007
02/01/2006
06/01/2006
02/01/2006
02/01/2006
02/01/2006
08/01/2007
09/01/2006
09/01/2006
09/01/2006
09/01/2006
04/01/2007
01/15/2008
04/01/2007
04/01/2007
03/14/2008
02/07/2007
02/07/2007
02/07/2007
04/09/2007
11/30/2007
03/12/2008
03/12/2008
11/30/2007
07/10/2007
07/10/2007
07/10/2007
07/10/2007
04/15/2005
06/05/2002
05/07/2003
12/01/2003
10/15/2003
04/15/2005
02/10/2004
07/01/2003
06/06/2005
05/23/2005
03/01/2004
02/01/2007
03/14/2005
01/01/2002
06/22/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
12/07/2007
07/02/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
54569175408
54569175409
54569416800
54868132300
54868132301
54868132302
54868132304
54868132305
54868132306
54868132307
54868132308
54868186700
54868284400
54868284401
55045159600
55045159601
55045159602
55045159603
55045159604
55045159605
55045159606
55045159608
55045159609
55045164309
55289046415
55289046479
55289053104
55887067504
55887093610
55887093612
55887093615
55887093620
55887093625
55887093628
55887093630
55887093660
55887093690
57866021501
57866432803
57866437901
57866437902
57866437904
57866437906
57866437907
57866437908
58016042400
58016042402
58016042403
58016042410
58016042412
58016042415
58016042420
58016042430
58016042440
58016042448
58016042450
58016042460
58016042473
58016042489
58016042490
58016400801
58864076110
58864076130
58864076142
60432060804
12/19/2013
HCPCS Description
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
PROMETHAZINE
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
HYDROCHLORIDE,
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
PRESC
Earliest Start
Date
11/12/2004
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
06/15/2005
09/21/2005
01/01/2002
01/01/2002
04/21/2008
12/06/2004
12/06/2004
08/09/2004
01/01/2003
02/09/2003
01/01/2003
01/01/2003
01/01/2004
12/06/2004
01/01/2003
12/01/2003
02/01/2005
02/26/2008
04/01/2004
07/01/2003
07/01/2003
04/01/2004
07/01/2003
01/01/2006
07/01/2003
07/01/2003
01/01/2005
01/01/2005
02/01/2004
10/01/2003
11/01/2005
04/15/2002
04/15/2002
01/02/2006
01/02/2006
04/11/2006
01/01/2002
09/15/2003
09/15/2003
03/26/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2007
01/01/2007
01/01/2002
07/13/2003
09/15/2003
09/15/2003
09/15/2003
01/01/2002
08/01/2004
05/01/2004
08/01/2004
01/01/2002
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
Earliest Start
Date
Latest End
Date
35356009890 CHLORPROMAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRES
02/29/2008
12/31/2078
Q0172
54868230200 CHLORPROMAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRES
01/01/2002
12/31/2078
Q0172
54868230202 CHLORPROMAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRES
01/01/2002
12/31/2078
Q0172
54868234700 CHLORPROMAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRES
01/01/2002
12/31/2078
Q0172
54868246400 CHLORPROMAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRES
01/01/2002
12/31/2078
Q0172
54868246402 CHLORPROMAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRES
08/08/2007
12/31/2078
Q0173
16590024010 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
02/01/2006
12/31/2078
Q0173
16590024020 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
02/01/2006
12/31/2078
Q0173
20254001801 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
01/01/2002
12/31/2078
Q0173
20254001803 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
01/01/2002
12/31/2078
Q0173
33358035210 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
07/10/2007
12/31/2078
HCPCS
NDC
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0170
Q0171
60432060816
60760083020
63629174201
63629174202
63629174203
63629174204
63629187001
63629187002
63739021310
63739021315
63874037001
63874037008
63874037010
63874037012
63874037015
63874037020
63874037024
63874037030
63874037040
63874037060
63874071212
66336008510
66336008512
66336008520
66336008525
66336008530
66336008560
68084015601
68115030200
68115030204
68115030210
68115030220
68115030230
68115030260
68115030290
68115059804
68382004101
68382004110
68387053612
68387053630
68387053660
68387053690
54868268401
Q0172
12/19/2013
HCPCS Description
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
PROMETHAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVED PRESC
CHLORPROMAZINE HYDROCHLORIDE, 10 MG, ORAL, FDA APPROVED PRE
01/01/2002
06/01/2005
11/01/2004
11/01/2004
11/01/2004
11/01/2004
11/01/2004
11/01/2004
02/27/2007
03/01/2006
05/07/2004
05/07/2004
05/07/2004
05/07/2004
05/07/2004
05/07/2004
05/07/2004
05/07/2004
05/07/2004
03/02/2006
01/01/2002
10/22/2004
10/22/2004
05/29/2008
05/29/2008
10/22/2004
05/29/2008
09/08/2006
07/27/2006
07/27/2006
10/26/2004
06/25/2004
10/01/2003
11/10/2004
07/27/2006
10/26/2004
12/01/2005
02/27/2007
03/08/2006
05/01/2006
05/04/2007
05/01/2006
02/01/2007
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
01/01/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
Q0173
33358035220 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
Q0173
51655052353 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
01/01/2002
12/31/2078
Q0173
51991062501 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
01/01/2002
12/31/2078
Q0173
52152016602 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
01/01/2002
12/31/2078
Q0173
52152018502 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
08/22/2003
12/31/2078
Q0173
52959047910 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
01/01/2002
12/31/2078
Q0173
52959047912 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
01/01/2002
12/31/2078
Q0173
52959047920 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
01/01/2002
12/31/2078
Q0173
52959047930 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
01/01/2002
12/31/2078
Q0173
52959081710 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
10/04/2005
12/31/2078
Q0173
53489037601 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
08/29/2003
12/31/2078
Q0173
54569558900 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
08/26/2004
12/31/2078
Q0173
54569558901 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
09/02/2005
12/31/2078
Q0173
54868518100 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
11/18/2004
12/31/2078
Q0173
54868574100 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
01/05/2007
12/31/2078
Q0173
55045162803 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
01/01/2003
12/31/2078
Q0173
55045320303 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
05/01/2005
12/31/2078
Q0173
55289021920 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
01/01/2002
12/31/2078
Q0173
55289042817 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
01/01/2002
12/31/2078
Q0173
55289095306 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
05/09/2006
12/31/2078
Q0173
55887008106 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
04/01/2007
12/31/2078
Q0173
58016097300 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
01/01/2002
12/31/2078
Q0173
58016097302 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
09/15/2003
12/31/2078
Q0173
58016097303 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
09/15/2003
12/31/2078
Q0173
58016097308 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
01/01/2002
12/31/2078
Q0173
58016097310 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
09/15/2003
12/31/2078
Q0173
58016097312 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
01/01/2002
12/31/2078
Q0173
58016097315 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
01/01/2002
12/31/2078
Q0173
58016097320 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
01/01/2002
12/31/2078
Q0173
58016097324 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
01/01/2002
12/31/2078
Q0173
58016097330 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
01/01/2002
12/31/2078
Q0173
58016097350 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
01/01/2002
12/31/2078
Q0173
58016097360 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
09/15/2003
12/31/2078
12/19/2013
07/10/2007
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
Q0173
58016097373 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
Q0173
58016097389 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
09/15/2003
12/31/2078
Q0173
58016097390 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
09/15/2003
12/31/2078
Q0173
61570007901 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
02/13/2002
12/31/2078
Q0173
66267020810 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
01/01/2002
12/31/2078
Q0173
66267020820 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
01/01/2002
12/31/2078
Q0173
66336062910 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
04/01/2010
12/31/2078
Q0173
68115033920 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
10/01/2003
12/31/2078
Q0173
68115058800 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250 MG, ORAL, FDA APPROVED
06/25/2004
12/31/2078
Q0174
Q0174
Q0175
Q0175
Q0175
Q0175
Q0175
Q0175
Q0175
Q0175
Q0175
Q0175
Q0175
Q0175
Q0175
Q0175
Q0175
Q0175
Q0175
Q0175
Q0175
Q0175
Q0175
Q0175
Q0175
Q0175
Q0175
Q0176
Q0176
Q0176
Q0176
Q0176
Q0176
Q0176
Q0176
Q0176
Q0176
Q0176
Q0176
Q0176
Q0176
Q0176
Q0176
Q0176
Q0176
Q0176
Q0176
Q0176
54868196300
54868196301
00172366760
00172366860
00490009100
00490009130
00490009160
00490009190
00603509021
00603509028
00603509121
00603509128
00781104601
00781104610
00781104613
00781104701
00781104710
00781104713
12280027630
12280027660
12280027690
21695041460
54868268600
57866413201
57866413202
57866413203
60429015360
00172366960
00172367060
00603509221
00603509228
00603509321
00781104801
00781104810
00781104813
00781104901
00781104913
12280027730
12280027760
12280027790
21695041560
35356009660
54868268701
54868268702
57866413301
57866413302
57866413303
60429015460
02/11/2003
02/11/2003
01/01/2002
01/01/2002
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
03/21/2006
03/21/2006
03/21/2006
04/01/2007
01/01/2002
04/15/2002
04/15/2002
04/15/2002
10/22/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
03/21/2006
03/21/2006
03/21/2006
06/27/2007
02/29/2008
01/01/2002
06/12/2007
04/15/2002
04/15/2002
04/15/2002
10/22/2002
12/31/2078
12/31/2078
11/30/2008
10/30/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2013
11/30/2013
12/31/2013
10/31/2013
12/31/2078
09/30/2005
12/31/2078
12/31/2078
10/31/2005
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2013
06/30/2013
12/31/2013
12/31/2078
11/30/2005
12/31/2078
12/31/2078
01/31/2004
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/19/2013
THIETHYLPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRIP
THIETHYLPERAZINE MALEATE, 10 MG, ORAL, FDA APPROVED PRESCRIP
PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EME
PERPHENAZINE, 8MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMET
PERPHENAZINE, 8MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMET
PERPHENAZINE, 8MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMET
PERPHENAZINE, 8MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMET
PERPHENAZINE, 8MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMET
PERPHENAZINE, 8MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMET
PERPHENAZINE, 8MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMET
PERPHENAZINE, 8MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMET
PERPHENAZINE, 8MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMET
PERPHENAZINE, 8MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMET
PERPHENAZINE, 8MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMET
PERPHENAZINE, 8MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMET
PERPHENAZINE, 8MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMET
PERPHENAZINE, 8MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMET
PERPHENAZINE, 8MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMET
PERPHENAZINE, 8MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMET
PERPHENAZINE, 8MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMET
PERPHENAZINE, 8MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMET
PERPHENAZINE, 8MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMET
PERPHENAZINE, 8MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMET
PERPHENAZINE, 8MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMET
09/15/2003
12/31/2078
Page 1 of 1
HCPCS
NDC
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
00069541066
00069544093
00069544097
00185061301
00185061305
00555032302
00555032304
00591080001
00591080005
10544032830
12280020504
16590035709
16590035712
16590035720
16590035730
21695057320
21695057330
23490573301
23490573302
33358018220
33358018230
51079007701
51079007720
51655053352
52959043310
52959043315
52959043320
52959043330
52959043340
52959043360
54569235305
54868016901
54868289200
54868289202
54868289203
54868289204
55045219502
55045219504
55045219505
55045219506
55045219507
55045219508
55045219509
55289022610
55289022615
55887042230
55887042260
57866389301
57866389302
57866389303
58016025900
58016025902
58016025910
58016025920
58016025930
58016025950
58016025960
58016025990
62927062104
62927062116
63629153301
63629153302
63629185601
63629185602
63874044202
12/19/2013
HCPCS Description
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
Earliest Start
Date
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/18/2006
09/18/2006
01/01/2008
06/29/2005
05/01/2006
05/01/2006
05/01/2006
05/01/2006
08/14/2008
08/14/2008
02/07/2007
02/07/2007
07/10/2007
07/10/2007
11/26/2007
01/01/2002
06/22/2005
06/06/2002
02/28/2002
12/27/2004
10/17/2002
01/01/2002
12/27/2004
01/01/2002
01/01/2002
01/01/2002
01/01/2002
09/19/2005
10/11/2005
12/06/2004
07/01/2004
03/24/2003
12/06/2004
03/01/2004
02/01/2004
12/06/2004
01/01/2002
03/06/2008
04/01/2004
03/23/2007
04/15/2002
04/15/2002
04/15/2002
01/01/2002
01/01/2007
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2007
01/01/2002
01/01/2002
11/01/2004
11/01/2004
11/01/2004
11/01/2004
05/11/2004
Latest End
Date
12/31/2078
12/01/2009
03/01/2008
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0177
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
63874044203
63874044204
63874044205
63874044209
63874044210
63874044214
63874044215
63874044220
63874044225
63874044228
63874044230
63874044240
63874044245
63874044260
63874044290
66336020820
66336020830
68115017700
68115017730
68115017760
00069542066
00185061501
00185061505
00555030202
00555030204
00555032402
00591080101
00591080105
38779022804
38779022805
49452365901
49452365902
49999003612
49999003660
51079007801
51079007820
51552097904
51927231600
52959083306
52959083320
54569257101
54868185400
54868185401
54868185403
54868185404
54868410900
55045166100
55045166101
55045166102
55045166103
55045166106
55045166108
55045166109
55289035410
57866389401
57866389402
57866389403
58016046410
58016046415
58016046420
58016046430
63874075701
63874075704
63874075710
63874075715
12/19/2013
HCPCS Description
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
HYDROXYZINE
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
PAMOATE,
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
25
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
50
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
MG,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
ORAL,
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
FDA
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
APPROVED
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
PRESCRIPTION
Earliest Start
Date
05/11/2004
05/11/2004
05/11/2004
05/11/2004
05/11/2004
05/11/2004
05/11/2004
05/11/2004
05/11/2004
05/11/2004
05/11/2004
05/11/2004
05/11/2004
05/11/2004
05/11/2004
10/22/2004
10/22/2004
05/05/2004
03/17/2004
10/01/2003
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/10/2002
01/01/2002
10/15/2004
07/01/2002
11/26/2007
01/01/2002
09/01/2003
09/08/2003
10/14/2005
10/14/2005
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
12/06/2004
12/06/2004
12/06/2004
09/01/2004
09/01/2004
06/01/2003
12/06/2004
10/01/2002
04/15/2002
04/15/2002
04/15/2002
01/01/2002
01/01/2002
01/01/2002
01/01/2002
01/15/2006
01/15/2006
01/15/2006
01/15/2006
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
Earliest Start
Date
Latest End
Date
00093730165 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
07/03/2007
01/31/2013
Q0179
00093730203 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
07/03/2007
11/30/2012
Q0179
00093730265 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
07/03/2007
11/30/2012
Q0179
00143242330 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
02/26/2008
12/31/2078
Q0179
00173044600 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
01/01/2002
12/31/2078
Q0179
00173044602 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
01/01/2002
11/30/2013
Q0179
00173044604 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
01/01/2002
12/31/2078
Q0179
00173044700 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
01/01/2002
12/31/2078
Q0179
00173044702 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
01/01/2002
07/31/2013
Q0179
00173044704 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
01/01/2002
12/31/2078
Q0179
00173048900 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
01/01/2002
12/31/2078
Q0179
00173056900 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
01/01/2002
12/31/2078
Q0179
00173057000 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
01/01/2002
12/31/2078
Q0179
00173057004 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
01/01/2002
08/31/2011
Q0179
00378031553 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/27/2007
07/31/2011
Q0179
00378031593 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/27/2007
12/31/2078
Q0179
00378034453 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/27/2007
07/31/2011
Q0179
00378034493 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/27/2007
12/31/2078
Q0179
00378773293 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/25/2007
12/31/2078
Q0179
00378773493 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/25/2007
12/31/2078
Q0179
00378773497 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/25/2007
12/31/2078
Q0179
00490007500 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
01/01/2007
12/31/2078
Q0179
00490007530 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
01/01/2007
12/31/2078
Q0179
00490007560 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
01/01/2007
12/31/2078
Q0179
00490007590 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
01/01/2007
12/31/2078
Q0179
00781168131 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
01/13/2009
12/31/2078
Q0179
00781523864 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL
12/29/2008
12/31/2078
HCPCS
NDC
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0178
Q0179
63874075720
63874075721
63874075724
63874075728
63874075730
63874075760
63874075790
68115017820
68387046830
68387046930
00093723656
Q0179
12/19/2013
HCPCS Description
HYDROXYZINE PAMOATE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION
HYDROXYZINE PAMOATE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION
HYDROXYZINE PAMOATE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION
HYDROXYZINE PAMOATE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION
HYDROXYZINE PAMOATE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION
HYDROXYZINE PAMOATE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION
HYDROXYZINE PAMOATE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION
HYDROXYZINE PAMOATE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION
HYDROXYZINE PAMOATE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION
HYDROXYZINE PAMOATE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION
ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
01/15/2006
01/15/2006
01/15/2006
01/15/2006
01/15/2006
01/15/2006
01/15/2006
01/05/2004
03/01/2007
03/01/2007
08/01/2007
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
Q0179
00781525713 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
Q0179
00781525731 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
12/27/2006
01/31/2013
Q0179
00781525733 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
12/27/2006
03/31/2011
Q0179
00781525813 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
12/27/2006
09/30/2011
Q0179
00781525831 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
12/27/2006
02/28/2013
Q0179
00781525833 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
12/27/2006
08/31/2011
Q0179
00781526564 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
12/26/2006
03/31/2011
Q0179
00781526664 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
12/26/2006
01/31/2010
Q0179
00781526680 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
12/26/2006
02/28/2011
Q0179
18837018440 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
09/01/2006
12/31/2078
Q0179
33358036902 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
07/10/2007
12/31/2078
Q0179
33358037002 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
07/10/2007
12/31/2078
Q0179
45802012714 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/25/2007
10/01/2008
Q0179
45802012765 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/25/2007
10/01/2008
Q0179
45802020514 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/25/2007
12/31/2078
Q0179
45802020565 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/25/2007
12/31/2078
Q0179
49999078330 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
01/11/2006
12/31/2078
Q0179
50111081942 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
11/27/2006
10/31/2012
Q0179
50111094543 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
12/26/2006
12/31/2078
Q0179
50111094643 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
12/26/2006
12/31/2078
Q0179
50111094669 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
12/26/2006
12/31/2078
Q0179
51079052401 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
07/09/2007
12/31/2078
Q0179
51079052420 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
07/09/2007
12/31/2078
Q0179
51079052501 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
07/09/2007
12/31/2078
Q0179
51079052520 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
07/09/2007
12/31/2078
Q0179
51672409103 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
09/19/2008
12/31/2078
Q0179
52152053830 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/25/2007
03/31/2013
Q0179
52152053930 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/25/2007
03/31/2013
Q0179
54569487201 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
12/07/2005
12/31/2078
Q0179
54569587300 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
01/12/2007
12/31/2078
Q0179
54868350800 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
01/01/2002
12/31/2078
Q0179
54868350801 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
01/01/2002
12/31/2078
Q0179
54868350802 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
10/20/2003
12/31/2078
12/19/2013
12/27/2006
07/31/2011
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
Q0179
54868350900 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
Q0179
54868350901 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/28/2005
12/31/2078
Q0179
54868350902 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
07/07/2005
12/31/2078
Q0179
54868350903 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
10/19/2005
12/31/2078
Q0179
54868508900 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/09/2004
12/31/2078
Q0179
54868508901 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/29/2005
12/31/2078
Q0179
54868508902 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
09/28/2005
12/31/2078
Q0179
54868508903 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
09/22/2005
12/31/2078
Q0179
54868508904 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
12/20/2005
12/31/2078
Q0179
54868508905 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
08/25/2006
12/31/2078
Q0179
54868573800 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
12/29/2006
12/31/2078
Q0179
54868574900 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
01/16/2007
12/31/2078
Q0179
54868574901 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
10/18/2007
12/31/2078
Q0179
54868580100 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
07/30/2007
12/31/2078
Q0179
54868580101 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
10/25/2007
12/31/2078
Q0179
54868588700 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
05/12/2008
12/31/2078
Q0179
55045372903 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
02/01/2007
12/31/2078
Q0179
55045381501 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
07/26/2007
12/31/2078
Q0179
55111015313 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
12/26/2006
08/31/2013
Q0179
55111015330 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
12/26/2006
12/31/2078
Q0179
55111015413 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
12/26/2006
08/31/2013
Q0179
55111015430 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
12/26/2006
12/31/2078
Q0179
55111015611 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
12/26/2006
08/31/2011
Q0179
55289055903 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
04/25/2008
12/31/2078
Q0179
55289055905 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/03/2008
12/31/2078
Q0179
55289055906 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
04/25/2008
12/31/2078
Q0179
55887007803 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
04/01/2007
12/31/2078
Q0179
58016008400 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
02/01/2006
12/31/2078
Q0179
58016008410 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
02/01/2006
12/31/2078
Q0179
58016008430 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
02/01/2006
12/31/2078
Q0179
58016008460 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
02/01/2006
12/31/2078
Q0179
58016008490 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
02/01/2006
12/31/2078
Q0179
58016082600 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
01/15/2004
12/31/2078
12/19/2013
01/01/2002
12/31/2078
Page 1 of 1
HCPCS
NDC
HCPCS Description
Earliest Start
Date
Latest End
Date
Q0179
58016082630 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
Q0179
58016082660 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
01/15/2004
12/31/2078
Q0179
58016082690 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
01/15/2004
12/31/2078
Q0179
58177036322 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/27/2007
10/31/2010
Q0179
58177036422 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/27/2007
03/31/2010
Q0179
58177036456 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/27/2007
03/31/2010
Q0179
60505038105 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
03/10/2008
12/31/2078
Q0179
62756013001 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/25/2007
12/31/2078
Q0179
62756013101 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/25/2007
12/31/2078
Q0179
62756024064 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/25/2007
12/31/2078
Q0179
62756035664 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/25/2007
12/31/2078
Q0179
62756035666 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/25/2007
12/31/2078
Q0179
63304045830 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/25/2007
12/31/2078
Q0179
63304045930 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/25/2007
12/31/2078
Q0179
65862018703 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
10/31/2007
12/31/2078
Q0179
65862018705 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
10/31/2007
12/31/2078
Q0179
65862018730 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
10/31/2007
12/31/2078
Q0179
65862018803 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
10/31/2007
12/31/2078
Q0179
65862018805 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
10/31/2007
12/31/2078
Q0179
65862018830 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
10/31/2007
12/31/2078
Q0179
66336026803 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
03/17/2008
12/31/2078
Q0179
66336079303 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
03/17/2008
12/31/2078
Q0179
68115080230 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
01/20/2004
12/31/2078
Q0179
68462010530 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/25/2007
12/31/2078
Q0179
68462010630 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/25/2007
12/31/2078
Q0179
68462015713 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/27/2007
12/31/2078
Q0179
68462015811 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/27/2007
12/31/2078
Q0179
68462015813 ONDANSETRON HYDROCHLORIDE 8 MG, ORAL, FDA APPROVED PRESCRIP
06/27/2007
12/31/2078
Q0180
Q0180
Q0180
Q0180
Q0180
Q0180
Q0181
Q0515
Q2004
Q2009
00088120205
00088120243
00088120305
00088120343
54868413800
54868413801
00187024701
44087405001
00327001105
00071400705
01/01/2002
01/01/2002
01/01/2002
01/01/2002
02/10/2005
09/22/2005
07/10/2006
01/01/2006
01/01/2002
01/01/2002
12/31/2078
08/31/2011
12/31/2078
10/31/2012
12/31/2078
12/31/2078
12/31/2078
10/01/1995
12/31/2078
09/30/2010
12/19/2013
DOLASETRON MESYLATE, 100 MG, ORAL, FDA APPROVED PRESCRIPTIO
DOLASETRON MESYLATE, 100 MG, ORAL, FDA APPROVED PRESCRIPTIO
DOLASETRON MESYLATE, 100 MG, ORAL, FDA APPROVED PRESCRIPTIO
DOLASETRON MESYLATE, 100 MG, ORAL, FDA APPROVED PRESCRIPTIO
DOLASETRON MESYLATE, 100 MG, ORAL, FDA APPROVED PRESCRIPTIO
DOLASETRON MESYLATE, 100 MG, ORAL, FDA APPROVED PRESCRIPTIO
UNSPECIFIED ORAL DOSAGE FORM, FDA APPROVED PRESCRIPTION ANTI
INJECTION, SERMORELIN ACETATE, 1 MICROGRAM
IRRIGATION SOLUTION FOR TREATMENT OF BLADDER CALCULI, FOR EX
INJECTION, FOSPHENYTOIN, 50 MG PHENYTOIN EQUIVALENT
01/15/2004
12/31/2078
Page 1 of 1
HCPCS
NDC
Q2009
Q2009
Q2009
Q2009
Q2009
Q2009
Q2009
Q2009
Q2009
Q2009
Q2009
Q2009
Q2009
Q2017
Q2017
Q2042
Q2044
Q2044
Q3026
Q3026
Q3026
Q4074
Q4079
Q4080
Q4080
Q4080
Q4080
Q4080
Q4081
Q4081
Q4081
Q4081
Q4081
Q4081
Q4081
Q4081
Q4081
Q4081
Q4081
Q4081
Q4081
Q4081
Q4081
Q4081
Q4081
Q4081
Q4081
Q4081
Q4081
Q4081
Q4081
Q4081
Q4081
Q4081
Q4081
Q4083
Q4083
Q4083
Q4083
Q4083
Q4083
Q4084
Q4084
Q4084
Q4084
00071400810
00409485702
00409485710
10019026301
10019026303
10139002521
10139002522
55390017510
55390017610
63323040302
63323040310
64679072901
64679073001
00015307519
00015307597
64011024301
49401010101
49401010201
44087002203
44087004403
44087882201
10148010101
59075073015
10148010100
10148010101
10148010130
10148010200
10148010230
54868252300
54868252301
55513012601
55513012610
55513014401
55513014410
55513014801
55513014810
55513026701
55513026710
55513028301
55513028310
55513047801
55513047810
55513082301
55513082310
59676030201
59676030202
59676030301
59676030302
59676030401
59676030402
59676031001
59676031002
59676031204
59676032004
59676034001
08024072412
08024072420
08363776101
08363776501
18837026502
21695037402
21695031303
35356003401
35356003403
54868421900
12/19/2013
HCPCS Description
INJECTION, FOSPHENYTOIN, 50 MG PHENYTOIN EQUIVALENT
INJECTION, FOSPHENYTOIN, 50 MG PHENYTOIN EQUIVALENT
INJECTION, FOSPHENYTOIN, 50 MG PHENYTOIN EQUIVALENT
INJECTION, FOSPHENYTOIN, 50 MG PHENYTOIN EQUIVALENT
INJECTION, FOSPHENYTOIN, 50 MG PHENYTOIN EQUIVALENT
INJECTION, FOSPHENYTOIN, 50 MG
INJECTION, FOSPHENYTOIN, 50 MG
INJECTION, FOSPHENYTOIN, 50 MG PHENYTOIN EQUIVALENT
INJECTION, FOSPHENYTOIN, 50 MG PHENYTOIN EQUIVALENT
INJECTION, FOSPHENYTOIN, 50 MG PHENYTOIN EQUIVALENT
INJECTION, FOSPHENYTOIN, 50 MG PHENYTOIN EQUIVALENT
INJECTION, FOSPHENYTOIN, 50 MG PHENYTOIN EQUIVALENT
INJECTION, FOSPHENYTOIN, 50 MG PHENYTOIN EQUIVALENT
INJECTION, TENIPOSIDE, 50 MG
INJECTION, TENIPOSIDE, 50 MG
HYDROXYPROGESTERONE CAPROATE, PER 1MG
BELIMUMAB PER 10MG
INJECTION, BELIMUMAB, 10 MG
INJECTION, INTERFERON BETA-1A, 11 MCG FOR SUBCUTANEOUS USE
INJECTION, INTERFERON BETA-1A, 11 MCG FOR SUBCUTANEOUS USE
INJECTION, INTERFERON BETA-1A, 11 MCG FOR SUBCUTANEOUS USE
ILOPROST, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, N
INJECTION, NATALIZUMAB, 1 MG
ILOPROST, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, N
ILOPROST, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, N
ILOPROST, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, N
ILOPROST, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, N
ILOPROST, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, N
INJECTION, EPOETIN ALFA, (DIALYSIS), 100 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 100 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 100 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 100 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 100 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 100 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 100 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 100 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 100 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 100 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 100 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 100 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 100 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 100 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 100 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 100 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 100 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 100 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 100 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 100 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 100 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 100 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 100 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 100 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 100 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 100 UNITS
INJECTION, EPOETIN ALFA, (DIALYSIS), 100 UNITS
HYALURONAN OR DERIVATIVE, HYALGAN OR SUPARTZ, FOR INTRA-ARTI
HYALURONAN OR DERIVATIVE, HYALGAN OR SUPARTZ, FOR INTRA-ARTI
HYALURONAN OR DERIVATIVE, HYALGAN OR SUPARTZ, FOR INTRA-ARTI
HYALURONAN OR DERIVATIVE, HYALGAN OR SUPARTZ, FOR INTRA-ARTI
HYALURONAN OR DERIVATIVE, HYALGAN OR SUPARTZ, FOR INTRA-ARTI
HYALURONAN OR DERIVATIVE, HYALGAN OR SUPARTZ, FOR INTRA-ARTI
HYALURONAN OR DERIVATIVE, SYNVISC, FOR INTRA-ARTICULAR INJEC
HYALURONAN OR DERIVATIVE, SYNVISC, FOR INTRA-ARTICULAR INJEC
HYALURONAN OR DERIVATIVE, SYNVISC, FOR INTRA-ARTICULAR INJEC
HYALURONAN OR DERIVATIVE, SYNVISC, FOR INTRA-ARTICULAR INJEC
Earliest Start
Date
01/01/2002
08/05/2007
08/05/2007
08/06/2007
08/06/2007
08/08/2007
08/08/2007
08/06/2007
08/06/2007
08/16/2007
08/16/2007
07/25/2007
07/25/2007
01/01/2002
01/01/2002
02/04/2011
07/01/2011
01/01/2011
01/01/2003
01/01/2003
02/14/2005
01/01/2010
01/01/2005
07/01/2005
07/01/2005
07/01/2005
12/08/2005
12/08/2005
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2006
01/01/2007
01/01/2007
01/01/2007
01/01/2007
06/01/2007
02/01/2007
02/01/2007
10/19/2007
10/19/2007
01/01/2007
Latest End
Date
02/28/2010
12/31/2078
12/31/2078
06/28/2009
06/28/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/14/2014
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
04/30/2008
10/31/2016
12/31/2078
04/30/2008
12/31/2078
11/30/2010
11/30/2010
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
07/31/2010
07/31/2010
12/31/2078
07/01/2013
12/31/2078
09/01/2013
12/31/2078
09/01/2013
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
HCPCS
NDC
Q4084
Q4084
Q4084
Q4085
Q4086
Q4087
Q4087
Q4087
Q4087
Q4088
Q4088
Q4088
Q4088
Q4088
Q4089
Q4089
Q4090
Q4090
Q4091
Q4091
Q4091
Q4091
Q4091
Q4091
Q4091
Q4091
Q4091
Q4092
Q4092
Q4092
Q4092
Q4092
Q4094
Q4094
Q4094
Q4094
Q4095
Q4096
Q4096
Q4096
Q4096
Q4096
Q4096
Q4097
Q4097
Q4097
Q4098
Q4098
Q4099
Q4100
Q4100
Q4100
Q4100
Q4100
Q4100
Q4100
Q4100
Q4100
Q4100
Q4100
Q4100
Q4100
Q4100
Q4100
Q4100
58468009001
66267092103
68115053503
55566410001
59676036001
68209084301
68209084302
68209084303
68209084304
00944270002
00944270003
00944270004
00944270005
00944270006
44206030001
44206030010
60492005101
60492005201
61953000301
61953000302
61953000303
61953000304
61953000401
61953000402
61953000403
61953000404
61953000405
13533064512
13533064515
13533064520
13533064524
13533064571
00085180601
00172640544
00172640549
50383074225
00078043561
68516460001
68516460002
68516460101
68516460201
68516460302
68516460402
44206043605
44206043710
44206043820
54868431900
54868471500
49502060561
08533601002
08533601004
08533601005
08533601006
08533601007
08533601008
08533601009
08533601010
08533601012
08533601013
08533601014
08533602002
08533602003
08533602005
08533603001
08533603002
12/19/2013
HCPCS Description
HYALURONAN OR DERIVATIVE, SYNVISC, FOR INTRA-ARTICULAR INJEC
HYALURONAN OR DERIVATIVE, SYNVISC, FOR INTRA-ARTICULAR INJEC
HYALURONAN OR DERIVATIVE, SYNVISC, FOR INTRA-ARTICULAR INJEC
HYALURONAN OR DERIVATIVE, EUFLEXXA, FOR INTRA-ARTICULAR INJE
HYALURONAN OR DERIVATIVE, ORTHOVISC, FOR INTRA-ARTICULAR INJ
INJECTION, IMMUNE GLOBULIN (OCTAGAM), INTRAVENOUS, NON-LYOPH
INJECTION, IMMUNE GLOBULIN (OCTAGAM), INTRAVENOUS, NON-LYOPH
INJECTION, IMMUNE GLOBULIN (OCTAGAM), INTRAVENOUS, NON-LYOPH
INJECTION, IMMUNE GLOBULIN (OCTAGAM), INTRAVENOUS, NON-LYOPH
INJECTION, IMMUNE GLOBULIN (GAMMAGARD LIQUID), INTRAVENOUS,
INJECTION, IMMUNE GLOBULIN (GAMMAGARD LIQUID), INTRAVENOUS,
INJECTION, IMMUNE GLOBULIN (GAMMAGARD LIQUID), INTRAVENOUS,
INJECTION, IMMUNE GLOBULIN (GAMMAGARD LIQUID), INTRAVENOUS,
INJECTION, IMMUNE GLOBULIN (GAMMAGARD LIQUID), INTRAVENOUS,
INJECTION, RHO(D) IMMUNE GLOBULIN (HUMAN), (RHOPHYLAC®) INTR
INJECTION, RHO(D) IMMUNE GLOBULIN (HUMAN), (RHOPHYLAC®) INTR
INJECTION, HEPATITIS B IMMUNE GLOBULIN (HEPAGAM B), INTRAMUS
INJECTION, HEPATITIS B IMMUNE GLOBULIN (HEPAGAM B), INTRAMUS
INJECTION, IMMUNE GLOBULIN (FLEBOGAMMA), INTRAVENOUS, NON-LY
INJECTION, IMMUNE GLOBULIN (FLEBOGAMMA), INTRAVENOUS, NON-LY
INJECTION, IMMUNE GLOBULIN (FLEBOGAMMA), INTRAVENOUS, NON-LY
INJECTION, IMMUNE GLOBULIN (FLEBOGAMMA), INTRAVENOUS, NON-LY
INJECTION, IMMUNE GLOBULIN (FLEBOGAMMA), INTRAVENOUS, NON-LY
INJECTION, IMMUNE GLOBULIN (FLEBOGAMMA), INTRAVENOUS, NON-LY
INJECTION, IMMUNE GLOBULIN (FLEBOGAMMA), INTRAVENOUS, NON-LY
INJECTION, IMMUNE GLOBULIN (FLEBOGAMMA), INTRAVENOUS, NON-LY
INJECTION, IMMUNE GLOBULIN (FLEBOGAMMA), INTRAVENOUS, NON-LY
INJECTION, IMMUNE GLOBULIN (GAMUNEX), INTRAVENOUS, NON-LYOPH
INJECTION, IMMUNE GLOBULIN (GAMUNEX), INTRAVENOUS, NON-LYOPH
INJECTION, IMMUNE GLOBULIN (GAMUNEX), INTRAVENOUS, NON-LYOPH
INJECTION, IMMUNE GLOBULIN (GAMUNEX), INTRAVENOUS, NON-LYOPH
INJECTION, IMMUNE GLOBULIN (GAMUNEX), INTRAVENOUS, NON-LYOPH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INH
INJECTION, ZOLEDRONIC ACID (RECLAST), 1 MG
INJECTION, VON WILLEBRAND FACTOR COMPLEX, HUMAN, RISTOCETIN
INJECTION, VON WILLEBRAND FACTOR COMPLEX, HUMAN, RISTOCETIN
INJECTION, VON WILLEBRAND FACTOR COMPLEX, HUMAN, RISTOCETIN
INJECTION, VON WILLEBRAND FACTOR COMPLEX, HUMAN, RISTOCETIN
INJECTION, VON WILLEBRAND FACTOR COMPLEX, HUMAN, RISTOCETIN
INJECTION, VON WILLEBRAND FACTOR COMPLEX, HUMAN, RISTOCETIN
INJECTION, IMMUNE GLOBULIN (PRIVIGEN), INTRAVENOUS, NON-LYOP
INJECTION, IMMUNE GLOBULIN (PRIVIGEN), INTRAVENOUS, NON-LYOP
INJECTION, IMMUNE GLOBULIN (PRIVIGEN), INTRAVENOUS, NON-LYOP
INJECTION, IRON DEXTRAN, 50 MG
INJECTION, IRON DEXTRAN, 50 MG
PERFOROMIST, 20 MCG/2 ML
SKIN SUBSTITUTE, NOT OTHERWISE SPECIFIED
SKIN SUBSTITUTE, NOT OTHERWISE SPECIFIED
SKIN SUBSTITUTE, NOT OTHERWISE SPECIFIED
SKIN SUBSTITUTE, NOT OTHERWISE SPECIFIED
SKIN SUBSTITUTE, NOT OTHERWISE SPECIFIED
SKIN SUBSTITUTE, NOT OTHERWISE SPECIFIED
SKIN SUBSTITUTE, NOT OTHERWISE SPECIFIED
SKIN SUBSTITUTE, NOT OTHERWISE SPECIFIED
SKIN SUBSTITUTE, NOT OTHERWISE SPECIFIED
SKIN SUBSTITUTE, NOT OTHERWISE SPECIFIED
SKIN SUBSTITUTE, NOT OTHERWISE SPECIFIED
SKIN SUBSTITUTE, NOT OTHERWISE SPECIFIED
SKIN SUBSTITUTE, NOT OTHERWISE SPECIFIED
SKIN SUBSTITUTE, NOT OTHERWISE SPECIFIED
SKIN SUBSTITUTE, NOT OTHERWISE SPECIFIED
SKIN SUBSTITUTE, NOT OTHERWISE SPECIFIED
Earliest Start
Date
01/01/2007
01/01/2007
01/01/2007
01/01/2007
01/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
07/01/2007
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
04/01/2008
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
Latest End
Date
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
03/24/2013
04/19/2013
06/26/2014
10/17/2013
10/22/2013
09/30/2008
10/31/2009
10/31/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1
Earliest Start
Date
Latest End
Date
08478400405 SKIN SUBSTITUTE, INTEGRA BILAYER MATRIX WOUND DRESSING (BMWD
01/01/2009
12/31/2078
Q4104
08478400406 SKIN SUBSTITUTE, INTEGRA BILAYER MATRIX WOUND DRESSING (BMWD
01/01/2009
12/31/2078
Q4104
08478400408 SKIN SUBSTITUTE, INTEGRA BILAYER MATRIX WOUND DRESSING (BMWD
01/01/2009
12/31/2078
Q4105
Q4105
Q4105
Q4105
Q4106
Q4107
Q4107
Q4107
Q4107
Q4107
Q4107
Q4107
Q4107
Q4108
Q4108
Q4108
Q4108
Q4109
Q4109
Q4109
Q4109
Q4110
Q4110
Q4110
Q4110
Q9967
08478800402
08478800405
08478800406
08478800408
08541000101
08121860047
08121860055
08121860204
08121860404
08121860407
08121860505
08121860510
08121860530
08478401402
08478401405
08478401406
08478401408
08533649501
08533649503
08533649504
08533649506
08533607009
08533607440
08533607812
08533607880
00407141361
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2009
01/01/2011
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
12/31/2078
S0080
S0180
63323011310 INJECTION, PENTAMIDINE ISETHIONATE, 300 MG
00052027201 ETONOGESTREL 68MG IMPLANT
10/01/1999
01/01/2007
12/31/2078
12/31/2078
HCPCS
NDC
Q4100
Q4100
Q4101
Q4104
08533603003
30170000001
09978000199
08478400402
Q4104
12/19/2013
HCPCS Description
SKIN
SKIN
SKIN
SKIN
SUBSTITUTE,
SUBSTITUTE,
SUBSTITUTE,
SUBSTITUTE,
NOT OTHERWISE SPECIFIED
NOT OTHERWISE SPECIFIED
APLIGRAF, PER SQUARE CENTIMETER
INTEGRA BILAYER MATRIX WOUND DRESSING (BMWD
SKIN SUBSTITUTE, INTEGRA DERMAL REGENERATION TEMPLATE (DRT),
SKIN SUBSTITUTE, INTEGRA DERMAL REGENERATION TEMPLATE (DRT),
SKIN SUBSTITUTE, INTEGRA DERMAL REGENERATION TEMPLATE (DRT),
SKIN SUBSTITUTE, INTEGRA DERMAL REGENERATION TEMPLATE (DRT),
SKIN SUBSTITUTE, DERMAGRAFT, PER SQUARE CENTIMETER
SKIN SUBSTITUTE, GRAFTJACKET, PER SQUARE CENTIMETER
SKIN SUBSTITUTE, GRAFTJACKET, PER SQUARE CENTIMETER
SKIN SUBSTITUTE, GRAFTJACKET, PER SQUARE CENTIMETER
SKIN SUBSTITUTE, GRAFTJACKET, PER SQUARE CENTIMETER
SKIN SUBSTITUTE, GRAFTJACKET, PER SQUARE CENTIMETER
SKIN SUBSTITUTE, GRAFTJACKET, PER SQUARE CENTIMETER
SKIN SUBSTITUTE, GRAFTJACKET, PER SQUARE CENTIMETER
SKIN SUBSTITUTE, GRAFTJACKET, PER SQUARE CENTIMETER
SKIN SUBSTITUTE, INTEGRA MATRIX, PER SQUARE CENTIMETER
SKIN SUBSTITUTE, INTEGRA MATRIX, PER SQUARE CENTIMETER
SKIN SUBSTITUTE, INTEGRA MATRIX, PER SQUARE CENTIMETER
SKIN SUBSTITUTE, INTEGRA MATRIX, PER SQUARE CENTIMETER
SKIN SUBSTITUTE, TISSUEMEND, PER SQUARE CENTIMETER
SKIN SUBSTITUTE, TISSUEMEND, PER SQUARE CENTIMETER
SKIN SUBSTITUTE, TISSUEMEND, PER SQUARE CENTIMETER
SKIN SUBSTITUTE, TISSUEMEND, PER SQUARE CENTIMETER
SKIN SUBSTITUTE, PRIMATRIX, PER SQUARE CENTIMETER
SKIN SUBSTITUTE, PRIMATRIX, PER SQUARE CENTIMETER
SKIN SUBSTITUTE, PRIMATRIX, PER SQUARE CENTIMETER
SKIN SUBSTITUTE, PRIMATRIX, PER SQUARE CENTIMETER
LOW OSMOLAR CONTRAST MATERIAL, 300-399 MG/ML IODINE CONCENTR
01/01/2009
01/01/2009
01/01/2009
01/01/2009
12/31/2078
12/31/2078
12/31/2078
12/31/2078
Page 1 of 1

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