#hcpcs hcpcs description ndc ndc description … · a4216 sterile water, saline and/or dextrose,...

HCPCS CrosswalkSeptember 15, 2017

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#HCPCS HCPCS_DESCRIPTION NDC NDC_DESCRIPTION BEGIN_DATE END_DATE90378 rsv-igim, 50mg, (synagis) 60574411301 SYNAGIS 100 MG/1 ML VIAL 01/01/2007 12/31/999990378 rsv-igim, 50mg, (synagis) 60574411401 SYNAGIS 50 MG/0.5 ML VIAL 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00074196604 BACTERIOSTATIC SALINE VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00074196612 BACTERIOSTATIC SALINE VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00074488710 WATER FOR INJECTION FLIPTOP 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00074488799 WATER FOR INJECTION FLIPTOP 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 49502050120 SODIUM CHLORIDE 0.9% SOLN 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00314079430 BACTERIOSTATIC WATER VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00074404402 WATER FOR INJECTION AMPUL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 63323024910 BACTERIOSTATIC WATER VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00074108101 04/25/2005 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 49502081003 WATER FOR INHALATION VIAL 01/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 49502081005 WATER FOR INHALATION VIAL 01/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 53298010106 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 59930160901 SODIUM CHLORIDE 0.9% AMPULE 01/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 59930160902 SODIUM CHLORIDE 0.9% AMPULE 01/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 49502082003 SODIUM CHLORIDE 0.45% VIAL 01/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 49502082005 SODIUM CHLORIDE 0.45% VIAL 01/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 54569403700 BRONCHO SALINE AEROSOL SOLN 01/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08290033006 NORMAL SALINE FLUSH SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08290033103 NORMAL SALINE FLUSH SYRINGE 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00074158401 SODIUM CHLORIDE 0.9% SOLUTION 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00074210205 SODIUM CHLORIDE 0.9% VIAL 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 49072066930 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 63323025910 BACTERIOSTATIC SALINE VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 15686011103 SODIUM CHLORIDE 0.9% VIAL 04/02/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 15686011105 SODIUM CHLORIDE 0.9% VIAL 04/02/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 54868011600 BACTERIOSTATIC SALINE VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08290031102 NORMAL SALINE FLUSH SYRINGE 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08290032103 NORMAL SALINE FLUSH SYRINGE 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00074402702 WATER FOR INJECTION AMPUL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00074488750 WATER FOR INJECTION FLIPTOP 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00074488820 SODIUM CHLORIDE 0.9% VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 12280023301 BACTERIOSTATIC WATER VIAL 08/18/2005 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 49502064015 SODIUM CHLORIDE 3% VIAL 01/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 49502083003 SODIUM CHLORIDE 0.9% INHAL VL 01/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 49502083005 SODIUM CHLORIDE 0.9% INHAL VL 01/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 49502083050 SODIUM CHLORIDE 0.9% INHAL VL 01/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 64054090203 SODIUM CHLORIDE 0.9% SYRNGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 64054090302 SODIUM CHLORIDE 0.9% SYRNGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 64054090306 SODIUM CHLORIDE 0.9% SYRNGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 64054090502 SODIUM CHLORIDE 0.9% SYRNGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 64054090506 SODIUM CHLORIDE 0.9% SYRNGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 64054091002 SODIUM CHLORIDE 0.9% SYRNGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08450090102 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08450090303 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08450090505 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08450090610 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08450601102 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08450601203 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08450601305 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08450601410 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 54868071005 12/15/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 64253011133 NORMAL SALINE FLUSH SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 64253011135 NORMAL SALINE FLUSH SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00223849602 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00223849605 SODIUM CHLORIDE 0.9% AMPUL 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00223849710 SODIUM CHLORIDE 0.9% AMPUL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00223850030 SODIUM CHLORIDE 0.9% VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00264180031 SODIUM CHLORIDE 0.9% SOLUTION 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00264180036 SODIUM CHLORIDE 0.9% SOLUTION 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 50486007822 BRONCHO SALINE AEROSOL SOLN 01/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 50486007823 BRONCHO SALINE AEROSOL SOLN 01/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 50962065001 01/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 54868252700 SODIUM CHLORIDE 0.9% SYRINGE 06/28/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00338004910 SODIUM CHLORIDE 0.9% SOLUTION 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00338004911 SODIUM CHLORIDE 0.9% SOLUTION 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00338004931 SODIUM CHLORIDE 0.9% SOLUTION 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 63323018500 WATER FOR INJECTION VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 63323018505 WATER FOR INJECTION VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 63323018510 WATER FOR INJECTION VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 63323018520 WATER FOR INJECTION VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 63323018550 WATER FOR INJECTION VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 63323018602 SODIUM CHLORIDE 0.9% VIAL 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 63323018610 SODIUM CHLORIDE 0.9% VIAL 01/01/2004 12/31/9999


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#HCPCS HCPCS_DESCRIPTION NDC NDC_DESCRIPTION BEGIN_DATE END_DATEA4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 63323018620 SODIUM CHLORIDE 0.9% VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 63323024930 BACTERIOSTATIC WATER VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00338004941 SODIUM CHLORIDE 0.9% SOLUTION 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00338055311 SODIUM CHLORIDE 0.9% SOLUTION 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 54868397500 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 63323025930 BACTERIOSTATIC SALINE VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00378698601 SODIUM CHLORIDE 0.9% INHAL VL 10/08/2009 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 54868446400 SODIUM CHLORIDE 0.9% VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00409108151 SODIUM CHLORIDE 0.9% VIAL 12/27/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 35356018130 05/16/2008 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 54868502600 SODIUM CHLORIDE 0.9% INHAL VL 01/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 58016060301 01/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 63323092410 BACTERIOSTATIC SALINE VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 63323092430 BACTERIOSTATIC SALINE VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 54868571400 SODIUM CHLORIDE 0.9% VIAL 12/11/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 58016483801 02/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 58016499501 SALINE FLUSH 0.9% SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 58016946401 WATER FOR INJECTION VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 68883090001 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 68883090003 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 68883090004 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00409191832 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00409191833 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00409191835 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00409196604 BACTERIOSTATIC SALINE VIAL 08/30/2005 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00409196605 BACTERIOSTATIC SALINE VIAL 05/02/2005 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00409196607 BACTERIOSTATIC SALINE VIAL 04/05/2005 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00409196612 BACTERIOSTATIC SALINE VIAL 10/06/2005 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00409196614 BACTERIOSTATIC SALINE VIAL 06/01/2005 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00409210202 SODIUM CHLORIDE 0.9% VIAL 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00409210205 SODIUM CHLORIDE 0.9% VIAL 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 83490010760 HYPER-SAL 7% VIAL 10/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00409397703 BACTERIOSTATIC WATER VIAL 04/07/2005 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00409402903 WATER FOR INJECTION AMPUL 03/01/2005 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00409404402 WATER FOR INJECTION AMPUL 02/09/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08166110903 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08166110905 VASCEZE SODIUM CL 0.9% FLUSH 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08166110910 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08290031002 NORMAL SALINE FLUSH SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08290031003 NORMAL SALINE FLUSH SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08290031103 NORMAL SALINE FLUSH SYRINGE 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08290032003 NORMAL SALINE FLUSH SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08290032005 NORMAL SALINE FLUSH SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08290032105 NORMAL SALINE FLUSH SYRINGE 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08290033003 NORMAL SALINE FLUSH SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08290033005 NORMAL SALINE FLUSH SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08290033010 NORMAL SALINE FLUSH SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08290033105 NORMAL SALINE FLUSH SYRINGE 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08290033110 NORMAL SALINE FLUSH SYRINGE 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08290091002 NORMAL SALINE FLUSH SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08290091102 NORMAL SALINE FLUSH SYRINGE 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08290093010 NORMAL SALINE FLUSH SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08881570128 MONOJECT PREFILL 0.9% NA SYR 07/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00409488710 WATER FOR INJECTION VIAL 08/18/2005 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00409488720 WATER FOR INJECTION VIAL 06/16/2005 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00409488750 WATER FOR INJECTION VIAL 08/05/2005 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00409488799 WATER FOR INJECTION VIAL 08/03/2005 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00409488810 SODIUM CHLORIDE 0.9% VIAL 04/22/2005 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00409488812 SODIUM CHLORIDE 0.9% VIAL 07/15/2005 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00409488820 SODIUM CHLORIDE 0.9% VIAL 02/23/2005 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00409488850 SODIUM CHLORIDE 0.9% VIAL 02/14/2005 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08881570129 MONOJECT PREFILL 0.9% NA SYR 07/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 55045371001 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00409710166 SODIUM CHLORIDE 0.9% SOLN 07/28/2005 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 63807010011 SODIUM CHLORIDE 0.9% ZR SYR 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 63807010020 SALINE FLUSH 0.9% SYRINGE 04/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 63807010030 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 63807010033 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 63807010035 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 63807010050 SALINE FLUSH 0.9% SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 63807010051 SODIUM CHLORIDE 0.9% ZR SYR 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 63807010055 SODIUM CHLORIDE 0.9% ZR SYR 04/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 63807010056 SALINE FLUSH 0.9% SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 63807010075 SODIUM CHLORIDE 0.9% ZR SYR 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 63807010092 SALINE FLUSH 0.9% SYRINGE 01/01/2007 12/31/9999


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#HCPCS HCPCS_DESCRIPTION NDC NDC_DESCRIPTION BEGIN_DATE END_DATEA4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 63807010211 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00074181222 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00074536505 SODIUM CHLORIDE 0.9% FLUSH 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00409798413 SODIUM CHLORIDE 0.9% SOLUTION 06/20/2005 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00409798420 SODIUM CHLORIDE 0.9% SOLUTION 06/17/2005 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00409798436 SODIUM CHLORIDE 0.9% SOLUTION 07/14/2005 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 48879000101 STERILE WATER STRIP VIAL 01/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 48879000102 STERILE WATER STRIP VIAL 01/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 48879000201 SODIUM CHLORIDE 0.45% VIAL 01/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 48879000202 SODIUM CHLORIDE 0.45% VIAL 01/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 48879000301 SODIUM CHLORIDE 0.9% VIAL 01/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 48879000302 SODIUM CHLORIDE 0.9% VIAL 01/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 48879000307 SODIUM CHLORIDE 0.9% VIAL 01/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00487900760 SODIUM CHLORIDE 7% VIAL 07/05/2012 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00487930102 SODIUM CHLORIDE 0.9% INHAL VL 01/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00487930103 SODIUM CHLORIDE 0.9% INHAL VL 01/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00487930133 SODIUM CHLORIDE 0.9% INHAL VL 01/01/2006 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 54569152200 SODIUM CHLORIDE 0.9% VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 54569307800 SODIUM CHLORIDE 0.9% INHAL VL 01/18/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00517064825 BACTERIOSTATIC SALINE VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00517066225 BACTERIOSTATIC WATER VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00517280225 SODIUM CHLORIDE 0.9% VIAL 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00517281025 SODIUM CHLORIDE 0.9% VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00517300525 WATER FOR INJECTION VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00517301025 WATER FOR INJECTION VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00517302025 WATER FOR INJECTION VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 00517305025 WATER FOR INJECTION VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 54868018300 BACTERIOSTATIC WATER VIAL 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 64253011121 NORMAL SALINE FLUSH SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 64253011122 NORMAL SALINE FLUSH SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 64253011123 NORMAL SALINE FLUSH SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 64253011125 NORMAL SALINE FLUSH SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 64253011130 NORMAL SALINE FLUSH SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08290091103 NORMAL SALINE FLUSH SYRINGE 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08290092005 NORMAL SALINE FLUSH SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08290092105 NORMAL SALINE FLUSH SYRINGE 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08290094010 NORMAL SALINE FLUSH SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08290094110 NORMAL SALINE FLUSH SYRINGE 01/01/2004 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08290095010 BD POSIFLUSH SALINE SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 68883090001 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 68883090003 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 68883090004 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 68883090005 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 68883090010 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 68883090016 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 08290091003 NORMAL SALINE FLUSH SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 68883090005 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 68883090010 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2007 12/31/9999A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML 68883090016 SODIUM CHLORIDE 0.9% SYRINGE 01/01/2007 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00074159002 STERILE WATER FOR INJECTION 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00074797307 STERILE WATER,IRRIGATION 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00074799009 STERILE WATER FOR INJECTION 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00074613822 SODIUM CHLORIDE 0.9% IRRIG. 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00074711807 STERILE WATER FOR INJECTION 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00074797507 SODIUM CHLORIDE 0.45% IRRIG 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 64938000901 SALJET SALINE 0.9% TOP SOLN 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00074614736 SODIUM CHLORIDE 0.45% IRRIG 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00338004146 SODIUM CHLORIDE 0.45% IRRIG 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 54868071002 SODIUM CHLORIDE 0.9% IRRIG. 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00264210100 STERILE WATER FOR IRRIGATION 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00264210110 STERILE WATER FOR IRRIGATION 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00264210150 STERILE WATER FOR IRRIGATION 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00264210170 STERILE WATER FOR IRRIGATION 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00264220100 SODIUM CHLORIDE 0.9% IRRIG. 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00264220110 SODIUM CHLORIDE 0.9% IRRIG. 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00264220150 SODIUM CHLORIDE 0.9% IRRIG. 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00264220170 SODIUM CHLORIDE 0.9% IRRIG. 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00264785000 STERILE WATER FOR INJECTION 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00264785010 STERILE WATER FOR INJECTION 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00264785020 STERILE WATER FOR INJECTION 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00264920055 STERILE WATER FOR INJECTION 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00264920155 STERILE WATER FOR INJECTION 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00264920555 STERILE WATER FOR INJECTION 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00338000344 STERILE WATER FOR IRRIGATION 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00338000346 STERILE WATER FOR IRRIGATION 01/01/2004 12/31/9999


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#HCPCS HCPCS_DESCRIPTION NDC NDC_DESCRIPTION BEGIN_DATE END_DATEA4217 STERILE WATER/SALINE, 500 ML 00338000347 STERILE WATER FOR IRRIGATION 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00338000349 STERILE WATER FOR IRRIGATION 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00338000402 STERILE WATER FOR IRRIGATION 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00338000403 STERILE WATER FOR IRRIGATION 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00338000404 STERILE WATER FOR IRRIGATION 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00338000405 STERILE WATER FOR IRRIGATION 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00338001304 STERILE WATER FOR INJECTION 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00338001306 STERILE WATER FOR INJECTION 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00338001308 STERILE WATER FOR INJECTION 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00338001329 STERILE WATER FOR INJECTION 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00338004724 SODIUM CHLORIDE 0.9% IRRIG. 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00338004727 SODIUM CHLORIDE 0.9% IRRIG. 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00338004729 SODIUM CHLORIDE 0.9% IRRIG. 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00338004744 SODIUM CHLORIDE 0.9% IRRIG. 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00338004746 SODIUM CHLORIDE 0.9% IRRIG. 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00338004747 SODIUM CHLORIDE 0.9% IRRIG. 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00338004802 SODIUM CHLORIDE 0.9% IRRIG. 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00338004803 SODIUM CHLORIDE 0.9% IRRIG. 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00338004804 SODIUM CHLORIDE 0.9% IRRIG. 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00338004805 SODIUM CHLORIDE 0.9% IRRIG. 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00338005047 SODIUM CHLORIDE 0.9% IRRIG. 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 54868390500 STERILE WATER FOR INJECTION 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 54868429600 STERILE WATER FOR IRRIGATION 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 54868431100 01/01/2004 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00409159002 STERILE WATER FOR INJECTION 08/05/2005 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00409159005 STERILE WATER FOR INJECTION 06/28/2005 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00409402702 WATER FOR INJECTION AMPUL 05/26/2006 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 08080100000 CURITY STERILE WATER,IRRIGATIO 03/01/2006 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 08080102000 CURITY STERILE SALINE 0.9% IRR 03/01/2006 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 08080102200 03/01/2006 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00409613803 SODIUM CHLORIDE 0.9% IRRIG. 06/01/2005 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00409613822 SODIUM CHLORIDE 0.9% IRRIG. 09/01/2005 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00409613903 STERILE WATER FOR IRRIGATION 05/09/2005 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00409613922 STERILE WATER FOR IRRIGATION 05/04/2005 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00409711807 STERILE WATER FOR INJECTION 08/16/2005 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00409713809 SODIUM CHLORIDE 0.9% IRRIG. 05/11/2005 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00409713836 SODIUM CHLORIDE 0.9% IRRIG. 06/09/2005 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00409713909 STERILE WATER FOR IRRIGATION 03/02/2005 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00409713936 STERILE WATER FOR IRRIGATION 05/04/2005 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00409797205 SODIUM CHLORIDE 0.9% IRRIG. 09/01/2005 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00409797207 SODIUM CHLORIDE 0.9% IRRIG. 04/05/2005 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00409797208 SODIUM CHLORIDE 0.9% IRRIG. 05/18/2005 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00409797305 STERILE WATER FOR IRRIGATION 03/16/2005 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00409797307 STERILE WATER FOR IRRIGATION 08/09/2005 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00409797308 STERILE WATER FOR IRRIGATION 07/14/2005 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00409797507 SODIUM CHLORIDE 0.45% IRRIG 04/26/2006 12/31/9999A4217 STERILE WATER/SALINE, 500 ML 00409799009 STERILE WATER FOR INJECTION 09/02/2005 12/31/9999A4218 STERILE SALINE OR WATER, METERED DOSE DISPENSER, 10 ML 49502050120 SODIUM CHLORIDE 0.9% SOLN 01/01/2006 12/31/9999A9579 Injection, gadolinium-based magnetic resonance contrast agent, not otherwise

specified (nos), per ml50419018801 MAGNEVIST VIAL 10/01/2007 12/31/9999

A9579 Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml

50419018802 MAGNEVIST VIAL 10/01/2007 12/31/9999


50419018805 MAGNEVIST VIAL 10/01/2007 12/31/9999


50419018811 MAGNEVIST BULK VIAL 10/01/2007 12/31/9999


50419018815 MAGNEVIST VIAL 10/01/2007 12/31/9999


50419018838 MAGNEVIST SYRINGE 10/01/2007 12/31/9999


50419018858 MAGNEVIST BULK VIAL 10/01/2007 12/31/9999


50419032528 GADAVIST 10 MMOL/10 ML SYRINGE 10/01/2007 12/31/9999


00407069005 OMNISCAN 287 MG/ML VIAL 10/01/2007 12/31/9999

A9581 Injection, gadoxetate disodium, 1 ml 50419032005 EOVIST 2.5 MMOL/10 ML VIAL 10/06/2008 12/31/9999A9581 Injection, gadoxetate disodium, 1 ml 50419032015 EOVIST 3.75 MMOL/15 ML VIAL 10/06/2008 12/31/9999A9585 Injection, gadobutrol, 0.1 ml 50419032511 GADAVIST 7.5 MMOL/7.5 ML VIAL 04/08/2011 12/31/9999A9585 Injection, gadobutrol, 0.1 ml 50419032512 GADAVIST 10 MMOL/10 ML VIAL 04/08/2011 12/31/9999A9585 Injection, gadobutrol, 0.1 ml 50419032513 GADAVIST 15 MMOL/15 ML VIAL 04/08/2011 12/31/9999A9585 Injection, gadobutrol, 0.1 ml 50419032514 GADAVIST 1 MMOL/ML BULK VIAL 04/08/2011 12/31/9999A9585 Injection, gadobutrol, 0.1 ml 50419032515 GADAVIST 1 MMOL/ML BULK VIAL 04/08/2011 12/31/9999A9585 Injection, gadobutrol, 0.1 ml 50419032527 GADAVIST 7.5 MMOL/7.5 ML SYR 04/08/2011 12/31/9999A9585 Injection, gadobutrol, 0.1 ml 50419032528 GADAVIST 10 MMOL/10 ML SYRINGE 04/08/2011 12/31/9999


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#HCPCS HCPCS_DESCRIPTION NDC NDC_DESCRIPTION BEGIN_DATE END_DATEA9606 Radium ra-223 dichloride, therapeutic, per microcurie 50419020801 XOFIGO 1,100 KBQ/ML VIAL 01/01/2015 12/31/9999C9021 Injection, obinutuzumab, 10 mg 50242007001 GAZYVA 1,000 MG/40 ML VIAL 02/12/2014 12/31/9999C9022 Injection, elosulfase alfa, 1mg 68135010001 VIMIZIM 5 MG/5 ML VIAL 06/12/2014 12/31/9999C9022 Injection, elosulfase alfa, 1mg 68135010001 VIMIZIM 5 MG/5 ML VIAL 06/12/2014 12/31/9999C9023 Injection, testosterone undecanoate, 1 mg 67979051143 AVEED 750 MG/3 ML VIAL 03/10/2014 12/31/9999C9023 Injection, testosterone undecanoate, 1 mg 67979051143 AVEED 750 MG/3 ML VIAL 03/10/2014 12/31/9999C9025 Injection, ramucirumab, 5 mg 00002766901 CYRAMZA 100 MG/10 ML VIAL 10/01/2014 12/31/9999C9025 Injection, ramucirumab, 5 mg 00002767801 CYRAMZA 500 MG/50 ML VIAL 10/01/2014 12/31/9999C9026 Injection, vedolizumab, 1 mg 64764030020 ENTYVIO 300 MG VIAL 10/01/2014 12/31/9999C9027 Injection, pembrolizumab, 1 mg 00006302602 KEYTRUDA 100 MG/4 ML VIAL 01/01/2015 12/31/9999C9027 Injection, pembrolizumab, 1 mg 00006302902 KEYTRUDA 50 MG VIAL 01/01/2015 12/31/9999C9113 Injection, pantoprazole sodium, per vial 00008092351 PROTONIX IV 40 MG VIAL 03/22/2001 12/31/9999C9121 Injection, argatroban, per 5 mg 00143967401 ARGATROBAN 250 MG/2.5 ML VIAL 12/12/2012 12/31/9999C9121 Injection, argatroban, per 5 mg 63323052603 ARGATROBAN 250 MG/2.5 ML VIAL 06/01/2015 12/31/9999C9121 Injection, argatroban, per 5 mg 00007440701 ARGATROBAN 250 MG/2.5 ML VIAL 11/06/2000 12/31/9999C9121 Injection, argatroban, per 5 mg 00007440754 ARGATROBAN 250 MG/2.5 ML VIAL 11/06/2000 12/31/9999C9121 Injection, argatroban, per 5 mg 42023018201 ARGATROBAN 250 MG/2.5 ML VIAL 06/15/2015 12/31/9999C9130 Injection, immune globulin (bivigam), 500 mg 59730650201 BIVIGAM LIQUID 10% VIAL 02/04/2013 12/31/9999C9130 Injection, immune globulin (bivigam), 500 mg 59730650301 BIVIGAM LIQUID 10% VIAL 02/04/2013 12/31/9999C9131 Injection, ado-trastuzumab emtansine, 1 mg 50242008701 KADCYLA 160 MG VIAL 02/22/2013 12/31/9999C9131 Injection, ado-trastuzumab emtansine, 1 mg 50242008801 KADCYLA 100 MG VIAL 02/22/2013 12/31/9999C9132 Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix

activity63833038602 KCENTRA 500 UNIT VIAL 10/01/2013 12/31/9999

C9132 Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity

63833038702 KCENTRA 1,000 UNIT VIAL 10/01/2013 12/31/9999

C9133 Factor ix (antihemophilic factor, recombinant), rixubis, per i.u 00944302602 RIXUBIS 250 UNIT NOMINAL 01/01/2015 12/31/9999C9133 Factor ix (antihemophilic factor, recombinant), rixubis, per i.u 00944302802 RIXUBIS 500 UNIT NOMINAL 01/01/2015 12/31/9999C9133 Factor ix (antihemophilic factor, recombinant), rixubis, per i.u 00944303002 RIXUBIS 1,000 UNIT NOMINAL 01/01/2015 12/31/9999C9133 Factor ix (antihemophilic factor, recombinant), rixubis, per i.u 00944303202 RIXUBIS 2,000 UNIT NOMINAL 01/01/2015 12/31/9999C9133 Factor ix (antihemophilic factor, recombinant), rixubis, per i.u 00944303402 RIXUBIS 3,000 UNIT NOMINAL 01/01/2015 12/31/9999C9134 Factor xiii (antihemophilic factor, recombinant), tretten, per 10 i.u. 00169701301 TRETTEN 2,500 UNIT VIAL 03/20/2014 12/31/9999C9135 Factor ix (antihemophilic factor, recombinant), alprolix, per i.u. 64406091101 ALPROLIX 500 UNIT NOMINAL 10/01/2014 12/31/9999C9135 Factor ix (antihemophilic factor, recombinant), alprolix, per i.u. 64406092201 ALPROLIX 1,000 UNIT NOMINAL 10/01/2014 12/31/9999C9135 Factor ix (antihemophilic factor, recombinant), alprolix, per i.u. 64406093301 ALPROLIX 2,000 UNIT NOMINAL 10/01/2014 12/31/9999C9135 Factor ix (antihemophilic factor, recombinant), alprolix, per i.u. 64406094401 ALPROLIX 3,000 UNIT NOMINAL 10/01/2014 12/31/9999C9136 Injection, factor viii, fc fusion protein, (recombinant), per i.u 64406080101 ELOCTATE 250 UNIT NOMINAL 01/01/2015 12/31/9999C9136 Injection, factor viii, fc fusion protein, (recombinant), per i.u 64406080201 ELOCTATE 500 UNIT NOMINAL 01/01/2015 12/31/9999C9136 Injection, factor viii, fc fusion protein, (recombinant), per i.u 64406080301 ELOCTATE 750 UNIT NOMINAL 01/01/2015 12/31/9999C9136 Injection, factor viii, fc fusion protein, (recombinant), per i.u 64406080401 ELOCTATE 1,000 UNIT NOMINAL 01/01/2015 12/31/9999C9136 Injection, factor viii, fc fusion protein, (recombinant), per i.u 64406080501 ELOCTATE 1,500 UNIT NOMINAL 01/01/2015 12/31/9999C9136 Injection, factor viii, fc fusion protein, (recombinant), per i.u 64406080601 ELOCTATE 2,000 UNIT NOMINAL 01/01/2015 12/31/9999C9136 Injection, factor viii, fc fusion protein, (recombinant), per i.u 64406080701 ELOCTATE 3,000 UNIT NOMINAL 01/01/2015 12/31/9999C9137 Injection, Factor VIII (antihemophilic factor, recombinant) PEGylated, 1 I.U. 00944425202 ADYNOVATE 200-400 UNIT VIAL 04/01/2016 12/31/9999

C9137 Injection, Factor VIII (antihemophilic factor, recombinant) PEGylated, 1 I.U. 00944425402 ADYNOVATE 401-800 UNIT VIAL 04/01/2016 12/31/9999

C9137 Injection, Factor VIII (antihemophilic factor, recombinant) PEGylated, 1 I.U. 00944425602 ADYNOVATE 801-1,250 UNIT VIAL 04/01/2016 12/31/9999

C9137 Injection, Factor VIII (antihemophilic factor, recombinant) PEGylated, 1 I.U. 00944425802 ADYNOVATE 1,251-2,500 UNIT VL 04/01/2016 12/31/9999

C9138 Injection, Factor VIII (antihemophilic factor, recombinant) (Nuwiq), 1 I.U. 68982013901 NUWIQ 250 UNIT VIAL PACK 04/01/2016 12/31/9999C9138 Injection, Factor VIII (antihemophilic factor, recombinant) (Nuwiq), 1 I.U. 68982014101 NUWIQ 500 UNIT VIAL PACK 04/01/2016 12/31/9999C9138 Injection, Factor VIII (antihemophilic factor, recombinant) (Nuwiq), 1 I.U. 68982014301 NUWIQ 1,000 UNIT VIAL PACK 04/01/2016 12/31/9999C9138 Injection, Factor VIII (antihemophilic factor, recombinant) (Nuwiq), 1 I.U. 68982014501 NUWIQ 2,000 UNIT VIAL PACK 04/01/2016 12/31/9999C9138 Injection, Factor VIII (antihemophilic factor, recombinant) (Nuwiq), 1 I.U. 68982013901 NUWIQ 250 UNIT VIAL PACK 04/01/2016 12/31/9999C9138 Injection, Factor VIII (antihemophilic factor, recombinant) (Nuwiq), 1 I.U. 68982014101 NUWIQ 500 UNIT VIAL PACK 04/01/2016 12/31/9999C9138 Injection, Factor VIII (antihemophilic factor, recombinant) (Nuwiq), 1 I.U. 68982014301 NUWIQ 1,000 UNIT VIAL PACK 04/01/2016 12/31/9999C9138 Injection, Factor VIII (antihemophilic factor, recombinant) (Nuwiq), 1 I.U. 68982014501 NUWIQ 2,000 UNIT VIAL PACK 04/01/2016 12/31/9999C9139 Injection, Factor IX, albumin fusion protein (recombinant), Idelvion, 1 i.u. 69911086402 IDELVION 250 UNIT VIAL 10/01/2016 12/31/9999C9139 Injection, Factor IX, albumin fusion protein (recombinant), Idelvion, 1 i.u. 69911086502 IDELVION 500 UNIT VIAL 10/01/2016 12/31/9999C9139 Injection, Factor IX, albumin fusion protein (recombinant), Idelvion, 1 i.u. 69911086602 IDELVION 1,000 UNIT VIAL 10/01/2016 12/31/9999C9139 Injection, Factor IX, albumin fusion protein (recombinant), Idelvion, 1 i.u. 69911086702 IDELVION 2,000 UNIT VIAL 10/01/2016 12/31/9999C9140 Injection, factor viii (antihemophilic factor, recombinant) (afstyla), 1 i.u. 69911047402 AFSTYLA 250 UNIT VIAL 06/13/2016 12/31/9999C9140 Injection, factor viii (antihemophilic factor, recombinant) (afstyla), 1 i.u. 69911047502 AFSTYLA 500 UNIT VIAL 06/13/2016 12/31/9999C9140 Injection, factor viii (antihemophilic factor, recombinant) (afstyla), 1 i.u. 69911047602 AFSTYLA 1,000 UNIT VIAL 06/13/2016 12/31/9999C9140 Injection, factor viii (antihemophilic factor, recombinant) (afstyla), 1 i.u. 69911047702 AFSTYLA 2,000 UNIT VIAL 06/13/2016 12/31/9999C9140 Injection, factor viii (antihemophilic factor, recombinant) (afstyla), 1 i.u. 69911047802 AFSTYLA 3,000 UNIT VIAL 06/13/2016 12/31/9999C9140 Injection, factor viii (antihemophilic factor, recombinant) (afstyla), 1 i.u 69911048002 AFSTYLA 1,500 UNIT RANGE VIAL 07/19/2017 12/31/9999C9140 Injection, factor viii (antihemophilic factor, recombinant) (afstyla), 1 i.u 69911048102 AFSTYLA 2,500 UNIT RANGE VIAL 07/19/2017 12/31/9999C9248 Injection, clevidipine butyrate, 1 mg 65293000511 CLEVIPREX 50 MG/100 ML VIAL 09/15/2008 12/31/9999C9248 Injection, clevidipine butyrate, 1 mg 65293000555 CLEVIPREX 25 MG/50 ML VIAL 09/15/2008 12/31/9999C9248 Injection, clevidipine butyrate, 1 mg 10122061110 CLEVIPREX 50 MG/100 ML VIAL 06/27/2017 12/31/9999C9250 Human plasma fibrin sealant, vapor-heated, solvent-detergent (artiss), 2 ml 00944850304 ARTISS FROZEN 4 ML SYRINGE 07/01/2009 12/31/9999


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#HCPCS HCPCS_DESCRIPTION NDC NDC_DESCRIPTION BEGIN_DATE END_DATEC9250 Human plasma fibrin sealant, vapor-heated, solvent-detergent (artiss), 2 ml 00944850310 ARTISS FROZEN 10 ML SYRINGE 07/01/2009 12/31/9999

C9254 Injection, lacosamide, 1 mg 00131181067 VIMPAT 200 MG/20 ML VIAL 05/26/2009 12/31/9999C9257 Injection, bevacizumab, 0.25 mg 50242006001 AVASTIN 100 MG/4 ML VIAL 02/26/2004 12/31/9999C9257 Injection, bevacizumab, 0.25 mg 50242006002 AVASTIN 400 MG/16 ML VIAL 02/26/2004 12/31/9999C9257 Injection, bevacizumab, 0.25 mg 50242006101 AVASTIN 400 MG/16 ML VIAL 02/26/2004 12/31/9999C9272 denosumab, per 1 mg 55513071001 PROLIA 60 MG/ML SYRINGE 06/05/2010 12/31/9999C9272 INJECTION, DENOSUMAB, 1 MG 55513073001 XGEVA 120 MG/1.7 ML VIAL 06/05/2010 12/31/9999C9275 Injection, hexaminolevulinate hydrochloride, 100 mg, per study dose 10511300101 CYSVIEW 100 MG KIT 01/01/2011 12/31/9999C9276 cabazitaxel, per 1mg 00024582411 JEVTANA 60 MG/1.5 ML KIT 01/01/2011 12/31/9999C9285 Lidocaine 70 mg/tetracaine 70 mg, per patch 10885000201 SYNERA PATCH 01/01/2014 12/31/9999C9285 Lidocaine 70 mg/tetracaine 70 mg, per patch 10885000210 SYNERA PATCH 01/01/2014 12/31/9999C9286 Injection, belatacept, 1 mg 00003037113 NULOJIX 250 MG VIAL 06/27/2011 12/31/9999C9287 Injection, brentuximab vedotin, 1 mg 51144005001 ADCETRIS 50 MG VIAL 08/19/2011 12/31/9999C9289 Injection, asparaginase erwinia chrysanthemi, 1,000 international units (i.u.) 57902024901 ERWINAZE 10,000 UNITS VIAL 11/21/2001 12/31/9999

C9289 Injection, asparaginase erwinia chrysanthemi, 1,000 international units (i.u.) 57902024905 ERWINAZE 10,000 UNITS VIAL 11/21/2001 12/31/9999

C9291 Injection, aflibercept, 2 mg vial 61755000502 EYLEA 2 MG/0.05 ML VIAL 11/21/2011 12/31/9999C9292 Injection, pertuzumab, 10 mg 50242014501 PERJETA 420 MG/14 ML VIAL 06/11/2012 12/31/9999C9294 Injection, taliglucerase alfa, 10 units 00069010601 ELELYSO 200 UNITS VIAL 05/07/2012 12/31/9999C9295 Injection, carfilzomib, 1 mg 76075010101 KYPROLIS 60 MG VIAL 07/26/2012 12/31/9999C9296 Injection, ziv-aflibercept, 1 mg 00024584001 ZALTRAP 100 MG/4 ML VIAL 08/17/2012 12/31/9999C9296 Injection, ziv-aflibercept, 1 mg 00024584101 ZALTRAP 200 MG/8 ML VIAL 08/17/2012 12/31/9999C9297 Injection, omacetaxine mepesuccinate, 0.01 mg 63459017714 SYNRIBO 3.5 MG/ML VIAL 11/19/2012 12/31/9999C9298 Injection, ocriplasmin, 0.125 mg 24856000100 JETREA 2.5 MG/ML VIAL 01/09/2013 12/31/9999C9441 Injection, ferric carboxymaltose, 1 mg 00517065001 INJECTAFER 750 MG/15 ML VIAL 08/12/2013 12/31/9999C9442 Injection, belinostat, 10 mg 68152010809 BELEODAQ 500 MG VIAL 01/01/2015 12/31/9999C9442 Injection, belinostat, 10 mg 68152010809 BELEODAQ 500 MG VIAL 01/01/2015 12/31/9999C9443 Injection, dalbavancin, 10 mg 57970010001 DALVANCE 500 MG VIAL 01/01/2015 12/31/9999C9444 Injection, oritavancin, 10 mg 65293001501 ORBACTIV 400 MG VIAL 01/01/2015 12/31/9999C9444 Injection, oritavancin, 10 mg 65293001503 ORBACTIV 400 MG VIAL 01/01/2015 12/31/9999C9445 Injection, c-1 esterase inhibitor (recombinant), ruconest, 10 units 68012035001 RUCONEST 2,100 UNIT VIAL 01/05/2014 12/31/9999C9445 Injection, c-1 esterase inhibitor (recombinant), ruconest, 10 units 68012035001 RUCONEST 2,100 UNIT VIAL 01/05/2014 12/31/9999C9446 Injection, tedizolid phosphate, 1 mg 67919004001 SIVEXTRO 200 MG VIAL 01/01/2015 12/31/9999C9446 Injection, tedizolid phosphate, 1 mg 67919004001 SIVEXTRO 200 MG VIAL 01/01/2015 12/31/9999C9447 Injection, phenylephrine and ketorolac, 4 ml vial 62225060004 OMIDRIA 1-0.3% VIAL 02/16/2015 12/31/9999C9448 Netupitant 300 mg and palonosetron 0.5 mg, oral 62856079601 AKYNZEO 300-0.5 MG CAPSULE 10/27/2014 12/31/9999C9449 Injection, blinatumomab, 1 mcg 55513016001 BLINCYTO 35MCG VIAL+STABILIZER 12/16/2014 12/31/9999C9450 Injection, fluocinolone acetonide intravitreal implant, 0.01 mg 24208041601 RETISERT IMPLANT 06/20/2005 12/31/9999C9450 Injection, fluocinolone acetonide intravitreal implant, 0.01 mg 68611019002 ILUVIEN 0.19 MG IMPLANT 12/22/2014 12/31/9999C9450 Injection, fluocinolone acetonide intravitreal implant, 0.01 mg 68611019002 ILUVIEN 0.19 MG IMPLANT 12/22/2014 12/31/9999C9451 Injection, peramivir, 1 mg 61364018103 RAPIVAB 200 MG/20 ML VIAL 12/26/2014 12/31/9999C9452 Injection, ceftolozane 50 mg and tazobactam 25 mg 67919003001 ZERBAXA 1.5 GRAM VIAL 12/22/2014 12/31/9999C9452 Injection, ceftolozane 50 mg and tazobactam 25 mg 67919003001 ZERBAXA 1.5 GRAM VIAL 12/22/2014 12/31/9999C9453 Injection, nivolumab, 1 mg 00003377211 OPDIVO 40 MG/4 ML VIAL 12/26/2014 12/31/9999C9453 Injection, nivolumab, 1 mg 00003377412 OPDIVO 100 MG/10 ML VIAL 12/26/2014 12/31/9999C9454 Injection, pasireotide long acting, 1 mg 00078064161 SIGNIFOR LAR 20 MG VIAL 03/10/2015 12/31/9999C9454 Injection, pasireotide long acting, 1 mg 00078064181 SIGNIFOR LAR 20 MG KIT 03/10/2015 12/31/9999C9454 Injection, pasireotide long acting, 1 mg 00078064261 SIGNIFOR LAR 40 MG VIAL 03/10/2015 12/31/9999C9454 Injection, pasireotide long acting, 1 mg 00078064281 SIGNIFOR LAR 40 MG KIT 03/10/2015 12/31/9999C9454 Injection, pasireotide long acting, 1 mg 00078064361 SIGNIFOR LAR 60 MG VIAL 03/10/2015 12/31/9999C9454 Injection, pasireotide long acting, 1 mg 00078064381 SIGNIFOR LAR 60 MG KIT 03/10/2015 12/31/9999C9455 Injection, siltuximab, 10 mg 57894042001 SYLVANT 100 MG VIAL 05/02/2014 12/31/9999C9455 Injection, siltuximab, 10 mg 57894042101 SYLVANT 400 MG VIAL 05/02/2014 12/31/9999C9456 Injection, isavuconazonium sulfate, 1 mg 00469042099 CRESEMBA 372 MG VIAL 04/15/2015 12/31/9999C9460 Injection, cangrelor, 1 mg 65293000301 KENGREAL 50 MG VIAL 07/08/2015 12/31/9999C9460 Injection, cangrelor, 1 mg 65293000310 KENGREAL 50 MG VIAL 07/08/2015 12/31/9999C9470 Injection, aripiprazole lauroxil, 1 mg 65757040103 ARISTADA ER 441 MG/1.6 ML SYRN 04/01/2016 12/31/9999C9470 Injection, aripiprazole lauroxil, 1 mg 65757040203 ARISTADA ER 662 MG/2.4 ML SYRN 04/01/2016 12/31/9999C9470 Injection, aripiprazole lauroxil, 1 mg 65757040303 ARISTADA ER 882 MG/3.2 ML SYRN 04/01/2016 12/31/9999C9472 Injection, talimogene laherparepvec, 1 million plaque forming units (PFU) 55513007801 IMLYGIC 1 MILLION PFU/ML VIAL 04/01/2016 12/31/9999C9472 Injection, talimogene laherparepvec, 1 million plaque forming units (PFU) 55513007901 IMLYGIC 100 MILLION PFU/ML VL 04/01/2016 12/31/9999C9473 Injection, mepolizumab, 1 mg 00173088101 NUCALA 100 MG VIAL 04/01/2016 12/31/9999C9474 Injection, irinotecan liposome, 1 mg 69171039801 ONIVYDE 43 MG/10 ML VIAL 04/01/2016 12/31/9999C9475 Injection, necitumumab, 1 mg 00002771601 PORTRAZZA 800 MG/50 ML VIAL 04/01/2016 12/31/9999C9476 Injection, daratumumab, 10 mg 57894050205 DARZALEX 100 MG/5 ML VIAL 07/01/2016 12/31/9999C9476 Injection, daratumumab, 10 mg 57894050220 DARZALEX 400 MG/20 ML VIAL 07/01/2016 12/31/9999C9477 Injection, elotuzumab, 1 mg 00003229111 EMPLICITI 300 MG VIAL 07/01/2016 12/31/9999C9477 Injection, elotuzumab, 1 mg 00003452211 EMPLICITI 400 MG VIAL 07/01/2016 12/31/9999C9478 Injection, sebelipase alfa, 1 mg 25682000701 KANUMA 20 MG/10 ML VIAL 07/01/2016 12/31/9999C9480 Injection, trabectedin, 0.1 mg 59676061001 YONDELIS 1 MG VIAL 07/01/2016 12/31/9999C9481 Injection, reslizumab, 1 mg 59310061031 CINQAIR 100 MG/10 ML VIAL 10/01/2016 12/31/9999C9482 Injection, sotalol hydrochloride, 1 mg 67457017610 SOTALOL HCL 150 MG/10 ML VIAL 10/01/2016 12/31/9999C9482 Injection, sotalol hydrochloride, 1 mg 67457017610 SOTALOL HCL 150 MG/10 ML VIAL 10/01/2016 12/31/9999


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#HCPCS HCPCS_DESCRIPTION NDC NDC_DESCRIPTION BEGIN_DATE END_DATEC9483 Injection, atezolizumab, 10 mg 50242091701 TECENTRIQ 1,200 MG/20 ML VIAL 10/01/2016 12/31/9999C9484 Injection, eteplirsen, 10 mg 60923028410 EXONDYS 51 500 MG/10 ML VIAL 04/01/2017 12/31/9999C9484 Injection, eteplirsen, 10 mg 60923036302 EXONDYS 51 100 MG/2 ML VIAL 04/01/2017 12/31/9999C9485 Injection, olaratumab, 10 mg 00002892601 LARTRUVO 500 MG/50 ML VIAL 04/01/2017 12/31/9999C9486 Injection, granisetron extended release, 0.1 mg 47426010106 SUSTOL 10 MG/0.4 ML SYRINGE 04/01/2017 12/31/9999C9487 Ustekinumab, for intravenous injection, 1 mg 57894005427 STELARA 130 MG/26 ML VIAL 04/01/2017 12/31/9999C9487 Ustekinumab, for intravenous injection, 1 mg 57894006003 STELARA 45 MG/0.5 ML SYRINGE 04/01/2017 12/31/9999C9487 Ustekinumab, for intravenous injection, 1 mg 57894006103 STELARA 90 MG/ML SYRINGE 04/01/2017 12/31/9999C9489 Injection, nusinersen, 0.1 mg 64406005801 SPINRAZA 12 MG/5 ML VIAL 07/01/2017 12/31/9999C9491 Injection, avelumab, 10 mg 44087353501 BAVENCIO 200 MG/10 ML VIAL 10/01/2017 12/31/9999C9492 Injection, durvalumab, 10 mg 00310450012 IMFINZI 120 MG/2.4 ML VIAL 10/01/2017 12/31/9999C9492 Injection, durvalumab, 10 mg 00310461150 IMFINZI 500 MG/10 ML VIAL 10/01/2017 12/31/9999C9494 Injection, ocrelizumab, 1 mg 50242015001 OCREVUS 300 MG/10 ML VIAL 10/01/2017 12/31/9999G9017 AMANTADINE HYDROCHLORIDE, ORAL, PER 100 MG (FOR USE IN A MEDICARE

APPROVED DEMONSTRATION PROJECT)00781204805 AMANTADINE 100 MG CAPSULE 01/20/2005 12/31/9999

J0120 INJECTION, TETRACYCLINE, UP TO 250 MG 51927244900 TETRACYCLINE POWDER 09/08/2003 12/31/9999J0128 INJECTION, ABARELIX, 10 MG 68158014951 PLENAXIS 100 MG VIAL 01/01/2005 12/31/9999J0128 INJECTION, ABARELIX, 10 MG 68158014951 PLENAXIS 100 MG VIAL 01/01/2005 12/31/9999J0129 Injection, abatacept, 10 mg 00003218710 ORENCIA 250 MG VIAL 01/01/2006 12/31/9999J0129 INJECTION, ABATACEPT, 10 MG 00003218851 ORENCIA CLICKJECT 125 MG/ML 06/13/2016 12/31/9999J0129 INJECTION, ABATACEPT, 10 MG (CODE MAY BE USED FOR MEDICARE WHEN

DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED)

00003281411 ORENCIA 50 MG/0.4 ML SYRINGE 04/06/2017 12/31/9999

J0129 INJECTION, ABATACEPT, 10 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED)

00003281811 ORENCIA 87.5 MG/0.7 ML SYRINGE 04/06/2017 12/31/9999

J0130 INJECTION ABCIXIMAB, 10 MG 57894020001 REOPRO 10 MG/5 ML VIAL 01/01/2017 12/31/9999J0130 INJECTION ABCIXIMAB, 10 MG 00002714001 REOPRO 10 MG/5 ML VIAL 01/01/2002 12/31/9999J0131 INJECTION, ACETAMINOPHEN, 10 MG 43825010201 OFIRMEV 1,000 MG/100 ML VIAL 01/03/2011 12/31/9999J0132 INJECTION, ACETYLCYSTEINE, 100 MG 66220010734 ACETADOTE 200 MG/ML VIAL 01/01/2006 12/31/9999J0132 INJECTION, ACETYLCYSTEINE, 100 MG 17478066030 ACETYLCYSTEINE 6 GRAM/30 ML VL 06/24/2015 12/31/9999J0132 INJECTION, ACETYLCYSTEINE, 100 MG 66220010730 ACETADOTE 200 MG/ML VIAL 01/01/2006 12/31/9999J0132 INJECTION, ACETYLCYSTEINE, 100 MG 55150025930 ACETYLCYSTEINE 6 GRAM/30 ML VL 10/06/2016 12/31/9999J0133 INJECTION, ACYCLOVIR, 5 MG 00173099501 ZOVIRAX 500 MG VIAL 01/01/2006 12/31/9999J0133 INJECTION, ACYCLOVIR, 5 MG 61703031121 ACYCLOVIR SOD 500 MG/20 ML 01/01/2006 12/31/9999J0133 INJECTION, ACYCLOVIR, 5 MG 61703031143 ACYCLOVIR SOD 1,000 MG/40 ML 01/01/2006 12/31/9999J0133 INJECTION, ACYCLOVIR, 5 MG 63323010510 ACYCLOVIR SODIUM 500 MG VIAL 01/01/2006 12/31/9999J0133 INJECTION, ACYCLOVIR, 5 MG 63323032510 ACYCLOVIR 500 MG/10 ML VIAL 01/01/2006 12/31/9999J0133 INJECTION, ACYCLOVIR, 5 MG 63323032520 ACYCLOVIR 1,000 MG/20 ML VIAL 01/01/2006 12/31/9999J0133 INJECTION, ACYCLOVIR, 5 MG 51552067101 ACYCLOVIR POWDER 01/01/2006 12/31/9999J0133 INJECTION, ACYCLOVIR, 5 MG 51552067102 ACYCLOVIR POWDER 01/01/2006 12/31/9999J0133 INJECTION, ACYCLOVIR, 5 MG 51552067103 ACYCLOVIR POWDER 01/01/2006 12/31/9999J0133 INJECTION, ACYCLOVIR, 5 MG 51552067104 ACYCLOVIR POWDER 01/01/2006 12/31/9999J0133 INJECTION, ACYCLOVIR, 5 MG 51552067105 ACYCLOVIR POWDER 01/01/2006 12/31/9999J0133 INJECTION, ACYCLOVIR, 5 MG 51552067106 ACYCLOVIR POWDER 01/01/2006 12/31/9999J0133 INJECTION, ACYCLOVIR, 5 MG 63370000725 ACYCLOVIR POWDER 01/01/2006 12/31/9999J0133 INJECTION, ACYCLOVIR, 5 MG 63370000735 01/01/2006 12/31/9999J0133 INJECTION, ACYCLOVIR, 5 MG 63370000750 01/01/2006 12/31/9999J0133 INJECTION, ACYCLOVIR, 5 MG 38779017301 ACYCLOVIR POWDER 01/01/2006 12/31/9999J0133 INJECTION, ACYCLOVIR, 5 MG 38779017304 ACYCLOVIR POWDER 01/01/2006 12/31/9999J0133 INJECTION, ACYCLOVIR, 5 MG 38779017305 ACYCLOVIR POWDER 01/01/2006 12/31/9999J0133 INJECTION, ACYCLOVIR, 5 MG 38779017308 ACYCLOVIR POWDER 01/01/2006 12/31/9999J0133 INJECTION, ACYCLOVIR, 5 MG 51927299400 ACYCLOVIR POWDER 01/01/2006 12/31/9999J0133 Injection, acyclovir, 5 mg 55150015410 ACYCLOVIR 500 MG/10 ML VIAL 02/20/2014 12/31/9999J0133 INJECTION, ACYCLOVIR, 5 MG 49452000103 ACYCLOVIR POWDER 06/01/2015 12/31/9999J0133 INJECTION, ACYCLOVIR, 5 MG 49452000104 09/01/2015 12/31/9999J0133 INJECTION, ACYCLOVIR, 5 MG 55390061210 ACYCLOVIR SODIUM 500 MG VIAL 01/01/2006 12/31/9999J0133 INJECTION, ACYCLOVIR, 5 MG 55390061320 ACYCLOVIR SODIUM 1 GM VIAL 01/01/2006 12/31/9999J0133 INJECTION, ACYCLOVIR, 5 MG 62991100401 ACYCLOVIR POWDER 01/01/2006 12/31/9999J0133 INJECTION, ACYCLOVIR, 5 MG 62991100402 ACYCLOVIR POWDER 01/01/2006 12/31/9999J0135 INJECTION, ADALIMUMAB, 20 MG 54868482200 HUMIRA 40 MG/0.8 ML SYRINGE 01/01/2005 12/31/9999J0135 INJECTION, ADALIMUMAB, 20 MG 00074379902 HUMIRA 40 MG/0.8 ML SYRINGE 01/01/2005 12/31/9999J0135 INJECTION, ADALIMUMAB, 20 MG 00074379903 HUMIRA PEDIATRIC CROHN'S START 10/01/2014 12/31/9999J0135 INJECTION, ADALIMUMAB, 20 MG 00074379906 HUMIRA PEDIATRIC CROHN'S START 10/01/2014 12/31/9999J0135 INJECTION, ADALIMUMAB, 20 MG 00074433902 HUMIRA 40 MG/0.8 ML PEN 07/17/2006 12/31/9999J0135 INJECTION, ADALIMUMAB, 20 MG 00074433906 HUMIRA PEN CROHN-UC-HS STARTER 02/27/2007 12/31/9999J0135 INJECTION, ADALIMUMAB, 20 MG 00074433907 HUMIRA PEN PSORIASIS-UVEITIS 03/19/2009 12/31/9999J0135 INJECTION, ADALIMUMAB, 20 MG 00074634702 HUMIRA 10 MG/0.2 ML SYRINGE 10/15/2014 12/31/9999J0135 INJECTION, ADALIMUMAB, 20 MG 00074937402 HUMIRA 20 MG/0.4 ML SYRINGE 02/22/2008 12/31/9999J0150 INJECTION, ADENOSINE FOR THERAPEUTIC USE, 6 MG (NOT TO BE USED TO

REPORT ANY ADENOSINE PHOSPHATE COMPOUNDS, INSTEAD USE A9270)10019006307 ADENOSINE 3 MG/ML SYRINGE 05/24/2005 12/31/9999

J0150 adenosine, per 6 mg 25021030102 ADENOSINE 6 MG/2 ML VIAL 11/24/2009 12/31/9999


8 of 295

#HCPCS HCPCS_DESCRIPTION NDC NDC_DESCRIPTION BEGIN_DATE END_DATEJ0150 INJECTION, ADENOSINE FOR THERAPEUTIC USE, 6 MG (NOT TO BE USED TO

REPORT ANY ADENOSINE PHOSPHATE COMPOUNDS, INSTEAD USE A9270)25021030167 ADENOSINE 6 MG/2 ML SYRINGE 05/01/2014 12/31/9999

J0150 INJECTION, ADENOSINE FOR THERAPEUTIC USE, 6 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE COMPOUNDS, INSTEAD USE A9270)

00703877103 ADENOSINE 6 MG/2 ML VIAL 06/16/2004 12/31/9999








54868555100 03/16/2006 12/31/9999






10019006308 ADENOSINE 6 MG/2 ML SYRINGE 05/24/2005 12/31/9999


10019006334 ADENOSINE 6 MG/2 ML SYRINGE 05/05/2007 12/31/9999


00469823412 ADENOCARD 6 MG/2 ML SYRINGE 06/14/2002 12/31/9999








54569561000 09/30/2004 12/31/9999

J0152 INJECTION, ADENOSINE FOR DIAGNOSTIC USE, 30 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE COMPOUNDS; INSTEAD USE A9270)

54868582500 ADENOSCAN 3 MG/ML VIAL 10/18/2007 12/31/9999




51927211600 ADENOSINE POWDER 01/01/2004 12/31/9999


51927213200 ADENOSINE-5-TRIPHOSPHATE POWD 01/01/2004 12/31/9999





J0153 Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)


J0153 adenosine, per 1 mg 25021030102 ADENOSINE 6 MG/2 ML VIAL 12/03/2007 12/31/9999J0153 INJECTION, ADENOSINE, 1 MG (NOT TO BE USED TO REPORT ANY ADENOSINE

PHOSPHATE COMPOUNDS)25021030167 ADENOSINE 6 MG/2 ML SYRINGE 01/01/2015 12/31/9999

J0153 INJECTION, ADENOSINE, 1 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE COMPOUNDS)





54868555100 01/01/2015 12/31/9999




9 of 295

#HCPCS HCPCS_DESCRIPTION NDC NDC_DESCRIPTION BEGIN_DATE END_DATEJ0153 Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate

compounds)00469087130 ADENOSCAN 3 MG/ML VIAL 10/01/1990 12/31/9999










54569561000 01/01/2015 12/31/9999

J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 00074490118 EPINEPHRINE 0.1 MG/ML SYRN 01/01/2002 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 00548101400 EPINEPHRINE 0.1 MG/ML SYRN 01/01/2002 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 66860002001 EPINEPHRINE 1 MG/ML VIAL 01/01/2003 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 61570040111 ADRENALIN CL 1 MG/ML VIAL 09/07/2002 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 61570041881 ADRENALIN 1 MG/ML AMPUL 01/01/2002 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 54569594600 08/13/2007 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 54569594900 08/14/2007 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 00548101600 EPINEPHRINE 0.1 MG/ML SYRINGE 01/01/2002 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 00548201600 EPINEPHRINE 0.1 MG/ML SYRINGE 01/01/2002 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 00548906100 EPINEPHRINE 1 MG/ML VIAL 01/01/2002 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 00143998490 EPINEPHRINE 1 MG/ML VIAL 07/20/2005 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 23490549702 04/30/2007 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 54868136300 ADRENALIN 1 MG/ML AMPUL 01/01/2002 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 54868206500 EPINEPHRINE 1 MG/ML AMPUL 01/01/2002 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 54868206501 EPINEPHRINE 1 MG/ML AMPUL 01/01/2002 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 66860002102 EPINEPHRINE 1 MG/ML AMPUL 01/01/2002 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 54868364100 EPINEPHRINE 1 MG/ML VIAL 01/01/2002 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 54868572500 EPINEPHRINE 0.1 MG/ML SYRINGE 12/11/2006 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 00409490118 EPINEPHRINE 0.1 MG/ML SYRINGE 09/23/2005 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 00409492134 EPINEPHRINE 0.1 MG/ML SYRINGE 12/23/2005 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 42023010101 ADRENALIN CL 1 MG/ML VIAL 02/28/2008 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 42023012225 ADRENALIN CL 1 MG/ML VIAL 06/04/2008 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 55045369603 08/17/2006 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 55045990303 EPINEPHRINE 0.1 MG/ML SYRINGE 03/15/2003 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 00409724101 EPINEPHRINE 1 MG/ML AMPUL 09/13/2005 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 00074492134 EPINEPHRINE 0.1 MG/ML ABBJCT 01/01/2002 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 00074724101 EPINEPHRINE 1 MG/ML AMPUL 04/09/2002 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 13436070001 TWINJECT 0.3 MG AUTO-INJECTOR 08/03/2005 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 13436070002 TWINJECT 0.3 MG AUTO-INJECTOR 08/03/2005 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 13436070101 TWINJECT 0.15 MG AUTO-INJECTOR 08/03/2005 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 13436070102 TWINJECT 0.15 MG AUTO-INJECTOR 08/03/2005 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 00517107125 EPINEPHRINE 1 MG/ML AMPUL 01/01/2002 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 00517113005 EPINEPHRINE 1 MG/ML VIAL 08/01/2003 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 00548331600 EPINEPHRINE 0.1 MG/ML SYRINGE 01/01/2002 12/31/9999J0170 injection, adrenalin(epinephrine) up to 1 ml 49502050001 EPIPEN 0.3 MG AUTO-INJECTOR 01/01/2010 12/31/9999J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE 66860002102 EPINEPHRINE 1 MG/ML AMPUL 01/01/2002 12/31/9999J0171 Injection, adrenalin, epinephrine, 0.1 mg 76329906100 EPINEPHRINE 1 MG/ML VIAL 09/13/2012 12/31/9999J0171 Injection, adrenalin, epinephrine, 0.1 mg 00409492134 EPINEPHRINE 0.1 MG/ML SYRINGE 09/30/1990 12/31/9999J0171 Injection, adrenalin, epinephrine, 0.1 mg 42023015925 ADRENALIN 1 MG/ML VIAL 08/07/2013 12/31/9999J0171 Injection, adrenalin, epinephrine, 0.1 mg 00409724101 EPINEPHRINE 1 MG/ML AMPUL 09/30/1990 12/31/9999J0171 INJECTION, ADRENALIN, EPINEPHRINE, 0.1 MG 00409724110 EPINEPHRINE 1 MG/ML AMPUL 09/01/2016 12/31/9999J0171 INJECTION, ADRENALIN, EPINEPHRINE, 0.1 MG 54505010101 EPINEPHRINE 0.15 MG AUTO-INJCT 11/13/2014 12/31/9999J0171 INJECTION, ADRENALIN, EPINEPHRINE, 0.1 MG 60842002201 AUVI-Q 0.15 MG AUTO-INJECTOR 01/19/2017 12/31/9999J0171 INJECTION, ADRENALIN, EPINEPHRINE, 0.1 MG 60842002301 AUVI-Q 0.3 MG AUTO-INJECTOR 01/19/2017 12/31/9999J0171 INJECTION, ADRENALIN, EPINEPHRINE, 0.1 MG 61553024372 07/01/2016 12/31/9999J0171 INJECTION, ADRENALIN, EPINEPHRINE, 0.1 MG 00115169449 EPINEPHRINE 0.3 MG AUTO-INJECT 02/15/2017 12/31/9999J0171 INJECTION, ADRENALIN, EPINEPHRINE, 0.1 MG 00115169549 EPINEPHRINE 0.15 MG AUTO-INJCT 02/10/2017 12/31/9999J0171 INJECTION, ADRENALIN, EPINEPHRINE, 0.1 MG 49502010102 EPINEPHRINE 0.15 MG AUTO-INJCT 12/15/2016 12/31/9999J0171 INJECTION, ADRENALIN, EPINEPHRINE, 0.1 MG 49502010202 EPINEPHRINE 0.3 MG AUTO-INJECT 12/15/2016 12/31/9999J0178 Injection, aflibercept, 1 mg 61755000502 EYLEA 2 MG/0.05 ML VIAL 11/21/2011 12/31/9999J0180 INJECTION, AGALSIDASE BETA, 1 MG 58468004001 FABRAZYME 35 MG VIAL 01/01/2005 12/31/9999J0180 INJECTION, AGALSIDASE BETA, 1 MG 58468004101 FABRAZYME 5 MG VIAL 01/01/2005 12/31/9999J0202 Injection, alemtuzumab, 1 mg 58468020001 LEMTRADA 12 MG/1.2 ML VIAL 12/03/2014 12/31/9999J0205 INJECTION, ALGLUCERASE, PER 10 UNITS 58468106001 CEREDASE 80 UNITS/ML VIAL 01/01/2002 12/31/9999J0207 INJECTION, AMIFOSTINE, 500 MG 58178001701 ETHYOL 500 MG VIAL 01/01/2002 12/31/9999J0207 INJECTION, AMIFOSTINE, 500 MG 58178001703 ETHYOL 500 MG VIAL 01/01/2002 12/31/9999J0207 INJECTION, AMIFOSTINE, 500 MG 62756058140 AMIFOSTINE 500 MG VIAL 03/26/2008 12/31/9999J0207 INJECTION, AMIFOSTINE, 500 MG 62756058142 AMIFOSTINE 500 MG VIAL 03/26/2008 12/31/9999J0207 INJECTION, AMIFOSTINE, 500 MG 55390030803 AMIFOSTINE 500 MG VIAL 04/08/2008 12/31/9999J0210 INJECTION, METHYLDOPATE HCL, UP TO 250 MG 00517890510 METHYLDOPATE 250 MG/5 ML VIAL 02/26/2003 12/31/9999J0215 INJECTION, ALEFACEPT, 0.5 MG 59627002104 AMEVIVE 15 MG VIAL 01/01/2004 12/31/9999J0215 INJECTION, ALEFACEPT, 0.5 MG 59627002103 AMEVIVE 15 MG VIAL 01/01/2004 12/31/9999J0215 INJECTION, ALEFACEPT, 0.5 MG 00469002103 AMEVIVE 15 MG VIAL 02/28/2008 12/31/9999


10 of 295

#HCPCS HCPCS_DESCRIPTION NDC NDC_DESCRIPTION BEGIN_DATE END_DATEJ0215 INJECTION, ALEFACEPT, 0.5 MG 00469002104 AMEVIVE 15 MG VIAL 12/31/2007 12/31/9999J0220 Injection, alglucosidase alfa, 10 mg, not otherwise specified 58468015001 MYOZYME 50 MG VIAL 05/11/2006 12/31/9999J0221 Injection, alglucosidase alfa, (lumizyme), 10 mg 58468016001 LUMIZYME 50 MG VIAL 06/15/2010 12/31/9999J0221 Injection, alglucosidase alfa, (lumizyme), 10 mg 58468016002 LUMIZYME 50 MG VIAL 06/15/2010 12/31/9999J0256 INJECTION, ALPHA 1 PROTEINASE INHIBITOR (HUMAN), NOT OTHERWISE

SPECIFIED, 10 MG00944281401 ARALAST NP 500 MG VIAL 05/01/2014 12/31/9999

J0256 INJECTION, ALPHA 1 PROTEINASE INHIBITOR (HUMAN), NOT OTHERWISE SPECIFIED, 10 MG

00944281501 ARALAST NP 1,000 MG VIAL 05/01/2014 12/31/9999


13533070001 PROLASTIN C 1,000 MG VIAL 12/01/2009 12/31/9999







J0257 INJECTION, ALPHA 1 PROTEINASE INHIBITOR (HUMAN), (GLASSIA), 10 MG 00944288401 GLASSIA 1 GM/50 ML VIAL 10/11/2010 12/31/9999J0270 INJECTION, ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDICARE

WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED)

62991112802 PROSTAGLANDIN E1 POWDER 09/15/2003 12/31/9999

J0270 INJECTION, ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED)







63275998809 12/04/2002 12/31/9999


00703150102 ALPROSTADIL 500 MCG/ML VIAL 01/01/2002 12/31/9999


51552049801 ALPROSTADIL POWDER 09/01/2003 12/31/9999








54868489000 CAVERJECT IMPULSE 20 MCG KIT 08/28/2003 12/31/9999










00009316906 PROSTIN VR PEDI 500 MCG/ML AMP 01/01/2002 12/31/9999


00009370105 CAVERJECT 20 MCG VIAL 01/01/2002 12/31/9999






11 of 295

#HCPCS HCPCS_DESCRIPTION NDC NDC_DESCRIPTION BEGIN_DATE END_DATEJ0270 INJECTION, ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDICARE

WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED)



00009765002 CAVERJECT 40 MCG/2 ML AMPUL 01/01/2002 12/31/9999








49452007303 09/01/2015 12/31/9999


49452007304 09/01/2015 12/31/9999


00091111016 EDEX 10 MCG CARTRIDGE 2-PK KIT 09/02/2004 12/31/9999















J0275 ALPROSTADIL URETHRAL SUPPOSITORY (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED)

62541011001 MUSE 125 MCG URETHRAL SUPPOS 01/01/2002 12/31/9999












62541014001 MUSE 1,000 MCG URETHRAL SUPP 01/01/2002 12/31/9999


62541014006 MUSE 1,000 MCG URETHRAL SUPP 01/01/2002 12/31/9999

J0278 INJECTION, AMIKACIN SULFATE, 100 MG 62991200203 01/01/2006 12/31/9999J0278 INJECTION, AMIKACIN SULFATE, 100 MG 54569591000 05/07/2007 12/31/9999J0278 INJECTION, AMIKACIN SULFATE, 100 MG 00015301520 AMIKIN 50 MG/ML VIAL 01/01/2006 12/31/9999J0278 INJECTION, AMIKACIN SULFATE, 100 MG 00015302320 AMIKIN 250 MG/ML VIAL 01/01/2006 12/31/9999J0278 INJECTION, AMIKACIN SULFATE, 100 MG 62991200201 AMIKACIN SULFATE POWDER 10/31/2011 12/31/9999J0278 INJECTION, AMIKACIN SULFATE, 100 MG 62991200202 AMIKACIN SULFATE POWDER 10/31/2011 12/31/9999J0278 INJECTION, AMIKACIN SULFATE, 100 MG 00641616610 AMIKACIN SULF 1 GRAM/4 ML VIAL 12/02/2015 12/31/9999


12 of 295

#HCPCS HCPCS_DESCRIPTION NDC NDC_DESCRIPTION BEGIN_DATE END_DATEJ0278 INJECTION, AMIKACIN SULFATE, 100 MG 00641616710 AMIKACIN SULF 500 MG/2 ML VIAL 12/02/2015 12/31/9999J0278 INJECTION, AMIKACIN SULFATE, 100 MG 25021017302 AMIKACIN SULF 500 MG/2 ML VIAL 06/15/2016 12/31/9999J0278 INJECTION, AMIKACIN SULFATE, 100 MG 25021017304 AMIKACIN SULF 1 GRAM/4 ML VIAL 06/15/2016 12/31/9999J0278 INJECTION, AMIKACIN SULFATE, 100 MG 00703903203 AMIKACIN SULF 500 MG/2 ML VIAL 01/01/2006 12/31/9999J0278 INJECTION, AMIKACIN SULFATE, 100 MG 00703904003 AMIKACIN SULF 1 GRAM/4 ML VIAL 01/01/2006 12/31/9999J0278 INJECTION, AMIKACIN SULFATE, 100 MG 63370001615 01/01/2006 12/31/9999J0278 INJECTION, AMIKACIN SULFATE, 100 MG 63370001625 01/01/2006 12/31/9999J0278 INJECTION, AMIKACIN SULFATE, 100 MG 63370001635 01/01/2006 12/31/9999J0278 INJECTION, AMIKACIN SULFATE, 100 MG 63370001650 01/01/2006 12/31/9999J0278 INJECTION, AMIKACIN SULFATE, 100 MG 00409195501 AMIKACIN SULFATE 100 MG/2 ML 01/01/2006 12/31/9999J0278 INJECTION, AMIKACIN SULFATE, 100 MG 00409195601 AMIKACIN SULFATE 500 MG/2 ML 01/01/2006 12/31/9999J0278 INJECTION, AMIKACIN SULFATE, 100 MG 00409195701 AMIKACIN SULFATE 1,000 MG/4 ML 01/01/2006 12/31/9999J0278 INJECTION, AMIKACIN SULFATE, 100 MG 38779029503 AMIKACIN SULFATE POWDER 01/01/2006 12/31/9999J0278 INJECTION, AMIKACIN SULFATE, 100 MG 38779029504 AMIKACIN SULFATE POWDER 01/01/2006 12/31/9999J0278 INJECTION, AMIKACIN SULFATE, 100 MG 38779029505 AMIKACIN SULFATE POWDER 01/01/2006 12/31/9999J0278 INJECTION, AMIKACIN SULFATE, 100 MG 51927270400 AMIKACIN SULFATE POWDER 01/01/2006 12/31/9999J0278 INJECTION, AMIKACIN SULFATE, 100 MG 55390022302 AMIKACIN (PF) 100 MG/2 ML 01/01/2006 12/31/9999J0278 INJECTION, AMIKACIN SULFATE, 100 MG 55390022402 AMIKACIN SULFATE 500 MG/2 ML 01/01/2006 12/31/9999J0278 INJECTION, AMIKACIN SULFATE, 100 MG 55390022404 AMIKACIN SULFATE 1,000 MG/4 ML 01/01/2006 12/31/9999J0278 INJECTION, AMIKACIN SULFATE, 100 MG 55390022502 AMIKACIN (PF) 100 MG/2 ML 01/01/2006 12/31/9999J0278 INJECTION, AMIKACIN SULFATE, 100 MG 55390022602 AMIKACIN SULF 500 MG/2 ML VIAL 01/01/2006 12/31/9999J0278 INJECTION, AMIKACIN SULFATE, 100 MG 55390022604 AMIKACIN SULF 1 GRAM/4 ML VIAL 01/01/2006 12/31/9999J0280 INJECTION, AMINOPHYLLIN, UP TO 250 MG 00074738601 AMINOPHYLLINE 500 MG/20 ML 01/01/2002 12/31/9999J0280 INJECTION, AMINOPHYLLIN, UP TO 250 MG 00074738501 AMINOPHYLLINE 250 MG/10 ML 01/01/2002 12/31/9999J0280 INJECTION, AMINOPHYLLIN, UP TO 250 MG 62991200301 AMINOPHYLLINE POWDER 01/01/2002 12/31/9999J0280 INJECTION, AMINOPHYLLIN, UP TO 250 MG 49452043006 01/01/2002 12/31/9999J0280 INJECTION, AMINOPHYLLIN, UP TO 250 MG 54868000400 AMINOPHYLLINE 250 MG/10 ML VL 01/01/2002 12/31/9999J0280 INJECTION, AMINOPHYLLIN, UP TO 250 MG 62991200302 AMINOPHYLLINE POWDER 01/01/2002 12/31/9999J0280 INJECTION, AMINOPHYLLIN, UP TO 250 MG 62991200303 AMINOPHYLLINE POWDER 01/01/2002 12/31/9999J0280 INJECTION, AMINOPHYLLIN, UP TO 250 MG 51552031305 AMINOPHYLLINE ANHYDROUS PWD 09/01/2003 12/31/9999J0280 INJECTION, AMINOPHYLLIN, UP TO 250 MG 51552031306 AMINOPHYLLINE ANHYDROUS POWDER 09/01/2003 12/31/9999J0280 INJECTION, AMINOPHYLLIN, UP TO 250 MG 51927144400 AMINOPHYLLINE POWDER 09/08/2003 12/31/9999J0280 INJECTION, AMINOPHYLLIN, UP TO 250 MG 38779057105 AMINOPHYLLINE POWDER 01/01/2002 12/31/9999J0280 INJECTION, AMINOPHYLLIN, UP TO 250 MG 38779057108 AMINOPHYLLINE POWDER 01/01/2002 12/31/9999J0280 INJECTION, AMINOPHYLLIN, UP TO 250 MG 00409592101 AMINOPHYLLINE 250 MG/10 ML VL 04/25/2005 12/31/9999J0280 INJECTION, AMINOPHYLLIN, UP TO 250 MG 00409592201 AMINOPHYLLINE 500 MG/20 ML VL 12/24/2004 12/31/9999J0280 INJECTION, AMINOPHYLLIN, UP TO 250 MG 00409738501 AMINOPHYLLINE 250 MG/10 ML VL 12/29/2005 12/31/9999J0280 INJECTION, AMINOPHYLLIN, UP TO 250 MG 00409738601 AMINOPHYLLINE 500 MG/20 ML VL 11/29/2005 12/31/9999J0280 INJECTION, AMINOPHYLLIN, UP TO 250 MG 00074490918 AMINOPHYLLINE 250 MG/10 ML 01/01/2002 12/31/9999J0280 INJECTION, AMINOPHYLLIN, UP TO 250 MG 49452043001 AMINOPHYLLINE POWDER 06/01/2015 12/31/9999J0280 INJECTION, AMINOPHYLLIN, UP TO 250 MG 49452043002 AMINOPHYLLINE POWDER 06/01/2015 12/31/9999J0280 INJECTION, AMINOPHYLLIN, UP TO 250 MG 00517381025 AMINOPHYLLINE 250 MG/10 ML VL 01/01/2002 12/31/9999J0280 INJECTION, AMINOPHYLLIN, UP TO 250 MG 00517382025 AMINOPHYLLINE 500 MG/20 ML VL 01/01/2002 12/31/9999J0280 INJECTION, AMINOPHYLLIN, UP TO 250 MG 17317002201 AMINOPHYLLINE POWDER 01/01/2002 12/31/9999J0280 INJECTION, AMINOPHYLLIN, UP TO 250 MG 17317002204 AMINOPHYLLINE POWDER 01/01/2002 12/31/9999J0280 INJECTION, AMINOPHYLLIN, UP TO 250 MG 17317002205 AMINOPHYLLINE POWDER 01/01/2002 12/31/9999J0282 INJECTION, AMIODARONE HYDROCHLORIDE, 30 MG 00143987510 AMIODARONE 150 MG/3 ML VIAL 05/26/2008 12/31/9999J0282 INJECTION, AMIODARONE HYDROCHLORIDE, 30 MG 10019013101 AMIODARONE HCL 50 MG/ML AMP 10/16/2002 12/31/9999J0282 INJECTION, AMIODARONE HYDROCHLORIDE, 30 MG 10139005009 AMIODARONE HCL 50 MG/ML VIAL 03/15/2005 12/31/9999J0282 INJECTION, AMIODARONE HYDROCHLORIDE, 30 MG 10139005011 AMIODARONE HCL 50 MG/ML VIAL 03/28/2005 12/31/9999J0282 INJECTION, AMIODARONE HYDROCHLORIDE, 30 MG 10139005028 AMIODARONE HCL 50 MG/ML VIAL 03/28/2005 12/31/9999J0282 INJECTION, AMIODARONE HYDROCHLORIDE, 30 MG 00008081401 CORDARONE I.V. AMPUL 01/01/2002 12/31/9999J0282 INJECTION, AMIODARONE HYDROCHLORIDE, 30 MG 10139005003 AMIODARONE HCL 50 MG/ML VIAL 03/15/2005 12/31/9999J0282 INJECTION, AMIODARONE HYDROCHLORIDE, 30 MG 10139005010 AMIODARONE HCL 50 MG/ML VIAL 03/28/2005 12/31/9999J0282 INJECTION, AMIODARONE HYDROCHLORIDE, 30 MG 61703024103 AMIODARONE HCL AMPUL 02/12/2003 12/31/9999J0282 INJECTION, AMIODARONE HYDROCHLORIDE, 30 MG 63323061613 AMIODARONE HCL 50 MG/ML VIAL 01/06/2003 12/31/9999J0282 INJECTION, AMIODARONE HYDROCHLORIDE, 30 MG 00548338000 AMIODARONE HCL 50 MG/ML SYRN 02/01/2004 12/31/9999J0282 INJECTION, AMIODARONE HYDROCHLORIDE, 30 MG 51927376000 AMIODARONE HCL POWDER 01/04/2008 12/31/9999J0282 INJECTION, AMIODARONE HYDROCHLORIDE

#hcpcs hcpcs description ndc ndc description … · a4216 sterile water, saline and/or dextrose,...

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