physicians administered drug (pad) list - ky …...j0171 76329906100 epinephrine epinephrine 1 mg/ml...
TRANSCRIPT
![Page 1: PHYSICIANS ADMINISTERED DRUG (PAD) LIST - Ky …...J0171 76329906100 EPINEPHRINE EPINEPHRINE 1 MG/ML 2012-09-11 2299-12-31 10 0.1 MG ML J0178 61755000502 EYLEA AFLIBERCEPT 2MG/0.05ML](https://reader033.vdocument.in/reader033/viewer/2022050609/5fb0ce012de8b10e1576cd83/html5/thumbnails/1.jpg)
Jcode NDC Brand Name Generic Name Strength Effective Begin
Date
Effective End
Date
Conversion
Factor
Jcode Billing Units NDC
Billing
Units
A9606 50419020801 XOFIGO RADIUM-223 DICHLORIDE 1000KBQ/ML 2015-01-01 2299-12-31 1000 1 KBQ EA
J0129 00003218710 ORENCIA ABATACEPT 250 MG 2016-07-01 2299-12-31 25 10 MG EA
J0135 00074379902 HUMIRA ADALIMUMAB 40MG/0.8ML 2007-07-01 2299-12-31 2 20 MG EA
J0135 00074379903 HUMIRA PEDIATRIC ADALIMUMAB 40MG/0.8ML 2014-10-01 2299-12-31 2 20 MG EA
J0135 00074379906 HUMIRA PEDIATRIC ADALIMUMAB 40MG/0.8ML 2014-10-01 2299-12-31 2 20 MG EA
J0135 00074433902 HUMIRA ADALIMUMAB 40MG/0.8ML 2007-07-01 2299-12-31 2 20 MG EA
J0135 00074433906 HUMIRA ADALIMUMAB 40MG/0.8ML 2007-07-01 2299-12-31 2 20 MG EA
J0135 00074433907 HUMIRA ADALIMUMAB 40MG/0.8ML 2009-03-19 2299-12-31 2 20 MG EA
J0135 00074433971 HUMIRA ADALIMUMAB 40MG/0.8ML 2015-04-15 2299-12-31 2 20 MG EA
J0135 00074634702 HUMIRA ADALIMUMAB 10MG/0.2ML 2014-10-15 2299-12-31 0.5 20 MG EA
J0135 00074937402 HUMIRA ADALIMUMAB 20MG/0.4ML 2008-02-22 2299-12-31 1.0 20 MG EA
J0171 00409490118 EPINEPHRINE EPINEPHRINE 0.1 MG/ML 2012-01-01 2299-12-31 1 0.1 MG ML
J0171 00409492134 EPINEPHRINE EPINEPHRINE 0.1 MG/ML 2012-01-01 2299-12-31 1 0.1 MG ML
J0171 00409724101 EPINEPHRINE EPINEPHRINE 1 MG/ML(1) 2012-01-01 2299-12-31 10 0.1 MG ML
J0171 00409724125 EPINEPHRINE EPINEPHRINE 1 MG/ML(1) 2014-03-01 2299-12-31 10 0.1 MG ML
J0171 00409724161 EPINEPHRINE EPINEPHRINE 1 MG/ML(1) 2012-01-01 2299-12-31 10 0.1 MG ML
J0171 00517113005 EPINEPHRINE EPINEPHRINE 1 MG/ML 2012-01-01 2016-04-20 10 0.1 MG ML
J0171 42023015925 ADRENALIN EPINEPHRINE 1 MG/ML 2013-08-01 2299-12-31 10 0.1 MG ML
J0171 42023016801 ADRENALIN EPINEPHRINE 1 MG/ML 2014-04-01 2299-12-31 10 0.1 MG ML
J0171 76329331601 EPINEPHRINE EPINEPHRINE 0.1 MG/ML 2012-05-10 2299-12-31 1 0.1 MG ML
J0171 76329906100 EPINEPHRINE EPINEPHRINE 1 MG/ML 2012-09-11 2299-12-31 10 0.1 MG ML
J0178 61755000502 EYLEA AFLIBERCEPT 2MG/0.05ML 2013-01-01 2299-12-31 40 1 MG ML
J0180 58468004001 FABRAZYME AGALSIDASE BETA 35 MG 2012-07-01 2299-12-31 35 1 MG EA
J0180 58468004101 FABRAZYME AGALSIDASE BETA 5 MG 2012-07-01 2299-12-31 5 1 MG EA
J0185 47426020101 CINVANTI APREPITANT 130 MG/18 ML 2019-01-01 2299-12-31 7.22222 1 MG ML
J0202 58468020001 LEMTRADA ALEMTUZUMAB 12 MG/1.2 ML 2016-01-01 2299-12-31 1 10 MG ML
J0207 47335058140 AMIFOSTINE AMIFOSTINE CRYSTALLINE 500 MG 2011-02-08 2299-12-31 1 500 MG EA
J0207 47335058142 AMIFOSTINE AMIFOSTINE CRYSTALLINE 500 MG 2011-02-08 2299-12-31 1 500 MG EA
J0207 55390030803 AMIFOSTINE AMIFOSTINE CRYSTALLINE 500 MG 2008-04-08 2299-12-31 1 500 MG EA
J0220 58468015001 MYOZYME ALGLUCOSIDASE ALFA 50 MG 2012-01-01 2299-12-31 0.1 10 MG EA
J0221 58468016001 LUMIZYME ALGLUCOSIDASE ALFA 50 MG 2012-01-01 2299-12-31 5 10 MG EA
J0221 58468016002 LUMIZYME ALGLUCOSIDASE ALFA 50 MG 2014-02-01 2299-12-31 5 10 MG EA
J0256 00053720102 ZEMAIRA ALPHA-1-PROTEINASE
INHIBITOR
1,000 MG 2012-01-01 2299-12-31 100 10 MG EA
J0256 00944280201 ARALAST NP ALPHA-1-PROTEINASE
INHIBITOR
500 MG 2012-01-01 2299-12-31 50 10 MG EA
J0256 00944280202 ARALAST NP ALPHA-1-PROTEINASE
INHIBITOR
1,000 MG 2012-01-01 2299-12-31 100 10 MG EA
J0256 00944281401 ARALAST NP ALPHA-1-PROTEINASE
INHIBITOR
500 MG 2014-05-01 2299-12-31 50 10 MG EA
J0256 00944281501 ARALAST NP ALPHA-1-PROTEINASE
INHIBITOR
1000 MG 2014-05-01 2299-12-31 100 10 MG EA
J0256 13533070001 PROLASTIN C ALPHA-1-PROTEINASE
INHIBITOR
1,000 MG 2012-01-01 2299-12-31 100 10 MG EA
J0256 13533070002 PROLASTIN C ALPHA-1-PROTEINASE
INHIBITOR
1,000 MG 2012-07-11 2299-12-31 100 10 MG EA
J0256 13533070101 PROLASTIN C ALPHA-1-PROTEINASE
INHIBITOR
1000 MG 2015-08-04 2299-12-31 100 10 MG EA
J0256 13533070211 PROLASTIN C ALPHA-1-PROTEINASE
INHIBITOR
1000 MG 2015-08-04 2299-12-31 100 10 MG EA
J0257 00944288401 GLASSIA ALPHA-1-PROTEINASE
INHIBITOR
1 G/50 ML 2012-01-01 2299-12-31 2 10 MG EA
J0401 59148001870 ABILIFY MAINTENA ARIPIPRAZOLE 300 MG 2014-01-30 2299-12-31 300 1 MG EA
J0401 59148001871 ABILIFY MAINTENA ARIPIPRAZOLE 300 MG 2014-01-01 2299-12-31 300 1 MG EA
J0401 59148001970 ABILIFY MAINTENA ARIPIPRAZOLE 400 MG 2014-01-30 2299-12-31 400 1 MG EA
J0401 59148001971 ABILIFY MAINTENA ARIPIPRAZOLE 400 MG 2014-01-01 2299-12-31 400 1 MG EA
J0401 59148004580 ABILIFY MAINTENA ARIPIPRAZOLE 300 MG 2015-01-09 2299-12-31 300 1 MG EA
J0401 59148007280 ABILIFY MAINTENA ARIPIPRAZOLE 400 MG 2015-01-09 2299-12-31 400 1 MG EA
J0475 45945015501 GABLOFEN BACLOFEN 10000/20ML 2013-01-21 2299-12-31 0.05 10 MG ML
J0475 45945015502 GABLOFEN BACLOFEN 10000/20ML 2011-02-08 2299-12-31 0.05 10 MG ML
J0475 45945015601 GABLOFEN BACLOFEN 20K MCG/20 2013-01-21 2299-12-31 0.1 10 MG ML
J0475 45945015602 GABLOFEN BACLOFEN 20K MCG/20 2012-06-25 2299-12-31 0.1 10 MG ML
PHYSICIANS ADMINISTERED DRUG (PAD) LIST
EFFECTIVE AUGUST 29, 2019
Page 1 of 26
![Page 2: PHYSICIANS ADMINISTERED DRUG (PAD) LIST - Ky …...J0171 76329906100 EPINEPHRINE EPINEPHRINE 1 MG/ML 2012-09-11 2299-12-31 10 0.1 MG ML J0178 61755000502 EYLEA AFLIBERCEPT 2MG/0.05ML](https://reader033.vdocument.in/reader033/viewer/2022050609/5fb0ce012de8b10e1576cd83/html5/thumbnails/2.jpg)
Jcode NDC Brand Name Generic Name Strength Effective Begin
Date
Effective End
Date
Conversion
Factor
Jcode Billing Units NDC
Billing
Units
J0475 45945015701 GABLOFEN BACLOFEN 40000/20ML 2013-01-21 2299-12-31 0.2 10 MG ML
J0475 45945015702 GABLOFEN BACLOFEN 40000/20ML 2011-02-08 2299-12-31 0.2 10 MG ML
J0475 58281056001 LIORESAL INTRATHECAL BACLOFEN 10MG/20ML 2007-07-01 2299-12-31 0.05 10 MG ML
J0475 58281056002 LIORESAL INTRATHECAL BACLOFEN 10MG/20ML 2007-07-01 2299-12-31 0.05 10 MG ML
J0475 58281056102 LIORESAL INTRATHECAL BACLOFEN 10MG/5ML 2007-07-01 2299-12-31 0.2 10 MG ML
J0475 58281056201 LIORESAL INTRATHECAL BACLOFEN 0.05MG/ML 2007-07-01 2299-12-31 0.005 10 MG ML
J0475 58281056301 LIORESAL INTRATHECAL BACLOFEN 40MG/20ML 2007-07-01 2299-12-31 0.2 10 MG ML
J0475 58281056302 LIORESAL INTRATHECAL BACLOFEN 40MG/20ML 2007-07-01 2299-12-31 0.2 10 MG ML
J0476 45945015101 GABLOFEN BACLOFEN 50 MCG/ML 2013-02-28 2299-12-31 1 50 MCG ML
J0480 00078033184 SIMULECT BASILIXIMAB 20 MG 2007-07-01 2299-12-31 1 20 MG EA
J0480 00078039361 SIMULECT BASILIXIMAB 10 MG 2007-07-01 2299-12-31 0.5 20 MG EA
J0485 00003037113 NULOJIX BELATACEPT 250 MG 2013-01-01 2299-12-31 250 1 MG EA
J0490 49401010101 BENLYSTA BELIMUMAB 120 MG 2012-01-01 2299-12-31 12 10 MG EA
J0490 49401010201 BENLYSTA BELIMUMAB 400 MG 2012-01-01 2299-12-31 40 10 MG EA
J0558 60793013001 PENICILLIN G PROCAINE PENICILLIN G PROCAINE 600000/ML 2015-06-29 2299-12-31 6 100,000 UNITS ML
J0558 60793013010 PENICILLIN G PROCAINE PENICILLIN G 600,000
UNITS/ML
2011-01-01 2299-12-31 6 100,000 UNITS ML
J0558 60793013101 PENICILLIN G PROCAINE PENICILLIN G PROCAINE 1.2MM/2 ML 2015-07-02 2299-12-31 6 100,000 UNITS ML
J0558 60793013110 PENICILLIN G PROCAINE PEN G 1.2 MILLION
UNITS/2ML
2011-01-01 2299-12-31 6 100,000 UNITS ML
J0558 60793060010 BICILLIN C-R PEN G BENZ/PEN G
PROCAINE
1.2MM/2ML 2011-01-01 2299-12-31 6 100,000 UNITS ML
J0558 60793060110 BICILLIN C-R PEN G BENZ/PEN G
PROCAINE
1.2MM/2ML 2011-01-01 2299-12-31 6 100,000 UNITS ML
J0558 60793060202 BICILLIN C-R PEN G BENZ/PEN G
PROCAINE
900-300/2 2014-10-31 2299-12-31 4.5 100,000 UNITS ML
J0558 60793060210 BICILLIN C-R PEN G BENZ/PEN G
PROCAINE
900-300/2 2011-01-01 2299-12-31 4.5 100,000 UNITS ML
J0558 60793070001 BICILLIN C-R PEN G BENZ/PEN G
PROCAINE
1.2MM/2 ML 2015-02-12 2299-12-31 6 100,000 UNITS ML
J0561 60793070001 BICILLIN L-A PENICILLIN G BENZATHINE 600000/ML 2015-06-30 2299-12-31 6 100,000 UNITS ML
J0561 60793070010 BICILLIN L-A PENICILLIN G BENZATHINE 600,000
UNITS/ML
2011-01-01 2299-12-31 6 100,000 UNITS ML
J0561 60793070010 BICILLIN L-A PENICILLIN G BENZATHINE 600,000 UNITS 2011-01-01 2299-12-31 6 100,000 UNITS ML
J0561 60793070102 BICILLIN L-A PENICILLIN G BENZATHINE 1.2MM/2 ML 2013-06-24 2299-12-31 6 100,000 UNITS ML
J0561 60793070110 BICILLIN L-A PENICILLIN G BENZATHINE 1.2MM/2ML 2011-01-01 2299-12-31 6 100,000 UNITS ML
J0561 60793070110 BICILLIN L-A PENICILLIN G BENZATHINE 1,200,000 UNITS 2011-01-01 2299-12-31 6 100,000 UNITS ML
J0561 60793070204 BICILLIN L-A PENICILLIN G BENZATHINE 2.4MM/4ML 2014-03-13 2299-12-31 6 100,000 UNITS ML
J0561 60793070210 BICILLIN L-A PENICILLIN G BENZATHINE 2.4MM/4ML 2011-01-01 2299-12-31 6 100,000 UNITS ML
J0561 60793070210 BICILLIN L-A PENICILLIN G BENZATHINE 2,400,000 UNITS 2011-01-01 2299-12-31 6 100,000 UNITS ML
J0570 58284010014 PROBUPHINE IMPLANT BUPRENORPHINE 74.2 MG 2017-01-01 2299-12-31 1 74.2 MG EA
J0585 00023114501 BOTOX ONABOTULINUMTOXINA 100 UNIT 2008-01-01 2299-12-31 100 1UNIT EA
J0585 00023391950 BOTOX COSMETIC ONABOTULINUMTOXINA 50 UNIT 2011-07-02 2299-12-31 50 1 UNIT EA
J0585 00023392102 BOTOX ONABOTULINUMTOXINA 200 UNIT 2009-12-31 2299-12-31 200 1 UNIT EA
J0585 00023923201 BOTOX COSMETIC ONABOTULINUMTOXINA 100 UNIT 2008-01-01 2299-12-31 100 1 UNIT EA
J0586 15054050001 DYSPORT ABOBOTULINUMTOXINA 500 UNITS 2009-10-26 2299-12-31 100 5 UNITS EA
J0586 15054053006 DYSPORT ABOBOTULINUMTOXINA 300 UNITS 2010-11-16 2299-12-31 60 5 UNITS EA
J0586 99207050030 DYSPORT ABOBOTULINUMTOXINA 300 UNITS 2013-04-03 2299-12-31 60 5 UNITS EA
J0587 10454071010 MYOBLOC RIMABOTULINUMTOXINB 2500/0.5ML 2007-07-01 2299-12-31 50 100 UNITS ML
J0587 10454071110 MYOBLOC RIMABOTULINUMTOXINB 5000/ML 2007-07-01 2299-12-31 50 100 UNITS ML
J0587 10454071210 MYOBLOC RIMABOTULINUMTOXINB 10000/2ML 2007-07-01 2299-12-31 50 100 UNITS ML
J0588 00259160501 XEOMIN INCOBOTULINUMTOXINA 50 UNIT 2012-01-01 2299-12-31 50 1 UNIT EA
J0588 00259161001 XEOMIN INCOBOTULINUMTOXINA 100 UNIT 2012-01-01 2299-12-31 100 1 UNIT EA
J0588 00259162001 XEOMIN INCOBOTULINUMTOXIN A 200U VIAL 2016-01-25 2299-12-31 1 1 UNIT EA
J0596 68012035001 RUCONEST C1 ESTERASE INHIBITOR 2100U VIAL 2016-01-01 2299-12-31 210 10 UNITS EA
J0596 68012035002 RUCONEST C1 ESTERASE INHIBITOR 2100U VIAL 2016-01-01 2299-12-31 210 10 UNITS EA
J0597 63833082502 BERINERT C1 ESTERASE INHIBITOR 500 UNIT 2012-01-01 2299-12-31 50 10 UNITS EA
J0597 63833083501 BERINERT C1 ESTERASE INHIBITOR 500(10 ML) 2012-05-10 2299-12-31 50 10 UNITS EA
J0598 42227008105 CINRYZE C1 ESTERASE INHIBITOR 500 (5 ML) 2015-10-01 2299-12-31 50 10 UNITS EA
J0638 00078058261 ILARIS CANAKINUMAB/PF 180 MG/1.2 2012-01-01 2299-12-31 180 1 MG EA
J0640 00703279701 CALCIUM FOLINATE LEUCOVORIN CALCIUM 10 MG/ML 2011-07-08 2299-12-31 0.2 50 MG ML
J0640 00703514001 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 100 MG 2007-07-01 2299-12-31 2 50 MG EA
J0640 00703514501 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 350 MG 2007-07-01 2299-12-31 7 50 MG EA
J0640 00703514591 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 350 MG 2013-05-09 2299-12-31 7 50 MG EA
J0640 25021081310 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 50 MG 2012-10-01 2299-12-31 1 50 MG EA
J0640 25021081366 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 50 MG 2012-11-10 2299-12-31 1 50 MG EA
J0640 25021081430 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 100 MG 2012-10-01 2299-12-31 2 50 MG EA
J0640 25021081467 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 100 MG 2013-09-27 2299-12-31 2 50 MG EA
J0640 25021081530 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 200 MG 2012-10-01 2299-12-31 4 50 MG EA
J0640 25021081567 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 200 MG 2013-09-27 2299-12-31 4 50 MG EA
J0640 25021081630 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 350 MG 2012-10-01 2299-12-31 7 50 MG EA
J0640 25021081667 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 350 MG 2013-08-20 2299-12-31 7 50 MG EA
Page 2 of 26
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Jcode NDC Brand Name Generic Name Strength Effective Begin
Date
Effective End
Date
Conversion
Factor
Jcode Billing Units NDC
Billing
Units
J0640 63323071050 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 200 MG 2010-11-03 2299-12-31 4 50 MG EA
J0640 63323071059 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 200 MG 2014-09-17 2299-12-31 4 50 MG EA
J0640 63323071100 LEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 500 MG 2007-07-01 2299-12-31 10 50 MG EA
J0641 00781320194 LEVOLEUCOVORIN
CALCIUM
LEVOLEUCOVORIN CALCIUM 10 MG/ML 2015-04-23 2299-12-31 20 0.5 MG ML
J0641 68152010100 FUSILEV LEVOLEUCOVORIN CALCIUM 50 MG 2009-01-01 2299-12-31 100 0.5 MG EA
J0696 00143985601 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 2 G 2016-01-01 2299-12-31 8 250 MG EA
J0696 00143985625 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 2 G 2016-01-01 2299-12-31 8 250 MG EA
J0696 00143985701 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 1 G 2016-01-01 2299-12-31 4 250 MG EA
J0696 00143985725 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 1 G 2016-01-01 2299-12-31 4 250 MG EA
J0696 00143985801 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 500 MG 2016-01-01 2299-12-31 2 250 MG EA
J0696 00143985825 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 500 MG 2016-01-01 2299-12-31 2 250 MG EA
J0696 00143985901 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 250 MG 2016-01-01 2299-12-31 1 250 MG EA
J0696 00143985925 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 250 MG 2016-01-01 2299-12-31 1 250 MG EA
J0696 00338500241 CEFTRIAXONE SODIUM IN DEXTROSECEFTRIAXONE SODIUM 1 G 2016-01-01 2299-12-31 0.08 250 MG ML
J0696 00338500341 CEFTRIAXONE SODIUM IN DEXTROSECEFTRIAXONE SODIUM 2 G 2016-01-01 2299-12-31 0.16 250 MG ML
J0696 00409733201 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 1 G 2016-01-01 2299-12-31 4 250 MG EA
J0696 00409733304 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 1 G 2016-01-01 2299-12-31 4 250 MG EA
J0696 00409733349 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 1 G 2016-01-01 2299-12-31 4 250 MG EA
J0696 00409733410 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 10G 2016-01-01 2299-12-31 40 250 MG EA
J0696 00409733503 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 2 G 2016-01-01 2299-12-31 8 250 MG EA
J0696 00409733604 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 2G 2016-01-01 2299-12-31 8 250 MG EA
J0696 00409733649 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 2 G 2016-01-01 2016-11-01 8 250 MG EA
J0696 00409733701 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 250 MG 2016-01-01 2299-12-31 1 250 MG EA
J0696 00409733801 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 500 MG 2016-01-01 2299-12-31 2 250 MG EA
J0696 00781320685 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 250 MG 2016-01-01 2299-12-31 1 250 MG EA
J0696 00781320695 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 250 MG 2016-01-01 2299-12-31 1 250 MG EA
J0696 00781320785 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 500 MG 2016-01-01 2299-12-31 2 250 MG EA
J0696 00781320795 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 500 MG 2016-01-01 2299-12-31 2 250 MG EA
J0696 00781320885 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 1G 2016-01-01 2299-12-31 4 250 MG EA
J0696 00781320895 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 1G 2016-01-01 2299-12-31 4 250 MG EA
J0696 00781320990 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 2 G 2016-01-01 2299-12-31 8 250 MG EA
J0696 00781320995 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 2 G 2016-01-01 2299-12-31 8 250 MG EA
J0696 00781321046 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 10G 2016-01-01 2299-12-31 40 250 MG EA
J0696 00781932785 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 500 MG 2016-01-01 2017-11-14 2 250 MG EA
J0696 00781932795 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 500 MG 2016-01-01 2017-09-16 2 250 MG EA
J0696 00781932885 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 1G 2016-01-01 2299-12-31 4 250 MG EA
J0696 00781932895 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 1G 2016-01-01 2299-12-31 4 250 MG EA
J0696 10019009801 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 1G 2016-01-01 2299-12-31 4 250 MG EA
J0696 10019009871 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 1G 2016-01-01 2299-12-31 4 250 MG EA
J0696 25021010510 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 500 MG 2016-01-01 2299-12-31 2 250 MG EA
J0696 25021010566 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 500 MG 2016-01-01 2299-12-31 2 250 MG EA
J0696 25021010610 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 1G 2016-01-01 2299-12-31 4 250 MG EA
J0696 25021010667 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 1 G 2016-01-01 2299-12-31 4 250 MG EA
J0696 25021010720 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 2 G 2016-01-01 2299-12-31 8 250 MG EA
J0696 25021010768 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 2 G 2016-01-01 2299-12-31 8 250 MG EA
J0696 25021010869 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 10 G 2016-01-01 2299-12-31 40 250 MG EA
J0696 25021010899 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 10 G 2016-01-01 2299-12-31 40 250 MG EA
J0696 44567070125 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 1G 2016-01-01 2299-12-31 4 250 MG EA
J0696 44567070225 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 2 G 2016-01-01 2299-12-31 8 250 MG EA
J0696 44567070301 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 10 G 2016-01-01 2299-12-31 40 250 MG EA
J0696 60505067905 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 10 G 2016-01-01 2299-12-31 40 250 MG EA
J0696 60505075000 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 250MG 2016-01-01 2299-12-31 1 250 MG EA
J0696 60505075001 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 250 MG 2016-01-01 2299-12-31 1 250 MG EA
J0696 60505075004 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 250 MG 2016-01-01 2299-12-31 1 250 MG EA
J0696 60505075100 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 500 MG 2016-01-01 2299-12-31 2 250 MG EA
J0696 60505075101 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 500 MG 2016-01-01 2299-12-31 2 250 MG EA
J0696 60505075104 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 500 MG 2016-01-01 2299-12-31 2 250 MG EA
J0696 60505075203 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 1 G 2016-01-01 2299-12-31 4 250 MG EA
J0696 60505075204 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 1 G 2016-01-01 2299-12-31 4 250 MG EA
J0696 60505075303 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 2 G 2016-01-01 2299-12-31 8 250 MG EA
J0696 60505075304 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 2 G 2016-01-01 2299-12-31 8 250 MG EA
J0696 60505610201 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 2 G 2016-01-01 2299-12-31 8 250 MG EA
J0696 60505610204 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 2 G 2016-01-01 2299-12-31 8 250 MG EA
J0696 60505610306 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 10 G 2016-01-01 2017-08-31 40 250 MG EA
Page 3 of 26
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Jcode NDC Brand Name Generic Name Strength Effective Begin
Date
Effective End
Date
Conversion
Factor
Jcode Billing Units NDC
Billing
Units
J0696 60505610401 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 250 MG 2016-01-01 2017-11-30 1 250 MG EA
J0696 60505610404 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 250MG 2016-01-01 2017-11-30 1 250 MG EA
J0696 60505614800 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 1 G 2017-06-21 2299-12-31 4 250 MG EA
J0696 60505614804 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 1 G 2017-06-21 2299-12-31 4 250 MG EA
J0696 60505614900 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 2 G 2017-06-21 2299-12-31 8 250 MG EA
J0696 60505614904 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 2 G 2017-06-21 2299-12-31 8 250 MG EA
J0696 60505615101 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 250 MG 2017-06-21 2299-12-31 1 250 MG EA
J0696 60505615104 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 250 MG 2017-06-21 2299-12-31 1 250 MG EA
J0696 60505615201 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 500 MG 2017-06-21 2299-12-31 2 250 MG EA
J0696 60505615204 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 500 MG 2017-06-21 2299-12-31 2 250 MG EA
J0696 63323034410 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 250MG 2016-01-01 2299-12-31 1 250 MG EA
J0696 63323034510 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 500 MG 2016-01-01 2299-12-31 2 250 MG EA
J0696 63323034610 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 1G 2016-01-01 2299-12-31 4 250 MG EA
J0696 63323034720 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 2 G 2016-01-01 2299-12-31 8 250 MG EA
J0696 63323034861 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 10G 2016-01-01 2299-12-31 40 250 MG EA
J0696 64679070102 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 250 MG 2016-01-01 2016-11-30 1 250 MG EA
J0696 64679070202 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 500 MG 2016-01-01 2016-10-31 2 250 MG EA
J0696 64679070301 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 2 G 2016-01-01 2017-10-31 8 250 MG EA
J0696 64679098301 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 1 G 2016-01-01 2019-02-28 4 250 MG EA
J0696 64679098302 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 1 G 2016-01-01 2019-02-28 4 250 MG EA
J0696 68180061101 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 250MG 2016-01-01 2299-12-31 1 250 MG EA
J0696 68180061110 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 250MG 2016-01-01 2299-12-31 1 250 MG EA
J0696 68180062201 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 500 MG 2016-01-01 2299-12-31 2 250 MG EA
J0696 68180062210 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 500 MG 2016-01-01 2299-12-31 2 250 MG EA
J0696 68180063301 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 1G 2016-01-01 2299-12-31 4 250 MG EA
J0696 68180063310 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 1G 2016-01-01 2299-12-31 4 250 MG EA
J0696 68180064401 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 2 G 2016-01-01 2299-12-31 8 250 MG EA
J0696 68180064410 CEFTRIAXONE SODIUM CEFTRIAXONE SODIUM 2 G 2016-01-01 2299-12-31 8 250 MG EA
J0702 00517072001 BETAMETHASONE AC-SP 6 MG/ML VLBETAMETHASONE ACETATE,SOD PHOS6 MG/ML 2017-01-01 2299-12-31 1 6 MG ML
J0702 35356008401 CELESTONE SOLUSPAN 30 MG/5 MLBETAMETHASONE ACETATE,SOD PHOS6 MG/ML 2017-05-15 2299-12-31 1 6 MG ML
J0702 49836001817 CELESTONE SOLUSPAN 6 MG/MLBETAMETHASONE ACETATE,SOD PHOS6 MG/ML 2017-01-01 2299-12-31 1 6 MG ML
J0712 00456040001 TEFLARO CEFTAROLINE FOSAMIL
ACETATE
400 MG 2012-01-01 2299-12-31 40 10 MG EA
J0712 00456040010 TEFLARO CEFTAROLINE FOSAMIL
ACETATE
400 MG 2012-01-01 2299-12-31 40 10 MG EA
J0712 00456060001 TEFLARO CEFTAROLINE FOSAMIL
ACETATE
600 MG 2012-01-01 2299-12-31 60 10 MG EA
J0712 00456060010 TEFLARO CEFTAROLINE FOSAMIL
ACETATE
600 MG 2012-01-01 2299-12-31 60 10 MG EA
J0714 00456270010 AVYCAZ CEFTAZIDIME/AVIBACTAM 2.5G 2016-01-01 2299-12-31 4 0.5G/0.125G EA
J0716 66621015001 ANASCORP CENTRUROIDES (SCORPN)
ANTIVENOM
120 MG 2013-01-01 2299-12-31 1 120 MG EA
J0775 66887000301 XIAFLEX COLLAGENASE CLOSTRIDIUM
HIST.
0.9 MG 2012-01-01 2299-12-31 90 0.01 MG EA
J0850 44206053211 CYTOGAM CYTOMEGALOVIRUS IMMUNE
GLOB
50 MG/ML 2011-01-18 2299-12-31 1 1 EA ML
J0875 57970010001 DALVANCE DALBAVANCIN 500 MG 2016-01-01 2299-12-31 50 10 UNITS EA
J0881 55513000201 ARANESP DARBEPOETIN ALFA IN
POLYSORBAT
25 MCG/ML 2007-07-01 2299-12-31 25 1 MCG ML
J0881 55513000204 ARANESP DARBEPOETIN ALFA IN
POLYSORBAT
25 MCG/ML 2007-07-01 2299-12-31 25 1 MCG ML
J0881 55513000301 ARANESP DARBEPOETIN ALFA IN
POLYSORBAT
40MCG/ML 2007-07-01 2299-12-31 40 1 MCG ML
J0881 55513000304 ARANESP DARBEPOETIN ALFA IN
POLYSORBAT
40MCG/ML 2007-07-01 2299-12-31 40 1 MCG ML
J0881 55513000401 ARANESP DARBEPOETIN ALFA IN
POLYSORBAT
60MCG/ML 2007-07-01 2299-12-31 60 1 MCG ML
J0881 55513000404 ARANESP DARBEPOETIN ALFA IN
POLYSORBAT
60MCG/ML 2007-07-01 2299-12-31 60 1 MCG ML
J0881 55513000501 ARANESP DARBEPOETIN ALFA IN
POLYSORBAT
100 MCG/ML 2007-07-01 2299-12-31 100 1 MCG ML
J0881 55513000504 ARANESP DARBEPOETIN ALFA IN
POLYSORBAT
100 MCG/ML 2007-07-01 2299-12-31 100 1 MCG ML
J0881 55513000601 ARANESP DARBEPOETIN ALFA IN
POLYSORBAT
200 MCG/ML 2007-07-01 2299-12-31 200 1 MCG ML
J0881 55513002101 ARANESP DARBEPOETIN ALFA IN
POLYSORBAT
40MCG/0.4 2007-07-01 2299-12-31 40 1 MCG ML
J0881 55513002104 ARANESP DARBEPOETIN ALFA IN
POLYSORBAT
40MCG/0.4 2007-07-01 2299-12-31 40 1 MCG ML
J0881 55513002301 ARANESP DARBEPOETIN ALFA IN
POLYSORBAT
60MCG/0.3 2007-07-01 2299-12-31 60 1 MCG ML
J0881 55513002304 ARANESP DARBEPOETIN ALFA IN
POLYSORBAT
60MCG/0.3 2007-07-01 2299-12-31 60 1 MCG ML
J0881 55513002501 ARANESP DARBEPOETIN ALFA IN
POLYSORBAT
100MCG/0.5 2007-07-01 2299-12-31 100 1 MCG ML
J0881 55513002504 ARANESP DARBEPOETIN ALFA IN
POLYSORBAT
100MCG/0.5 2007-07-01 2299-12-31 100 1 MCG ML
J0881 55513002701 ARANESP DARBEPOETIN ALFA IN
POLYSORBAT
150MCG/0.3 2007-07-01 2299-12-31 500 1 MCG ML
J0881 55513002704 ARANESP DARBEPOETIN ALFA IN
POLYSORBAT
150MCG/0.3 2007-07-01 2299-12-31 500 1 MCG ML
J0881 55513002801 ARANESP DARBEPOETIN ALFA IN
POLYSORBAT
200MCG/0.4 2007-07-01 2299-12-31 500 1 MCG ML
J0881 55513003201 ARANESP DARBEPOETIN ALFA IN
POLYSORBAT
500MCG/ML 2007-07-01 2299-12-31 500 1 MCG ML
J0881 55513005301 ARANESP DARBEPOETIN ALFA IN
POLYSORBAT
150MCG/.75 2007-07-01 2299-12-31 200 1 MCG ML
J0881 55513005701 ARANESP DARBEPOETIN ALFA IN
POLYSORBAT
25MCG/0.42 2007-07-01 2299-12-31 59.52381 1 MCG ML
J0881 55513005704 ARANESP DARBEPOETIN ALFA IN
POLYSORBAT
25MCG/0.42 2007-07-01 2299-12-31 59.52381 1 MCG ML
J0881 55513009801 ARANESP DARBEPOETIN ALFA IN
POLYSORBAT
10MCG/0.4 2015-03-16 2299-12-31 25 1 MCG ML
J0881 55513009804 ARANESP DARBEPOETIN ALFA IN
POLYSORBAT
10MCG/0.4 2015-03-16 2299-12-31 25 1 MCG ML
Page 4 of 26
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Jcode NDC Brand Name Generic Name Strength Effective Begin
Date
Effective End
Date
Conversion
Factor
Jcode Billing Units NDC
Billing
Units
J0881 55513011001 ARANESP DARBEPOETIN ALFA IN
POLYSORBAT
300MCG/ML 2007-07-01 2299-12-31 300 1 MCG ML
J0881 55513011101 ARANESP DARBEPOETIN ALFA IN
POLYSORBAT
300MCG/0.6 2007-07-01 2299-12-31 500 1 MCG ML
J0885 55513012601 EPOGEN EPOETIN ALFA 2000/ML 2007-07-01 2299-12-31 2 1000 UNITS ML
J0885 55513012610 EPOGEN EPOETIN ALFA 2000/ML 2007-07-01 2299-12-31 2 1000 UNITS ML
J0885 55513014401 EPOGEN EPOETIN ALFA 10000/ML 2007-07-01 2299-12-31 10 1000 UNITS ML
J0885 55513014410 EPOGEN EPOETIN ALFA 10000/ML 2007-07-01 2299-12-31 10 1000 UNITS ML
J0885 55513014801 EPOGEN EPOETIN ALFA 4000/ML 2007-07-01 2299-12-31 4 1000 UNITS ML
J0885 55513014810 EPOGEN EPOETIN ALFA 4000/ML 2007-07-01 2299-12-31 4 1000 UNITS ML
J0885 55513026701 EPOGEN EPOETIN ALFA 3000/ML 2007-07-01 2299-12-31 3 1000 UNITS ML
J0885 55513026710 EPOGEN EPOETIN ALFA 3000/ML 2007-07-01 2299-12-31 3 1000 UNITS ML
J0885 55513028301 EPOGEN EPOETIN ALFA 20000/2ML 2007-07-01 2299-12-31 10 1000 UNITS ML
J0885 55513028310 EPOGEN EPOETIN ALFA 20000/2ML 2007-07-01 2299-12-31 10 1000 UNITS ML
J0885 55513047801 EPOGEN EPOETIN ALFA 20000/ML 2007-07-01 2299-12-31 20 1000 UNITS ML
J0885 55513047810 EPOGEN EPOETIN ALFA 20000/ML 2007-07-01 2299-12-31 20 1000 UNITS ML
J0885 59676030201 PROCRIT EPOETIN ALFA 2000/ML 2007-07-01 2299-12-31 2 1000 UNITS ML
J0885 59676030300 PROCRIT EPOETIN ALFA 3000/ML 2015-08-03 2299-12-31 3 1000 UNITS ML
J0885 59676030301 PROCRIT EPOETIN ALFA 3000/ML 2007-07-01 2299-12-31 3 1000 UNITS ML
J0885 59676030400 PROCRIT EPOETIN ALFA 4000/ML 2015-08-03 2299-12-31 4 1000 UNITS ML
J0885 59676030401 PROCRIT EPOETIN ALFA 4000/ML 2007-07-01 2299-12-31 4 1000 UNITS ML
J0885 59676031000 PROCRIT EPOETIN ALFA 10000/ML 2007-07-01 2299-12-31 10 1000 UNITS ML
J0885 59676031001 PROCRIT EPOETIN ALFA 10000/ML 2007-07-01 2299-12-31 10 1000 UNITS ML
J0885 59676031002 PROCRIT EPOETIN ALFA 10000/ML 2007-07-01 2299-12-31 10 1000 UNITS ML
J0885 59676031204 PROCRIT EPOETIN ALFA 20000/2ML 2008-01-18 2299-12-31 10 1000 UNITS ML
J0885 59676032000 PROCRIT EPOETIN ALFA 20000/ML 2013-09-06 2299-12-31 2 1000 UNITS ML
J0885 59676032004 PROCRIT EPOETIN ALFA 20000/ML 2007-10-15 2299-12-31 20 1000 UNITS ML
J0885 59676034000 PROCRIT EPOETIN ALFA 40000/ML 2015-05-27 2299-12-31 4 1000 UNITS ML
J0885 59676034001 PROCRIT EPOETIN ALFA 40000/ML 2007-07-01 2299-12-31 40 1000 UNITS ML
J0888 00004040109 MIRCERA METHOXY PEG-EPOETIN
BETA
50 MCG/0.3 ML 2015-01-01 2299-12-31 150 1 MCG ML
J0888 00004040209 MIRCERA METHOXY PEG-EPOETIN
BETA
75 MCG/0.3 ML 2015-01-01 2299-12-31 225 1 MCG ML
J0888 00004040309 MIRCERA METHOXY PEG-EPOETIN
BETA
100 MCG/0.3 ML 2015-01-01 2299-12-31 330 1 MCG ML
J0888 00004040509 MIRCERA METHOXY PEG-EPOETIN
BETA
200MCG/0.3 2015-03-04 2299-12-31 666 1 MCG ML
J0897 55513071001 PROLIA DENOSUMAB 60 MG/ML 2012-01-01 2299-12-31 60 1 MG ML
J0897 55513073001 XGEVA DENOSUMAB 120 MG/1.7 2012-01-01 2299-12-31 70 1 MG ML
J1030 00009028002 DEPO-MEDROL (M.D.V.) 40 MG/MLMETHYLPREDNISOLONE ACETATE 40 MG/ML 2018-04-01 2299-12-31 1 40 MG ML
J1030 00009028003 DEPO-MEDROL (M.D.V.) 40 MG/MLMETHYLPREDNISOLONE ACETATE 40 MG/ML 2018-04-01 2299-12-31 1 40 MG ML
J1030 00009028051 DEPO-MEDROL (M.D.V.) 40 MG/MLMETHYLPREDNISOLONE ACETATE 40 MG/ML 2018-04-01 2299-12-31 1 40 MG ML
J1030 00009028052 DEPO-MEDROL (M.D.V.) 40 MG/MLMETHYLPREDNISOLONE ACETATE 40 MG/ML 2018-04-01 2299-12-31 1 40 MG ML
J1030 00009307301 DEPO-MEDROL (S.D.V.) 40 MG/MLMETHYLPREDNISOLONE ACETATE 40 MG/ML 2018-04-01 2299-12-31 1 40 MG ML
J1030 00009307303 DEPO-MEDROL (S.D.V.) 40 MG/MLMETHYLPREDNISOLONE ACETATE 40 MG/ML 2018-04-01 2299-12-31 1 40 MG ML
J1030 00009307322 DEPO-MEDROL (S.D.V.) 40 MG/MLMETHYLPREDNISOLONE ACETATE 40 MG/ML 2018-04-01 2299-12-31 1 40 MG ML
J1030 00009307323 DEPO-MEDROL (S.D.V.) 40 MG/MLMETHYLPREDNISOLONE ACETATE 40 MG/ML 2018-04-01 2299-12-31 1 40 MG ML
J1030 00703003101 METHYLPREDNISOLONE ACETATE (SDV) 40 MG/MLMETHYLPREDNISOLONE ACETATE 40 MG/ML 2018-04-01 2299-12-31 1 40 MG ML
J1030 00703003104 METHYLPREDNISOLONE ACETATE (SDV) 40 MG/MLMETHYLPREDNISOLONE ACETATE 40 MG/ML 2018-04-01 2299-12-31 1 40 MG ML
J1030 00703004301 METHYLPREDNISOLONE ACETATE (MDV,USP) 40 MG/MLMETHYLPREDNISOLONE ACETATE 40 MG/ML 2018-04-01 2299-12-31 1 40 MG ML
J1030 00703004501 METHYLPREDNISOLONE ACETATE (MDV,USP) 40 MG/MLMETHYLPREDNISOLONE ACETATE 40 MG/ML 2018-04-01 2299-12-31 1 40 MG ML
J1030 00781313171 METHYLPREDNISOLONE ACETATE (SDV) 40 MG/MLMETHYLPREDNISOLONE ACETATE 40 MG/ML 2018-04-01 2299-12-31 1 40 MG ML
J1030 00781313195 METHYLPREDNISOLONE ACETATE (SDV) 40 MG/MLMETHYLPREDNISOLONE ACETATE 40 MG/ML 2018-04-01 2299-12-31 1 40 MG ML
J1030 00781313670 METHYLPREDNISOLONE ACETATE (MDV,USP) 40 MG/MLMETHYLPREDNISOLONE ACETATE 40 MG/ML 2018-04-01 2299-12-31 1 40 MG ML
J1040 00009030602 DEPO-MEDROL SUSP METHYLPREDNISOLONE 80MG/ML 2015-10-01 2299-12-31 1 5 ML ML
J1040 00009030612 DEPO-MEDROL SUSP METHYLPREDNISOLONE 80MG/ML 2015-10-01 2299-12-31 1 5 ML ML
J1040 00009347501 DEPO-MEDROL SUSP METHYLPREDNISOLONE 80MG/ML 2015-10-01 2299-12-31 1 1 ML ML
J1040 00009347503 DEPO-MEDROL SUSP METHYLPREDNISOLONE 80MG/ML 2015-10-01 2299-12-31 1 1 ML ML
J1040 00009347522 DEPO-MEDROL SUSP METHYLPREDNISOLONE 80MG/ML 2015-10-01 2299-12-31 1 1 ML ML
J1040 00009347523 DEPO-MEDROL SUSP METHYLPREDNISOLONE 80MG/ML 2015-10-01 2299-12-31 1 1 ML ML
J1040 00703005101 METHYLPREDNISOLONE
ACETATE SUSP
METHYLPREDNISOLONE 80MG/ML 2015-10-01 2299-12-31 1 1 ML ML
J1040 00703005104 METHYLPREDNISOLONE
ACETATE SUSP
METHYLPREDNISOLONE 80MG/ML 2015-10-01 2299-12-31 1 1 ML ML
J1040 00703006301 METHYLPREDNISOLONE
ACETATE SUSP
METHYLPREDNISOLONE 80MG/ML 2015-10-01 2299-12-31 1 5 ML ML
J1040 00781313295 METHYLPREDNISOLONE
ACETATE SUSP
METHYLPREDNISOLONE 80MG/ML 2015-10-01 2299-12-31 1 1 ML ML
J1040 00781313775 METHYLPREDNISOLONE
ACETATE SUSP
METHYLPREDNISOLONE 80MG/ML 2015-10-01 2299-12-31 1 5 ML ML
J1050 00009062601 DEPO-PROVERA MEDROXYPROGESTERONE
ACETATE
400 MG/ML 2015-10-01 2299-12-31 400 1 MG ML
J1050 00009074630 DEPO-PROVERA MEDROXYPROGESTERONE
ACETATE
150 MG/ML 2013-01-01 2299-12-31 150 1 MG ML
J1050 00009074635 DEPO-PROVERA MEDROXYPROGESTERONE
ACETATE
150 MG/ML 2013-01-01 2299-12-31 150 1 MG ML
J1050 00009737611 DEPO-PROVERA MEDROXYPROGESTERONE
ACETATE
150 MG/ML 2013-01-01 2299-12-31 150 1 MG ML
J1050 00548540000 MEDROXYPROGESTERONE ACETATEMEDROXYPROGESTERONE ACETATE150 MG/ML 2018-05-23 2299-12-31 150 1 MG ML
Page 5 of 26
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Jcode NDC Brand Name Generic Name Strength Effective Begin
Date
Effective End
Date
Conversion
Factor
Jcode Billing Units NDC
Billing
Units
J1050 00548540025 MEDROXYPROGESTERONE ACETATEMEDROXYPROGESTERONE ACETATE150 MG/ML 2018-05-23 2299-12-31 150 1 MG ML
J1050 00548570100 MEDROXYPROGESTERONE ACETATEMEDROXYPROGESTERONE ACETATE150 MG/ML 2018-07-01 2299-12-31 150 1 MG ML
J1050 00703680101 MEDROXYPROGESTERONE
ACETATE
MEDROXYPROGESTERONE
ACETATE
150 MG/ML 2013-01-01 2299-12-31 150 1 MG ML
J1050 00703680104 MEDROXYPROGESTERONE
ACETATE
MEDROXYPROGESTERONE
ACETATE
150 MG/ML 2013-01-01 2299-12-31 150 1 MG ML
J1050 59762453701 MEDROXYPROGESTERONE
ACETATE
MEDROXYPROGESTERONE
ACETATE
150 MG/ML 2013-01-01 2299-12-31 150 1 MG ML
J1050 59762453702 MEDROXYPROGESTERONE
ACETATE
MEDROXYPROGESTERONE
ACETATE
150 MG/ML 2013-01-01 2299-12-31 150 1 MG ML
J1050 59762453801 MEDROXYPROGESTERONE
ACETATE
MEDROXYPROGESTERONE
ACETATE
150 MG/ML 2013-01-01 2299-12-31 150 1 MG ML
J1050 59762453802 MEDROXYPROGESTERONE
ACETATE
MEDROXYPROGESTERONE
ACETATE
150 MG/ML 2013-01-01 2299-12-31 150 1 MG ML
J1071 00009008510 DEPO-TESTOSTERONE TESTOSTERONE CYPIONATE 100 MG/ML 2015-01-01 2299-12-31 100 1 MG ML
J1071 00009008601 DEPO-TESTOSTERONE TESTOSTERONE CYPIONATE 200 MG/ML 2015-01-01 2299-12-31 200 1 MG ML
J1071 00009008610 DEPO-TESTOSTERONE TESTOSTERONE CYPIONATE 200 MG/ML 2015-01-01 2299-12-31 200 1 MG ML
J1071 00009034702 DEPO-TESTOSTERONE TESTOSTERONE CYPIONATE 100 MG/ML 2015-01-01 2299-12-31 100 1 MG ML
J1071 00009041701 DEPO-TESTOSTERONE TESTOSTERONE CYPIONATE 200 MG/ML 2015-01-01 2299-12-31 200 1 MG ML
J1071 00009041702 DEPO-TESTOSTERONE TESTOSTERONE CYPIONATE 200 MG/ML 2015-01-01 2299-12-31 200 1 MG ML
J1071 00009052001 DEPO-TESTOSTERONE TESTOSTERONE CYPIONATE 200 MG/ML 2015-01-01 2299-12-31 200 1 MG ML
J1071 00009052010 DEPO-TESTOSTERONE TESTOSTERONE CYPIONATE 200 MG/ML 2015-01-01 2299-12-31 200 1 MG ML
J1071 00143972601 TESTOSTERON CYP TESTOSTERONE CYPIONATE 200 MG/ML 2015-01-01 2299-12-31 200 1 MG ML
J1071 00574082001 TESTOSTERON CYP TESTOSTERONE CYPIONATE 200 MG/ML 2015-01-01 2299-12-31 200 1 MG ML
J1071 00574082010 TESTOSTERON CYP TESTOSTERONE CYPIONATE 200 MG/ML 2015-01-01 2299-12-31 200 1 MG ML
J1071 00574082710 TESTOSTERON CYP TESTOSTERONE CYPIONATE 200 MG/ML 2015-01-01 2299-12-31 200 1 MG ML
J1071 00591412879 TESTOSTERON CYP TESTOSTERONE CYPIONATE 200 MG/ML 2015-03-05 2299-12-31 200 1 MG ML
J1071 00781307370 TESTOSTERON CYP TESTOSTERONE CYPIONATE 100 MG/ML 2015-01-01 2299-12-31 100 1 MG ML
J1071 00781307470 TESTOSTERON CYP TESTOSTERONE CYPIONATE 200 MG/ML 2015-01-01 2299-12-31 200 1 MG ML
J1071 00781307471 TESTOSTERON CYP TESTOSTERONE CYPIONATE 200 MG/ML 2015-01-01 2299-12-31 200 1 MG ML
J1071 62756001540 TESTOSTERON CYP TESTOSTERONE CYPIONATE 200 MG/ML 2015-01-01 2299-12-31 200 1 MG ML
J1071 62756001640 TESTOSTERON CYP TESTOSTERONE CYPIONATE 200 MG/ML 2015-01-01 2299-12-31 200 1 MG ML
J1071 62756001740 TESTOSTERON CYP TESTOSTERONE CYPIONATE 100 MG/ML 2015-01-01 2299-12-31 100 1 MG ML
J1100 00641036721 DEXAMETHASONE 10 MG/ML VIALDEXAMETHASONE SOD PHOSPHATE10MG/ML 2017-01-01 2299-12-31 4 1 MG ML
J1100 00641036725 DEXAMETHASONE 10 MG/ML VIALDEXAMETHASONE SOD PHOSPHATE10MG/ML 2017-01-01 2299-12-31 10 1 MG ML
J1100 00641614501 DEXAMETHASONE SODIUM PHOSPHATE DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML 2017-01-26 2299-12-31 4 1 MG ML
J1100 00641614525 DEXAMETHASONE 4 MG/ML VIALDEXAMETHASONE SOD PHOSPHATE4 MG/ML 2017-03-16 2299-12-31 4 1 MG ML
J1100 00641614601 DEXAMETHASONE SODIUM PHOSPHATE DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML 2017-01-26 2299-12-31 4 1 MG ML
J1100 00641614625 DEXAMETHASONE 20 MG/5 ML VIALDEXAMETHASONE SOD PHOSPHATE4 MG/ML 2017-03-16 2299-12-31 4 1 MG ML
J1100 55150023701 DEXAMETHASONE 4 MG/ML VIALDEXAMETHASONE SOD PHOSPHATE4 MG/ML 2017-01-01 2299-12-31 4 1 MG ML
J1100 55150023805 DEXAMETHASONE 20 MG/5 ML VIALDEXAMETHASONE SOD PHOSPHATE4 MG/ML 2017-01-01 2299-12-31 4 1 MG ML
J1100 55150023930 DEXAMETHASONE 120 MG/30 ML VLDEXAMETHASONE SOD PHOSPHATE4 MG/ML 2017-01-01 2299-12-31 4 1 MG ML
J1100 63323016501 DEXAMETHASONE 4 MG/ML VIALDEXAMETHASONE SOD PHOSPHATE4MG/ML 2017-01-01 2299-12-31 4 1 MG ML
J1100 63323016505 DEXAMETHASONE 20 MG/5 ML VIALDEXAMETHASONE SOD PHOSPHATE4MG/ML 2017-01-01 2299-12-31 4 1 MG ML
J1100 63323016516 DEXAMETHASONE SODIUM PHOSPHATE DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML 2017-01-01 2299-12-31 4 1 MG ML
J1100 63323016526 DEXAMETHASONE SODIUM PHOSPHATE DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML 2017-01-01 2299-12-31 4 1 MG ML
J1100 63323016530 DEXAMETHASONE SODIUM PHOSPHATE DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML 2017-01-01 2299-12-31 4 1 MG ML
J1100 63323050601 DEXAMETHASONE SODIUM PHOSPHATE DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML 2017-01-01 2299-12-31 10 1 MG ML
J1100 63323050616 DEXAMETHASONE SODIUM PHOSPHATE DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML 2017-01-01 2299-12-31 10 1 MG ML
J1100 63323051610 DEXAMETHASONE SODIUM PHOSPHATE DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML 2017-01-01 2299-12-31 10 1 MG ML
J1100 67457042010 DEXAMETHASONE SODIUM PHOSPHATE DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML 2017-01-01 2299-12-31 10 1 MG ML
J1100 67457042100 DEXAMETHASONE SODIUM PHOSPHATE DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML 2017-01-01 2299-12-31 4 1 MG ML
J1100 67457042130 DEXAMETHASONE SODIUM PHOSPHATE DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML 2017-01-01 2299-12-31 4 1 MG ML
J1100 67457042200 DEXAMETHASONE SODIUM PHOSPHATE DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML 2017-03-09 2299-12-31 4 1 MG ML
J1100 67457042254 DEXAMETHASONE SODIUM PHOSPHATE DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML 2017-01-01 2299-12-31 4 1 MG ML
J1100 67457042300 DEXAMETHASONE SODIUM PHOSPHATE DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML 2017-01-01 2299-12-31 4 1 MG ML
J1100 67457042312 DEXAMETHASONE SODIUM PHOSPHATE DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML 2017-01-01 2299-12-31 4 1 MG ML
J1100 76045010610 DEXAMETHASONE SODIUM PHOSPHATE DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML 2017-01-01 2299-12-31 4 1 MG ML
J1170 00409128305 HYDROMORPHONE HCL HYDROMORPHONE HCL 0.5MG/.5ML 2013-08-16 2299-12-31 0.25 4 MG ML
J1170 00409128310 HYDROMORPHONE HCL HYDROMORPHONE HCL/PF 1 MG/ML 2011-02-08 2299-12-31 0.25 4 MG ML
J1170 00409128331 HYDROMORPHONE HCL HYDROMORPHONE HCL/PF 1 MG/ML 2007-07-01 2299-12-31 0.25 4 MG ML
J1170 00409130431 HYDROMORPHONE HCL HYDROMORPHONE HCL/PF 4 MG/ML 2007-07-01 2299-12-31 1 4 MG ML
J1170 00409131210 HYDROMORPHONE HCL HYDROMORPHONE HCL/PF 2 MG/ML 2011-02-08 2299-12-31 0.5 4 MG ML
J1170 00409131230 HYDROMORPHONE HCL HYDROMORPHONE HCL/PF 2 MG/ML 2007-07-01 2299-12-31 0.5 4 MG ML
J1170 00409254001 HYDROMORPHONE HCL HYDROMORPHONE HCL/PF 4 MG/ML 2007-07-01 2299-12-31 1 4 MG ML
J1170 00409255201 HYDROMORPHONE HCL HYDROMORPHONE HCL/PF 1 MG/ML 2007-07-01 2299-12-31 0.25 4 MG ML
J1170 00409263401 HYDROMORPHONE HCL HYDROMORPHONE HCL/PF 10 MG/ML 2008-07-18 2299-12-31 2.5 4 MG ML
J1170 00409263405 HYDROMORPHONE HCL HYDROMORPHONE HCL/PF 10 MG/ML 2008-07-18 2299-12-31 2.5 4 MG ML
J1170 00409263450 HYDROMORPHONE HCL HYDROMORPHONE HCL/PF 10 MG/ML 2008-07-18 2299-12-31 2.5 4 MG ML
J1170 00409335601 HYDROMORPHONE HCL HYDROMORPHONE HCL/PF 2 MG/ML 2007-07-01 2299-12-31 0.5 4 MG ML
Page 6 of 26
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Jcode NDC Brand Name Generic Name Strength Effective Begin
Date
Effective End
Date
Conversion
Factor
Jcode Billing Units NDC
Billing
Units
J1170 00409336501 HYDROMORPHONE HCL HYDROMORPHONE HCL/PF 2 MG/ML 2007-07-01 2299-12-31 0.5 4 MG ML
J1170 00641012121 HYDROMORPHONE HCL HYDROMORPHONE HCL 2 MG/ML 2007-07-01 2299-12-31 0.5 4 MG ML
J1170 00641012125 HYDROMORPHONE HCL HYDROMORPHONE HCL 2 MG/ML 2007-07-01 2299-12-31 0.5 4 MG ML
J1170 00641234139 HYDROMORPHONE HCL HYDROMORPHONE HCL 2 MG/ML 2007-07-01 2299-12-31 0.5 4 MG ML
J1170 00641234141 HYDROMORPHONE HCL HYDROMORPHONE HCL 2 MG/ML 2007-07-01 2299-12-31 0.5 4 MG ML
J1170 00703001801 HYDROMORPHONE HCL HYDROMORPHONE HCL/PF 10 MG/ML 2011-01-06 2299-12-31 2.5 4 MG ML
J1170 00703011003 HYDROMORPHONE HCL HYDROMORPHONE HCL/PF 10 MG/ML 2011-01-06 2299-12-31 2.5 4 MG ML
J1170 00703011303 HYDROMORPHONE HCL HYDROMORPHONE HCL/PF 10 MG/ML 2011-01-06 2299-12-31 2.5 4 MG ML
J1170 17478054001 HYDROMORPHONE HCL HYDROMORPHONE HCL/PF 10 MG/ML 2007-07-01 2299-12-31 2.5 4 MG ML
J1170 17478054005 HYDROMORPHONE HCL HYDROMORPHONE HCL/PF 10 MG/ML 2007-07-01 2299-12-31 2.5 4 MG ML
J1170 17478054050 HYDROMORPHONE HCL HYDROMORPHONE HCL/PF 10 MG/ML 2007-07-01 2299-12-31 2.5 4 MG ML
J1170 59011044110 DILAUDID HYDROMORPHONE HCL/PF 1 MG/ML 2009-01-01 2016-05-08 0.25 4 MG ML
J1170 59011044210 DILAUDID HYDROMORPHONE HCL/PF 2 MG/ML 2008-11-03 2016-09-14 0.5 4 MG ML
J1170 59011044225 DILAUDID HYDROMORPHONE HCL/PF 2 MG/ML 2009-01-01 2017-02-28 0.5 4 MG ML
J1170 59011044410 DILAUDID HYDROMORPHONE HCL/PF 4 MG/ML 2008-11-03 2017-04-30 1 4 MG ML
J1170 59011044501 DILAUDID-HP HYDROMORPHONE HCL/PF 10 MG/ML 2008-11-03 2299-12-31 2.5 4 MG ML
J1170 59011044505 DILAUDID-HP HYDROMORPHONE HCL/PF 10 MG/ML 2008-11-03 2299-12-31 2.5 4 MG ML
J1170 59011044550 DILAUDID-HP HYDROMORPHONE HCL/PF 10 MG/ML 2008-11-03 2016-07-27 2.5 4 MG ML
J1170 59011044625 DILAUDID-HP HYDROMORPHONE HCL/PF 250 MG 2008-11-03 2016-07-27 62.5 4 MG ML
J1190 00013871762 ZINECARD DEXRAZOXANE 250 MG 2009-09-10 2299-12-31 1 250 MG EA
J1190 00013872789 ZINECARD DEXRAZOXANE 500 MG 2009-09-10 2299-12-31 2 250 MG EA
J1190 67457020425 DEXRAZOXANE DEXRAZOXANE 250 MG 2009-10-10 2299-12-31 1 250 MG EA
J1190 67457020725 DEXRAZOXANE DEXRAZOXANE 250 MG 2009-10-10 2299-12-31 1 250 MG EA
J1190 67457020850 DEXRAZOXANE DEXRAZOXANE 500 MG 2009-10-10 2299-12-31 1 250 MG EA
J1190 67457020950 DEXRAZOXANE DEXRAZOXANE 500 MG 2009-10-10 2299-12-31 1 250 MG EA
J1200 00409229031 DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL 50 MG/ML 2014-11-25 2299-12-31 1 50 MG ML
J1200 00641037621 DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL 50 MG/ML 2014-11-25 2299-12-31 1 50 MG ML
J1200 00641037625 DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL 50 MG/ML 2014-11-25 2299-12-31 1 50 MG ML
J1200 63323066401 DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL 50 MG/ML 2014-11-25 2299-12-31 1 50 MG ML
J1200 67457012410 DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL 50 MG/ML 2014-11-25 2299-12-31 1 50 MG ML
J1200 76045010210 DIPHENHYDRAMINE HCL DIPHENHYDRAMINE HCL 50 MG/ML 2014-11-25 2299-12-31 1 50 MG ML
J1260 00088120632 ANZEMET DOLASETRON MESYLATE 100 MG/5ML 2007-07-01 2299-12-31 2 10 MG ML
J1260 00088120806 ANZEMET DOLASETRON MESYLATE 12.5/0.625 2007-07-01 2299-12-31 2 10 MG ML
J1260 00088120926 ANZEMET DOLASETRON MESYLATE 20 MG/ML 2007-07-01 2299-12-31 2 10 MG ML
J1290 47783010101 KALBITOR ECALLANTIDE 10MG/ML(1) 2012-01-01 2299-12-31 10 1 MG ML
J1322 68135010001 VIMIZIM ELOSULFASE ALFA 5 MG/ML 2015-01-01 2299-12-31 5 1 MG ML
J1439 00517065001 INJECTAFER FERRIC CARBOXYMALTOSE 750 MG/15 ML 2015-01-01 2299-12-31 50 1 MG ML
J1442 55513020901 NEUPOGEN FILGRASTIM 480MCG/0.8 2014-01-01 2299-12-31 600 1 MCG ML
J1442 55513020910 NEUPOGEN FILGRASTIM 480MCG/0.8 2014-01-01 2299-12-31 600 1 MCG ML
J1442 55513020991 NEUPOGEN FILGRASTIM 480MCG/0.8 2014-04-07 2299-12-31 600 1 MCG ML
J1442 55513053001 NEUPOGEN FILGRASTIM 300MCG/ML 2014-01-01 2299-12-31 300 1 MCG ML
J1442 55513053010 NEUPOGEN FILGRASTIM 300MCG/ML 2014-01-01 2299-12-31 300 1 MCG ML
J1442 55513054601 NEUPOGEN FILGRASTIM 480MCG/1.6 2014-01-01 2299-12-31 300 1 MCG ML
J1442 55513054610 NEUPOGEN FILGRASTIM 480MCG/1.6 2014-01-01 2299-12-31 300 1 MCG ML
J1442 55513092401 NEUPOGEN FILGRASTIM 300MCG/0.5 2014-01-01 2299-12-31 600 1 MCG ML
J1442 55513092410 NEUPOGEN FILGRASTIM 300MCG/0.5 2014-01-01 2299-12-31 600 1 MCG ML
J1442 55513092491 NEUPOGEN FILGRASTIM 300MCG/0.5 2014-04-07 2299-12-31 600 1 MCG ML
J1446 63459091012 GRANIX TBO-FILGRASTIM 300MCG/0.5 2015-04-02 2299-12-31 120 5 MCG ML
J1446 63459091212 GRANIX TBO-FILGRASTIM 480MCG/0.8 2015-04-02 2299-12-31 120 5 MCG ML
J1447 63459091011 GRANIX TBO-FILGRASTIM 300 MGC/0.5 ML 2016-01-01 2299-12-31 0.5 1 MCG ML
J1447 63459091015 GRANIX TBO-FILGRASTIM 300 MGC/0.5 ML 2016-01-01 2299-12-31 0.5 1 MCG ML
J1447 63459091017 GRANIX TBO-FILGRASTIM 300MCG/0.5 2016-01-01 2299-12-31 0.5 1 MCG ML
J1447 63459091036 GRANIX TBO-FILGRASTIM 300MCG/0.5 2016-01-01 2299-12-31 0.5 1 MCG ML
J1447 63459091211 GRANIX TBO-FILGRASTIM 480 MGC/0.8 ML 2016-01-01 2299-12-31 0.8 1 MCG ML
J1447 63459091215 GRANIX TBO-FILGRASTIM 480 MGC/0.8 ML 2016-01-01 2299-12-31 0.8 1 MCG ML
J1447 63459091217 GRANIX TBO-FILGRASTIM 480MCG/0.8 2016-01-01 2299-12-31 0.8 1 MCG ML
J1447 63459091236 GRANIX TBO-FILGRASTIM 480MCG/0.8 2016-01-01 2299-12-31 0.8 1 MCG ML
J1453 00006306100 EMEND FOSAPREPITANT DIMEGLUMINE150 MG 2017-10-01 2299-12-31 150 1 MG EA
J1453 00006394132 EMEND FOSAPREPITANT
DIMEGLUMINE
150 MG 2011-02-08 2299-12-31 150 1 MG EA
J1458 68135002001 NAGLAZYME GALSULFASE 5 MG/5 ML 2007-07-01 2299-12-31 1 1 MG ML
J1459 44206043605 PRIVIGEN IMMUNE GLOBULIN,GAMMA
(IGG)
10 % 2009-01-01 2299-12-31 0.2 500 MG ML
J1459 44206043710 PRIVIGEN IMMUNE GLOBULIN,GAMMA
(IGG)
10 % 2009-01-01 2299-12-31 0.2 500 MG ML
J1459 44206043820 PRIVIGEN IMMUNE GLOBULIN,GAMMA
(IGG)
10 % 2009-01-01 2299-12-31 0.2 500 MG ML
J1459 44206043940 PRIVIGEN IMMUNE
GLOBULIN,GAMMA(IGG)
10 % 2013-05-20 2299-12-31 0.2 500 MG ML
Page 7 of 26
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Jcode NDC Brand Name Generic Name Strength Effective Begin
Date
Effective End
Date
Conversion
Factor
Jcode Billing Units NDC
Billing
Units
J1460 13533063504 GAMASTAN S-D IMMUNE GLOBULIN,GAMMA
(IGG)
15%-18% 2007-07-01 2299-12-31 1 1 ML ML
J1460 13533063512 GAMASTAN S-D IMMUNE GLOBULIN,GAMMA
(IGG)
15%-18% 2007-07-01 2299-12-31 1 1 ML ML
J1556 59730650201 BIVIGAM IMMUNE
GLOBULIN,GAMMA(IGG)
10 % 2014-01-01 2299-12-31 0.2 500 MG ML
J1556 59730650301 BIVIGAM IMMUNE
GLOBULIN,GAMMA(IGG)
10 % 2014-01-01 2299-12-31 0.2 500 MG ML
J1557 64208823401 GAMMAPLEX IMMUNE GLOBULIN,GAMMA
(IGG)
5 % 2012-05-26 2016-01-31 0.1 500 MG ML
J1557 64208823402 GAMMAPLEX IMMUNE GLOBULIN,GAMMA
(IGG)
5 % 2012-05-26 2299-12-31 0.1 500 MG ML
J1557 64208823403 GAMMAPLEX IMMUNE GLOBULIN,GAMMA
(IGG)
5 % 2012-05-26 2299-12-31 0.1 500 MG ML
J1557 64208823404 GAMMAPLEX IMMUNE
GLOBULIN,GAMMA(IGG)
5 % 2014-06-16 2299-12-31 0.1 500 MG ML
J1557 64208823405 GAMMAPLEX IMMUNE
GLOBULIN,GAMMA(IGG)
5 % 2013-07-26 2016-01-31 0.1 500 MG ML
J1557 64208823406 GAMMAPLEX IMMUNE
GLOBULIN,GAMMA(IGG)
5 % 2013-07-26 2299-12-31 0.1 500 MG ML
J1557 64208823407 GAMMAPLEX IMMUNE
GLOBULIN,GAMMA(IGG)
5 % 2013-07-26 2299-12-31 0.1 500 MG ML
J1557 64208823408 GAMMAPLEX IMMUNE
GLOBULIN,GAMMA(IGG)
5 % 2014-06-16 2299-12-31 0.1 500 MG ML
J1561 13533080012 GAMUNEX-C IMMUNE GLOB,GAM
CAPRYLATE(IGG)
1G/10ML 2011-02-08 2299-12-31 0.2 500 MG ML
J1561 13533080013 GAMUNEX-C IMMUNE GLOB,GAM
CAPRYLATE(IGG)
1 G/10 ML 2013-12-23 2299-12-31 0.2 500 MG ML
J1561 13533080015 GAMUNEX-C IMMUNE GLOB,GAM
CAPRYLATE(IGG)
2.5G/25ML 2011-02-08 2299-12-31 0.2 500 MG ML
J1561 13533080016 GAMUNEX-C IMMUNE GLOB,GAM
CAPRYLATE(IGG)
2.5G/25ML 2013-12-23 2299-12-31 0.2 500 MG ML
J1561 13533080020 GAMUNEX-C IMMUNE GLOB,GAM
CAPRYLATE(IGG)
5G/50ML 2011-02-08 2299-12-31 0.2 500 MG ML
J1561 13533080021 GAMUNEX-C IMMUNE GLOB,GAM
CAPRYLATE(IGG)
5 G/50 ML 2013-12-23 2299-12-31 0.2 500 MG ML
J1561 13533080024 GAMUNEX-C IMMUNE GLOB,GAM
CAPRYLATE(IGG)
20G/200ML 2011-02-08 2299-12-31 0.2 500 MG ML
J1561 13533080025 GAMUNEX-C IMMUNE GLOB,GAM
CAPRYLATE(IGG)
20 G/200ML 2013-05-16 2299-12-31 0.2 500 MG ML
J1561 13533080040 GAMUNEX-C IMMUNE GLOB,GAM
CAPRYLATE(IGG)
40 G/400ML 2014-10-01 2299-12-31 0.2 500 MG ML
J1561 13533080041 GAMUNEX-C IMMUNE GLOB,GAM
CAPRYLATE(IGG)
40 G/400ML 2014-10-29 2299-12-31 0.2 500 MG ML
J1561 13533080071 GAMUNEX-C IMMUNE GLOB,GAM
CAPRYLATE(IGG)
10G/100ML 2011-02-08 2299-12-31 0.2 500 MG ML
J1561 13533080072 GAMUNEX-C IMMUNE GLOB,GAM
CAPRYLATE(IGG)
10 G/100ML 2013-05-16 2299-12-31 0.2 500 MG ML
J1561 76125090001 GAMMAKED IMMUNE GLOB,GAM
CAPRYLATE(IGG)
1G/10ML 2011-12-05 2299-12-31 0.2 500 MG ML
J1561 76125090010 GAMMAKED IMMUNE GLOB,GAM
CAPRYLATE(IGG)
10G/100ML 2011-12-05 2299-12-31 0.2 500 MG ML
J1561 76125090020 GAMMAKED IMMUNE GLOB,GAM
CAPRYLATE(IGG)
20G/200ML 2011-12-05 2299-12-31 0.2 500 MG ML
J1561 76125090025 GAMMAKED IMMUNE GLOB,GAM
CAPRYLATE(IGG)
2.5G/25ML 2011-12-05 2299-12-31 0.2 500 MG ML
J1561 76125090050 GAMMAKED IMMUNE GLOB,GAM
CAPRYLATE(IGG)
5G/50ML 2011-12-05 2299-12-31 0.2 500 MG ML
J1566 00944265603 GAMMAGARD S-D IMMUNE
GLOBULIN,GAMMA(IGG)
5 G 2013-01-24 2299-12-31 10 500 MG EA
J1566 00944265804 GAMMAGARD S-D IMMUNE
GLOBULIN,GAMMA(IGG)
10 G 2013-01-24 2299-12-31 20 500 MG EA
J1566 44206041706 CARIMUNE NF NANOFILTEREDIMMUNE GLOBULIN,GAMMA (IGG)6 G 2018-01-01 2299-12-31 12 500 MG EA
J1566 44206041812 CARIMUNE NF NANOFILTEREDIMMUNE GLOBULIN,GAMMA (IGG)12 G 2018-01-01 2299-12-31 24 500 MG EA
J1568 68982085001 OCTAGAM IMMUNE
GLOBULIN,G(IGG)/MALTOSE
10 % 2015-01-09 2299-12-31 0.1 500 MG ML
J1568 68982085002 OCTAGAM IMMUNE
GLOBULIN,G(IGG)/MALTOSE
10 % 2015-01-09 2299-12-31 0.1 500 MG ML
J1568 68982085003 OCTAGAM IMMUNE
GLOBULIN,G(IGG)/MALTOSE
10 % 2015-01-09 2299-12-31 0.1 500 MG ML
J1568 68982085004 OCTAGAM IMMUNE
GLOBULIN,G(IGG)/MALTOSE
10 % 2015-01-09 2299-12-31 0.1 500 MG ML
J1569 00944270002 GAMMAGARD LIQUID IMMUNE GLOBULIN,GAMMA
(IGG)
10 % 2008-01-01 2299-12-31 0.2 500 MG ML
J1569 00944270003 GAMMAGARD LIQUID IMMUNE GLOBULIN,GAMMA
(IGG)
10 % 2008-01-01 2299-12-31 0.2 500 MG ML
J1569 00944270004 GAMMAGARD LIQUID IMMUNE GLOBULIN,GAMMA
(IGG)
10 % 2008-01-01 2299-12-31 0.2 500 MG ML
J1569 00944270005 GAMMAGARD LIQUID IMMUNE GLOBULIN,GAMMA
(IGG)
10 % 2008-01-01 2299-12-31 0.2 500 MG ML
J1569 00944270006 GAMMAGARD LIQUID IMMUNE GLOBULIN,GAMMA
(IGG)
10 % 2008-01-01 2299-12-31 0.2 500 MG ML
J1569 00944270007 GAMMAGARD LIQUID IMMUNE GLOBULIN,GAMMA
(IGG)
10 % 2011-03-04 2299-12-31 0.2 500 MG ML
J1569 00944270008 GAMMAGARD LIQUID IMMUN GLOB G (IGG)/GLY/IGA
50+
10 % 2015-04-14 2299-12-31 0.2 500 MG ML
J1569 00944270009 GAMMAGARD LIQUID IMMUN GLOB G (IGG)/GLY/IGA
50+
10 % 2015-04-14 2299-12-31 0.2 500 MG ML
J1569 00944270010 GAMMAGARD LIQUID IMMUN GLOB G (IGG)/GLY/IGA
50+
10 % 2015-04-14 2299-12-31 0.2 500 MG ML
J1569 00944270011 GAMMAGARD LIQUID IMMUN GLOB G (IGG)/GLY/IGA
50+
10 % 2015-03-13 2299-12-31 0.2 500 MG ML
J1569 00944270012 GAMMAGARD LIQUID IMMUN GLOB G (IGG)/GLY/IGA
50+
10 % 2015-03-13 2299-12-31 0.2 500 MG ML
J1569 00944270013 GAMMAGARD LIQUID IMMUN GLOB G (IGG)/GLY/IGA
50+
10 % 2015-04-14 2299-12-31 0.2 500 MG ML
J1572 61953000400 FLEBOGAMMA DIF IMMUNE
GLOBULIN,GAMMA(IGG)
5 % 2013-12-30 2299-12-31 0.1 500 MG ML
J1572 61953000401 FLEBOGAMMA DIF IMMUNE GLOBULIN,GAMMA
(IGG)
5 % 2008-01-01 2299-12-31 0.1 500 MG ML
J1572 61953000402 FLEBOGAMMA DIF IMMUNE GLOBULIN,GAMMA
(IGG)
5 % 2008-01-01 2299-12-31 0.1 500 MG ML
J1572 61953000403 FLEBOGAMMA DIF IMMUNE GLOBULIN,GAMMA
(IGG)
5 % 2008-01-01 2299-12-31 0.1 500 MG ML
J1572 61953000404 FLEBOGAMMA DIF IMMUNE GLOBULIN,GAMMA
(IGG)
5 % 2008-01-01 2299-12-31 0.1 500 MG ML
J1572 61953000405 FLEBOGAMMA DIF IMMUNE GLOBULIN,GAMMA
(IGG)
5 % 2008-01-01 2299-12-31 0.1 500 MG ML
J1572 61953000406 FLEBOGAMMA DIF IMMUNE
GLOBULIN,GAMMA(IGG)
5 % 2013-12-30 2299-12-31 0.1 500 MG ML
J1572 61953000407 FLEBOGAMMA DIF IMMUNE
GLOBULIN,GAMMA(IGG)
5 % 2013-12-30 2299-12-31 0.1 500 MG ML
J1572 61953000408 FLEBOGAMMA DIF IMMUNE
GLOBULIN,GAMMA(IGG)
5 % 2013-12-30 2299-12-31 0.1 500 MG ML
J1572 61953000409 FLEBOGAMMA DIF IMMUNE
GLOBULIN,GAMMA(IGG)
5 % 2013-12-30 2299-12-31 0.1 500 MG ML
J1572 61953000501 FLEBOGAMMA DIF IMMUNE GLOBULIN,GAMMA
(IGG)
10 % 2011-02-08 2299-12-31 0.2 500 MG ML
J1572 61953000502 FLEBOGAMMA DIF IMMUNE GLOBULIN,GAMMA
(IGG)
10 % 2011-02-08 2299-12-31 0.2 500 MG ML
J1572 61953000503 FLEBOGAMMA DIF IMMUNE GLOBULIN,GAMMA
(IGG)
10 % 2011-02-08 2299-12-31 0.2 500 MG ML
J1572 61953000504 FLEBOGAMMA DIF IMMUNE
GLOBULIN,GAMMA(IGG)
10 % 2013-12-27 2299-12-31 0.2 500 MG ML
J1572 61953000505 FLEBOGAMMA DIF IMMUNE
GLOBULIN,GAMMA(IGG)
10 % 2013-12-27 2299-12-31 0.2 500 MG ML
Page 8 of 26
![Page 9: PHYSICIANS ADMINISTERED DRUG (PAD) LIST - Ky …...J0171 76329906100 EPINEPHRINE EPINEPHRINE 1 MG/ML 2012-09-11 2299-12-31 10 0.1 MG ML J0178 61755000502 EYLEA AFLIBERCEPT 2MG/0.05ML](https://reader033.vdocument.in/reader033/viewer/2022050609/5fb0ce012de8b10e1576cd83/html5/thumbnails/9.jpg)
Jcode NDC Brand Name Generic Name Strength Effective Begin
Date
Effective End
Date
Conversion
Factor
Jcode Billing Units NDC
Billing
Units
J1572 61953000506 FLEBOGAMMA DIF IMMUNE
GLOBULIN,GAMMA(IGG)
10 % 2013-12-27 2299-12-31 0.2 500 MG ML
J1575 00944251002 HYQVIA 2.5 GM/25ML KIT IMMUNE GLOBULIN/HYALURONIDASE100 MG/ML 2016-04-01 2299-12-31 1 100 MG ML
J1575 00944251102 HYQVIA 5 GM/50ML KIT IMMUNE GLOBULIN/HYALURONIDASE100 MG/ML 2016-04-01 2299-12-31 1 100 MG ML
J1575 00944251202 HYQVIA 10 GM/100ML KIT IMMUNE GLOBULIN/HYALURONIDASE100 MG/ML 2016-04-01 2299-12-31 1 100 MG ML
J1575 00944251302 HYQVIA 20 GM/200ML KIT IMMUNE GLOBULIN/HYALURONIDASE100 MG/ML 2016-04-01 2299-12-31 1 100 MG ML
J1575 00944251402 HYQVIA 30 GM/300ML KIT IMMUNE GLOBULIN/HYALURONIDASE100 MG/ML 2016-04-01 2299-12-31 1 100 MG ML
J1599 44206041706 CARIMUNE NF
NANOFILTERED
IMMUNE GLOBULIN,GAMMA
(IGG)
6G 2012-01-01 2017-12-31 12 500 MG EA
J1599 44206041812 CARIMUNE NF
NANOFILTERED
IMMUNE GLOBULIN,GAMMA
(IGG)
12G 2012-01-01 2017-12-31 24 500 MG EA
J1626 00143974410 GRANISETRON HCL GRANISETRON HCL 1 MG/ML(1) 2010-09-14 2299-12-31 10 100 MCG ML
J1626 00143974505 GRANISETRON HCL GRANISETRON HCL 1 MG/ML 2010-09-14 2299-12-31 10 100 MCG ML
J1626 00703789101 GRANISETRON HCL GRANISETRON HCL/PF 100 MCG/ML 2010-08-04 2299-12-31 1 100 MCG ML
J1626 00703797103 GRANISETRON HCL GRANISETRON HCL 1 MG/ML(1) 2008-01-03 2299-12-31 10 100 MCG ML
J1626 00703797301 GRANISETRON HCL GRANISETRON HCL 1 MG/ML 2008-06-30 2299-12-31 10 100 MCG ML
J1626 17478054602 GRANISETRON HCL GRANISETRON HCL 1 MG/ML(1) 2011-07-20 2299-12-31 10 100 MCG ML
J1626 17478054605 GRANISETRON HCL GRANISETRON HCL 1 MG/ML 2011-07-20 2299-12-31 10 100 MCG ML
J1626 25021077801 GRANISETRON HCL GRANISETRON HCL/PF 100 MCG/ML 2010-12-15 2299-12-31 1 100 MCG ML
J1626 25021077866 GRANISETRON HCL GRANISETRON HCL/PF 100 MCG/ML 2013-08-20 2299-12-31 1 100 MCG ML
J1626 25021077901 GRANISETRON HCL GRANISETRON HCL/PF 1 MG/ML(1) 2010-12-15 2299-12-31 10 100 MCG ML
J1626 25021078104 GRANISETRON HCL GRANISETRON HCL 1 MG/ML 2010-12-15 2299-12-31 10 100 MCG ML
J1626 63323031701 GRANISETRON HCL GRANISETRON HCL/PF 100 MCG/ML 2007-12-14 2299-12-31 1 100 MCG ML
J1626 63323031801 GRANISETRON HCL GRANISETRON HCL/PF 1 MG/ML(1) 2008-06-25 2299-12-31 10 100 MCG ML
J1626 63323031904 GRANISETRON HCL GRANISETRON HCL 1 MG/ML 2008-06-25 2299-12-31 10 100 MCG ML
J1626 66758003501 GRANISETRON HCL GRANISETRON HCL 1 MG/ML(1) 2008-06-30 2299-12-31 10 100 MCG ML
J1626 66758003601 GRANISETRON HCL GRANISETRON HCL 1 MG/ML 2008-06-30 2299-12-31 10 100 MCG ML
J1630 00703704101 HALOPERIDOL LACTATE HALOPERIDOL LACTATE 5 MG/ML 2007-07-01 2299-12-31 1 5 MG ML
J1630 00703704104 HALOPERIDOL LACTATE HALOPERIDOL LACTATE 5 MG/ML 2010-07-16 2299-12-31 1 5 MG ML
J1630 00703704501 HALOPERIDOL LACTATE HALOPERIDOL LACTATE 5 MG/ML 2007-07-01 2299-12-31 1 5 MG ML
J1630 10147091101 HALOPERIDOL HALOPERIDOL LACTATE 5 MG/ML 2011-07-07 2299-12-31 1 5 MG ML
J1630 25021080601 HALOPERIDOL LACTATE HALOPERIDOL LACTATE 5 MG/ML 2011-11-21 2299-12-31 1 5 MG ML
J1630 25021082310 HALOPERIDOL LACTATE HALOPERIDOL LACTATE 5 MG/ML 2011-11-21 2299-12-31 1 5 MG ML
J1630 50458025501 HALDOL HALOPERIDOL LACTATE 5 MG/ML 2010-08-02 2299-12-31 1 5 MG ML
J1630 63323047401 HALOPERIDOL LACTATE HALOPERIDOL LACTATE 5 MG/ML 2007-07-01 2299-12-31 1 5 MG ML
J1630 63323047410 HALOPERIDOL LACTATE HALOPERIDOL LACTATE 5 MG/ML 2007-07-01 2299-12-31 1 5 MG ML
J1630 67457042600 HALOPERIDOL LACTATE HALOPERIDOL LACTATE 5 MG/ML 2014-04-04 2299-12-31 1 5 MG ML
J1630 67457042612 HALOPERIDOL LACTATE HALOPERIDOL LACTATE 5 MG/ML 2014-04-04 2299-12-31 1 5 MG ML
J1631 00703701103 HALOPERIDOL DECANOATE HALOPERIDOL DECANOATE 50 MG/ML 2007-07-01 2299-12-31 1 50 MG ML
J1631 00703701103 HALOPERIDOL DECANOATE HALOPERIDOL DECANOATE 50 MG/ML 2007-07-01 2299-12-31 1 50 MG ML
J1631 00703701301 HALOPERIDOL DECANOATE HALOPERIDOL DECANOATE 50 MG/ML 2007-07-01 2299-12-31 1 50 MG ML
J1631 00703702103 HALOPERIDOL DECANOATE HALOPERIDOL DECANOATE 100 MG/ML 2007-07-01 2299-12-31 2 50 MG ML
J1631 00703702301 HALOPERIDOL DECANOATE HALOPERIDOL DECANOATE 100 MG/ML 2007-07-01 2299-12-31 2 50 MG ML
J1631 10147092103 HALOPERIDOL DECANOATE HALOPERIDOL DECANOATE 50 MG/ML 2011-11-08 2299-12-31 1 50 MG ML
J1631 10147092205 HALOPERIDOL DECANOATE
100
HALOPERIDOL DECANOATE 100 MG/ML 2011-07-07 2299-12-31 2 50 MG ML
J1631 50458025303 HALDOL DECANOATE 50 HALOPERIDOL DECANOATE 50 MG/ML 2011-07-26 2299-12-31 1 50 MG ML
J1631 50458025414 HALDOL DECANOATE 100 HALOPERIDOL DECANOATE 100 MG/ML 2011-07-26 2299-12-31 2 50 MG ML
J1631 53150042201 HALOPERIDOL DECANOATE HALOPERIDOL DECANOATE 50 MG/ML 2013-05-13 2016-04-30 1 50 MG ML
J1631 53150042205 HALOPERIDOL DECANOATE HALOPERIDOL DECANOATE 50 MG/ML 2013-05-21 2016-04-30 1 50 MG ML
J1631 63323046901 HALOPERIDOL DECANOATE HALOPERIDOL DECANOATE 50 MG/ML 2007-07-01 2299-12-31 1 50 MG ML
J1631 63323046905 HALOPERIDOL DECANOATE HALOPERIDOL DECANOATE 50 MG/ML 2007-07-01 2299-12-31 1 50 MG ML
J1631 63323047101 HALOPERIDOL DECANOATE HALOPERIDOL DECANOATE 100 MG/ML 2007-07-01 2299-12-31 2 50 MG ML
J1631 63323047105 HALOPERIDOL DECANOATE HALOPERIDOL DECANOATE 100 MG/ML 2007-07-01 2299-12-31 2 50 MG ML
J1631 67457038100 HALOPERIDOL DECANOATE HALOPERIDOL DECANOATE 100 MG/ML 2014-07-24 2299-12-31 2 50 MG ML
J1631 67457038158 HALOPERIDOL DECANOATE HALOPERIDOL DECANOATE 100 MG/ML 2014-07-23 2299-12-31 2 50 MG ML
J1631 67457038200 HALOPERIDOL DECANOATE HALOPERIDOL DECANOATE 50 MG/ML 2013-08-21 2299-12-31 1 50 MG ML
J1631 67457038258 HALOPERIDOL DECANOATE HALOPERIDOL DECANOATE 50 MG/ML 2013-08-21 2299-12-31 1 50 MG ML
J1631 67457040900 HALOPERIDOL DECANOATE HALOPERIDOL DECANOATE 100 MG/ML 2014-09-23 2299-12-31 2 50 MG ML
J1631 67457040913 HALOPERIDOL DECANOATE HALOPERIDOL DECANOATE 100 MG/ML 2014-09-22 2299-12-31 2 50 MG ML
J1631 67457041000 HALOPERIDOL DECANOATE HALOPERIDOL DECANOATE 50 MG/ML 2013-08-21 2299-12-31 1 50 MG ML
J1631 67457041013 HALOPERIDOL DECANOATE HALOPERIDOL DECANOATE 50 MG/ML 2013-08-21 2299-12-31 1 50 MG ML
J1725 62559054015 HYDROXYPROGESTERONE CAPROATEHYDROXYPROGESTERONE CAPROATE250 MG/ML 2016-06-16 2017-12-31 250 1 MG ML
J1725 64011024301 MAKENA HYDROXYPROGESTERONE
CAPROATE
250 MG/ML 2012-01-01 2017-12-31 250 1 MG ML
J1725 64011024301 MAKENA HYDROXYPROGESTERONE CAPROATE250 MG/ML 2012-01-01 2017-12-31 250 1 MG ML
J1725 64011024702 MAKENA HYDROXYPROGESTERONE
CAPROATE
250 MG/ML 2016-04-01 2017-12-31 250 1 MG ML
J1725 64011024702 MAKENA HYDROXYPROGESTERONE CAPROATE250 MG/ML 2016-04-01 2017-12-31 250 1 MG ML
J1726 64011024301 MAKENA HYDROXYPROGESTERONE CAPROATE250 MG/ML 2018-01-01 2299-12-31 250 1 MG ML
Page 9 of 26
![Page 10: PHYSICIANS ADMINISTERED DRUG (PAD) LIST - Ky …...J0171 76329906100 EPINEPHRINE EPINEPHRINE 1 MG/ML 2012-09-11 2299-12-31 10 0.1 MG ML J0178 61755000502 EYLEA AFLIBERCEPT 2MG/0.05ML](https://reader033.vdocument.in/reader033/viewer/2022050609/5fb0ce012de8b10e1576cd83/html5/thumbnails/10.jpg)
Jcode NDC Brand Name Generic Name Strength Effective Begin
Date
Effective End
Date
Conversion
Factor
Jcode Billing Units NDC
Billing
Units
J1726 64011024702 MAKENA HYDROXYPROGESTERONE CAPROATE250 MG/ML 2018-01-01 2299-12-31 250 1 MG ML
J1729 62559054015 HYDROXYPROGESTERONE CAPROATEHYDROXYPROGESTERONE CAPROATE250 MG/ML 2018-01-01 2299-12-31 250 1 MG ML
J1729 67457088605 HYDROXYPROGESTERONE CAPROATEHYDROXYPROGESTERONE CAPROATE250 MG/ML 2018-01-01 2299-12-31 250 1 MG ML
J1740 00004019109 BONIVA IBANDRONATE SODIUM 3 MG/3 ML 2011-11-08 2299-12-31 1 1 MG ML
J1740 25021082273 IBANDRONATE SODIUM IBANDRONATE SODIUM 3 MG/3 ML 2014-09-03 2299-12-31 1 1 MG ML
J1740 25021082761 IBANDRONATE SODIUM IBANDRONATE SODIUM 3 MG/3 ML 2014-09-02 2299-12-31 1 1 MG ML
J1740 62756021840 IBANDRONATE SODIUM IBANDRONATE SODIUM 3 MG/3 ML 2014-03-05 2299-12-31 1 1 MG ML
J1740 67457052433 IBANDRONATE SODIUM IBANDRONATE SODIUM 3 MG/3 ML 2014-09-02 2299-12-31 1 1 MG ML
J1743 54092070001 ELAPRASE IDURSULFASE 6MG/3ML 2012-08-25 2299-12-31 2 1 MG ML
J1744 54092070202 FIRAZYR ICATIBANT 30 MG/3ML 2013-01-01 2299-12-31 10 1 MG ML
J1744 54092070203 FIRAZYR ICATIBANT 30 MG/3ML 2013-01-01 2299-12-31 10 1 MG ML
J1745 57894003001 REMICADE INFLIXIMAB 100 MG 2007-07-01 2299-12-31 10 10 MG EA
J1750 00517013410 DEXFERRUM IRON DEXTRAN COMPLEX 50 MG/ML 2009-01-01 2016-05-06 1 50 MG ML
J1750 00517023410 DEXFERRUM IRON DEXTRAN COMPLEX 50 MG/ML 2009-01-01 2016-05-06 1 50 MG ML
J1750 52544093102 INFED IRON DEXTRAN COMPLEX 50 MG/ML 2009-01-01 2299-12-31 1 50 MG ML
J1750 52544093107 INFED IRON DEXTRAN COMPLEX 50 MG/ML 2011-12-06 2299-12-31 1 50 MG ML
J1756 00517231005 VENOFER IRON SUCROSE COMPLEX 200MG/10ML 2012-08-25 2299-12-31 20 1 MG ML
J1756 00517232510 VENOFER IRON SUCROSE COMPLEX 50MG/2.5ML 2012-08-25 2299-12-31 20 1 MG ML
J1756 00517234010 VENOFER IRON SUCROSE COMPLEX 100MG/5ML 2012-08-25 2299-12-31 20 1 MG ML
J1756 00517234025 VENOFER IRON SUCROSE COMPLEX 100MG/5ML 2012-08-25 2299-12-31 20 1 MG ML
J1756 00517234099 VENOFER IRON SUCROSE COMPLEX 100 MG/5ML 2014-07-11 2299-12-31 20 1 MG ML
J1756 49230053010 VENOFER IRON SUCROSE COMPLEX 50MG/2.5ML 2012-08-25 2299-12-31 20 1 MG ML
J1756 49230053025 VENOFER IRON SUCROSE COMPLEX 50MG/2.5ML 2012-08-25 2299-12-31 20 1 MG ML
J1756 49230053410 VENOFER IRON SUCROSE COMPLEX 100MG/5ML 2012-08-25 2299-12-31 20 1 MG ML
J1756 49230053425 VENOFER IRON SUCROSE COMPLEX 100MG/5ML 2012-08-25 2299-12-31 20 1 MG ML
J1786 58468466301 CEREZYME IMIGLUCERASE 400 UNITS 2011-01-01 2299-12-31 40 10 UNITS EA
J1885 00409228703 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 30 MG/ML 2017-06-22 2299-12-31 2 15 MG ML
J1885 00409228720 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 30 MG/ML 2016-11-17 2299-12-31 2 15 MG ML
J1885 00409228723 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 30 MG/ML 2016-01-01 2299-12-31 2 15 MG ML
J1885 00409379319 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 15 MG/ML 2016-01-01 2299-12-31 1 15 MG ML
J1885 00409379501 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 30 MG/ML 2018-07-01 2299-12-31 2 15 MG ML
J1885 00409379519 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 30 MG/ML 2016-01-01 2299-12-31 2 15 MG ML
J1885 00409379601 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 60 MG/2 ML 2018-07-01 2299-12-31 2 15 MG ML
J1885 00409379619 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 30 MG/ML 2016-01-01 2299-12-31 2 15 MG ML
J1885 00641604101 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 15 MG/ML 2016-01-01 2299-12-31 1 15 MG ML
J1885 00641604125 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 15 MG/ML 2016-01-01 2299-12-31 1 15 MG ML
J1885 00641604201 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 30 MG/ML 2016-01-01 2299-12-31 2 15 MG ML
J1885 00641604225 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 30 MG/ML 2016-01-01 2299-12-31 2 15 MG ML
J1885 00641604301 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 30 MG/ML 2016-01-01 2299-12-31 2 15 MG ML
J1885 00641604325 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 30 MG/ML 2016-01-01 2299-12-31 2 15 MG ML
J1885 47781058368 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 15 MG/ML 2017-10-12 2299-12-31 1 15 MG ML
J1885 47781058393 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 15 MG/ML 2017-10-12 2299-12-31 1 15 MG ML
J1885 47781058468 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 30 MG/ML 2017-10-12 2299-12-31 2 15 MG ML
J1885 47781058493 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 30 MG/ML 2017-10-12 2299-12-31 2 15 MG ML
J1885 47781058568 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 60 MG/2 ML 2018-07-01 2299-12-31 2 15 MG ML
J1885 63323016112 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 15 MG/ML 2016-01-01 2299-12-31 1 15 MG ML
J1885 63323016116 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 15 MG/ML 2016-01-01 2299-12-31 1 15 MG ML
J1885 63323016202 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 60 MG/2 ML 2018-07-01 2299-12-31 2 15 MG ML
J1885 63323016212 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 30 MG/ML 2016-01-01 2299-12-31 2 15 MG ML
J1885 63323016214 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 30 MG/ML 2016-01-01 2299-12-31 2 15 MG ML
J1885 63323016216 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 30 MG/ML 2016-01-01 2299-12-31 2 15 MG ML
J1885 63323016226 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 30 MG/ML 2016-01-01 2299-12-31 2 15 MG ML
J1885 70860070001 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 15 MG/ML 2017-07-20 2299-12-31 1 15 MG ML
J1885 70860070101 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 30 MG/ML 2017-07-20 2299-12-31 2 15 MG ML
J1885 70860070102 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 30 MG/ML 2017-07-20 2299-12-31 2 15 MG ML
J1885 76045010410 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 30 MG/ML 2016-01-01 2299-12-31 2 15 MG ML
J1885 76045010520 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 30 MG/ML 2016-01-01 2299-12-31 2 15 MG ML
J1885 76045010710 KETOROLAC TROMETHAMINEKETOROLAC TROMETHAMINE 15 MG/ML 2016-01-01 2299-12-31 1 15 MG ML
J1930 15054006001 SOMATULINE DEPOT LANREOTIDE ACETATE 60 MG/0.2 ML 2015-01-02 2299-12-31 300 1 MG ML
J1930 15054009001 SOMATULINE DEPOT LANREOTIDE ACETATE 90 MG/0.3 ML 2007-10-01 2299-12-31 300 1 MG ML
J1930 15054012001 SOMATULINE DEPOT LANREOTIDE ACETATE 120 MG/0.5 ML 2009-11-25 2299-12-31 240 1 MG ML
J1930 15054106003 SOMATULINE DEPOT LANREOTIDE ACETATE 60 MG/0.2 ML 2015-01-02 2299-12-31 300 1 MG ML
J1930 15054109003 SOMATULINE DEPOT LANREOTIDE ACETATE 90 MG/0.3 ML 2015-01-02 2299-12-31 300 1 MG ML
J1930 15054112003 SOMATULINE DEPOT LANREOTIDE ACETATE 120 MG/0.5 ML 2015-01-02 2299-12-31 240 1 MG ML
Page 10 of 26
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Jcode NDC Brand Name Generic Name Strength Effective Begin
Date
Effective End
Date
Conversion
Factor
Jcode Billing Units NDC
Billing
Units
J1931 58468007001 ALDURAZYME LARONIDASE 2.9 MG/5ML 2007-07-01 2299-12-31 5.8 0.1 MG ML
J1940 00409610218 FUROSEMIDE FUROSEMIDE 10 MG/ML 2016-01-01 2299-12-31 0.5 20 MG ML
J1940 00409610219 FUROSEMIDE FUROSEMIDE 10 MG/ML 2016-01-01 2299-12-31 0.5 20 MG ML
J1940 00409610220 FUROSEMIDE FUROSEMIDE 10 MG/ML 2017-06-22 2299-12-31 0.5 20 MG ML
J1940 00409610225 FUROSEMIDE FUROSEMIDE 10 MG/ML 2016-01-01 2299-12-31 0.5 20 MG ML
J1940 00409610226 FUROSEMIDE FUROSEMIDE 10 MG/ML 2016-01-01 2299-12-31 0.5 20 MG ML
J1940 00409610227 FUROSEMIDE FUROSEMIDE 10 MG/ML 2016-01-01 2299-12-31 0.5 20 MG ML
J1940 00409610235 FUROSEMIDE FUROSEMIDE 10 MG/ML 2017-04-27 2299-12-31 0.5 20 MG ML
J1940 23155047331 FUROSEMIDE FUROSEMIDE 10 MG/ML 2016-01-01 2299-12-31 0.5 20 MG ML
J1940 23155047332 FUROSEMIDE FUROSEMIDE 10 MG/ML 2016-01-01 2299-12-31 0.5 20 MG ML
J1940 23155047333 FUROSEMIDE FUROSEMIDE 10 MG/ML 2016-01-01 2299-12-31 0.5 20 MG ML
J1940 23155052132 FUROSEMIDE FUROSEMIDE 10 MG/ML 2016-01-01 2299-12-31 0.5 20 MG ML
J1940 63323028016 FUROSEMIDE FUROSEMIDE 10 MG/ML 2016-01-01 2299-12-31 0.5 20 MG ML
J1940 63323028026 FUROSEMIDE FUROSEMIDE 10 MG/ML 2016-01-01 2299-12-31 0.5 20 MG ML
J1940 63323028036 FUROSEMIDE FUROSEMIDE 10 MG/ML 2016-01-01 2299-12-31 0.5 20 MG ML
J1940 70121107601 FUROSEMIDE FUROSEMIDE 10 MG/ML 2017-09-21 2299-12-31 0.5 20 MG ML
J1940 70121107605 FUROSEMIDE FUROSEMIDE 10 MG/ML 2017-09-21 2299-12-31 0.5 20 MG ML
J1940 70121116301 FUROSEMIDE FUROSEMIDE 10 MG/ML 2017-09-21 2299-12-31 0.5 20 MG ML
J1940 70121116305 FUROSEMIDE FUROSEMIDE 10 MG/ML 2017-09-21 2299-12-31 0.5 20 MG ML
J1940 70121116401 FUROSEMIDE FUROSEMIDE 10 MG/ML 2017-09-21 2299-12-31 0.5 20 MG ML
J1940 70121116405 FUROSEMIDE FUROSEMIDE 10 MG/ML 2017-09-21 2299-12-31 0.5 20 MG ML
J1950 00074210803 LUPRON DEPOT-PED LEUPROLIDE ACETATE 7.5 MG 2009-08-03 2299-12-31 2 3.75 MG EA
J1950 00074228203 LUPRON DEPOT-PED LEUPROLIDE ACETATE 11.25MG 2009-04-03 2299-12-31 3 3.75 MG EA
J1950 00074244003 LUPRON DEPOT-PED LEUPROLIDE ACETATE 15 MG 2009-04-17 2299-12-31 4 3.75 MG EA
J1950 00074364103 LUPRON DEPOT LEUPROLIDE ACETATE 3.75 MG 2009-04-13 2299-12-31 1 3.75 MG EA
J1950 00074366303 LUPRON DEPOT LEUPROLIDE ACETATE 11.25MG 2009-05-21 2299-12-31 3 3.75 MG EA
J1950 00074377903 LUPRON DEPOT-PED LEUPROLIDE ACETATE 11.25 MG 2011-11-08 2299-12-31 3 3.75 MG EA
J1950 00074969403 LUPRON DEPOT-PED LEUPROLIDE ACETATE 30 MG 2011-11-08 2299-12-31 8 3.75 MG EA
J2182 00173088101 NUCALA MEPOLIZUMAB 100 MG 2017-01-01 2299-12-31 100 1 MG EA
J2212 65649055102 RELISTOR METHYLNALTREXONE 12 MG/0.6 ML 2013-01-01 2299-12-31 180 0.1 MG ML
J2212 65649055103 RELISTOR METHYLNALTREXONE 12 MG/0.6 ML 2013-01-01 2299-12-31 180 0.1 MG ML
J2212 65649055107 RELISTOR METHYLNALTREXONE 12 MG/0.6 ML 2013-04-19 2299-12-31 180 0.1 MG ML
J2212 65649055204 RELISTOR METHYLNALTREXONE 8 MG/0.4 ML 2013-04-19 2299-12-31 180 0.1 MG ML
J2274 00409381412 MORPHINE SULFATE PRESERVATIVE-FREEMORPHINE SULFATE PRESERVATIVE-FREE0.5 MG/ML 2016-01-01 2299-12-31 0.05 10 MG ML
J2274 00409381512 MORPHINE SULFATE PRESERVATIVE-FREEMORPHINE SULFATE PRESERVATIVE-FREE1 MG/ML 2016-01-01 2299-12-31 0.1 10 MG ML
J2274 00641601901 DURAMORPH MORPHINE SULFATE PRESERVATIVE-FREE1 MG/ML 2016-09-01 2299-12-31 0.1 10 MG ML
J2274 00641601910 DURAMORPH MORPHINE SULFATE PRESERVATIVE-FREE1 MG/ML 2016-09-01 2299-12-31 0.1 10 MG ML
J2274 00641602001 DURAMORPH MORPHINE SULFATE PRESERVATIVE-FREE0.5 MG/ML 2016-09-01 2299-12-31 0.05 10 MG ML
J2274 00641602010 DURAMORPH MORPHINE SULFATE PRESERVATIVE-FREE0.5 MG/ML 2016-09-01 2299-12-31 0.05 10 MG ML
J2274 00641603901 INFUMORPH MORPHINE SULFATE PRESERVATIVE-FREE10 MG/ML 2016-09-01 2299-12-31 1 10 MG ML
J2274 00641604001 INFUMORPH MORPHINE SULFATE PRESERVATIVE-FREE25 MG/ML 2016-09-01 2299-12-31 2.5 10 MG ML
J2278 18860072010 PRIALT ZICONOTIDE ACETATE 100 MCG/ML 2011-02-08 2299-12-31 100 1 MCG ML
J2278 18860072210 PRIALT ZICONOTIDE ACETATE 100 MCG/ML 2011-02-08 2299-12-31 100 1 MCG ML
J2278 18860072310 PRIALT ZICONOTIDE ACETATE 25 MCG/ML 2011-02-08 2299-12-31 25 1 MCG ML
J2310 00409121501 NALOXONE HCL NALOXONE HCL 0.4 MG/ML 2017-01-01 2299-12-31 0.4 1 MG ML
J2310 00409121525 NALOXONE HCL NALOXONE HCL 0.4 MG/ML 2017-01-01 2299-12-31 0.4 1 MG ML
J2310 00409121901 NALOXONE HCL NALOXONE HCL 0.4 MG/ML 2017-01-01 2299-12-31 0.4 1 MG ML
J2310 00409121925 NALOXONE HCL NALOXONE HCL 0.4 MG/ML 2017-01-01 2299-12-31 0.4 1 MG ML
J2310 00409178269 NALOXONE HCL NALOXONE HCL 0.4 MG/ML 2017-01-01 2299-12-31 0.4 1 MG ML
J2310 00641613201 NALOXONE HCL NALOXONE HCL 0.4 MG/ML 2017-01-01 2299-12-31 0.4 1 MG ML
J2310 00641613225 NALOXONE HCL NALOXONE HCL 0.4 MG/ML 2017-01-01 2299-12-31 0.4 1 MG ML
J2310 17478004101 NALOXONE HCL NALOXONE HCL 0.4 MG/ML 2017-08-07 2299-12-31 0.4 1 MG ML
J2310 17478004210 NALOXONE HCL NALOXONE HCL 0.4 MG/ML 2017-08-14 2299-12-31 0.4 1 MG ML
J2310 67457029200 NALOXONE HCL NALOXONE HCL 0.4 MG/ML 2017-01-01 2299-12-31 0.4 1 MG ML
J2310 67457029202 NALOXONE HCL NALOXONE HCL 0.4 MG/ML 2017-01-01 2299-12-31 0.4 1 MG ML
J2310 67457029900 NALOXONE HCL NALOXONE HCL 0.4 MG/ML 2017-01-01 2299-12-31 0.4 1 MG ML
J2310 67457029910 NALOXONE HCL NALOXONE HCL 0.4 MG/ML 2017-01-01 2299-12-31 0.4 1 MG ML
J2310 67457059900 NALOXONE HCL NALOXONE HCL 0.4 MG/ML 2017-01-01 2299-12-31 0.4 1 MG ML
J2310 67457059902 NALOXONE HCL NALOXONE HCL 0.4 MG/ML 2017-01-01 2299-12-31 0.4 1 MG ML
J2310 70069007101 NALOXONE HCL NALOXONE HCL 0.4 MG/ML 2017-08-09 2299-12-31 0.4 1 MG ML
J2310 70069007110 NALOXONE HCL NALOXONE HCL 0.4 MG/ML 2017-08-09 2299-12-31 0.4 1 MG ML
J2310 70069007201 NALOXONE HCL NALOXONE HCL 0.4 MG/ML 2017-08-09 2299-12-31 0.4 1 MG ML
J2310 70069007210 NALOXONE HCL NALOXONE HCL 0.4 MG/ML 2017-08-09 2299-12-31 0.4 1 MG ML
J2310 76329146901 NALOXONE HCL NALOXONE HCL 1 MG/ML 2017-01-01 2299-12-31 1 1 MG ML
Page 11 of 26
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Jcode NDC Brand Name Generic Name Strength Effective Begin
Date
Effective End
Date
Conversion
Factor
Jcode Billing Units NDC
Billing
Units
J2310 76329336901 NALOXONE HCL NALOXONE HCL 1 MG/ML 2017-01-01 2299-12-31 1 1 MG ML
J2310 76329346901 NALOXONE HCL NALOXONE HCL 1 MG/ML 2017-01-01 2299-12-31 1 1 MG ML
J2315 65757030001 VIVITROL NALTREXONE MICROSPHERES380 MG 2018-10-01 2299-12-31 380 1 MG EA
J2323 64406000801 TYSABRI NATALIZUMAB 300MG/15ML 2013-08-01 2299-12-31 20 1 MG ML
J2325 65847020525 NATRECOR NESIRITIDE 1.5 MG 2007-07-01 2299-12-31 15 0.1 MG EA
J2353 00078034061 SANDOSTATIN LAR OCTREOTIDE ACETATE 10 MG 2014-11-25 2299-12-31 10 1 MG EA
J2353 00078034161 SANDOSTATIN LAR OCTREOTIDE ACETATE 20 MG 2014-11-25 2299-12-31 20 1 MG EA
J2353 00078034261 SANDOSTATIN LAR OCTREOTIDE ACETATE 30 MG 2014-11-25 2299-12-31 30 1 MG EA
J2353 00078064661 SANDOSTATIN LAR DEPOT OCTREOTIDE ACETATE,MI-
SPHERES
10 MG 2015-04-14 2299-12-31 10 1 MG EA
J2353 00078064681 SANDOSTATIN LAR DEPOT OCTREOTIDE ACETATE,MI-
SPHERES
10 MG 2015-04-10 2299-12-31 10 1 MG EA
J2353 00078064761 SANDOSTATIN LAR DEPOT OCTREOTIDE ACETATE,MI-
SPHERES
20 MG 2015-04-14 2299-12-31 20 1 MG EA
J2353 00078064781 SANDOSTATIN LAR DEPOT OCTREOTIDE ACETATE,MI-
SPHERES
20 MG 2015-04-10 2299-12-31 20 1 MG EA
J2353 00078064861 SANDOSTATIN LAR DEPOT OCTREOTIDE ACETATE,MI-
SPHERES
30 MG 2015-04-14 2299-12-31 30 1 MG EA
J2353 00078064881 SANDOSTATIN LAR DEPOT OCTREOTIDE ACETATE,MI-
SPHERES
30 MG 2015-04-10 2299-12-31 30 1 MG EA
J2355 58394000408 NEUMEGA OPRELVEKIN 5 MG 2008-08-26 2016-09-14 1 5 MG EA
J2355 58394010408 NEUMEGA OPRELVEKIN 5 MG 2015-07-31 2299-12-31 1 5 MG EA
J2357 50242004062 XOLAIR OMALIZUMAB 150 MG 2010-01-01 2299-12-31 30 5 MG EA
J2358 00002763511 ZYPREXA RELPREVV OLANZAPINE PAMOATE 210 MG 2012-01-01 2299-12-31 210 1 MG EA
J2358 00002763611 ZYPREXA RELPREVV OLANZAPINE PAMOATE 300 MG 2012-01-01 2299-12-31 300 1 MG EA
J2358 00002763711 ZYPREXA RELPREVV OLANZAPINE PAMOATE 405 MG 2012-01-01 2299-12-31 405 1 MG EA
J2358 00002765801 ZYPREXA RELPREVV OLANZAPINE PAMOATE 210 MG 2013-09-03 2299-12-31 210 1 MG EA
J2358 00002765901 ZYPREXA RELPREVV OLANZAPINE PAMOATE 300 MG 2013-09-03 2299-12-31 300 1 MG EA
J2358 00002766001 ZYPREXA RELPREVV OLANZAPINE PAMOATE 405 MG 2013-09-03 2299-12-31 405 1 MG EA
J2405 00143989001 ONDANSETRON HCL ONDANSETRON HCL 2 MG/ML 2007-07-01 2299-12-31 2 1 MG ML
J2405 00143989125 ONDANSETRON HCL ONDANSETRON HCL/PF 4 MG/2 ML 2011-04-07 2299-12-31 2 1 MG ML
J2405 00173044200 ZOFRAN ONDANSETRON HCL 2 MG/ML 2007-07-01 2299-12-31 2 1 MG ML
J2405 00409112011 ONDANSETRON HCL ONDANSETRON HCL/PF 4 MG/2 ML 2015-04-20 2299-12-31 2 1 MG ML
J2405 00409475503 ONDANSETRON HCL ONDANSETRON HCL/PF 4MG/2ML 2009-01-01 2299-12-31 2 1 MG ML
J2405 00409475518 ONDANSETRON HCL ONDANSETRON HCL/PF 4 MG/2 ML 2013-06-19 2299-12-31 2 1 MG ML
J2405 00409475563 ONDANSETRON HCL ONDANSETRON HCL/PF 4MG/2ML 2008-10-16 2299-12-31 2 1 MG ML
J2405 00409475901 ONDANSETRON HCL ONDANSETRON HCL 2 MG/ML 2007-07-01 2299-12-31 2 1 MG ML
J2405 00641607801 ONDANSETRON HCL ONDANSETRON HCL/PF 4 MG/2 ML 2011-11-11 2299-12-31 2 1 MG ML
J2405 00641607825 ONDANSETRON HCL ONDANSETRON HCL/PF 4 MG/2 ML 2011-11-09 2299-12-31 2 1 MG ML
J2405 00641607901 ONDANSETRON HCL ONDANSETRON HCL 2 MG/ML 2012-02-17 2299-12-31 2 1 MG ML
J2405 00703722101 ONDANSETRON HCL ONDANSETRON HCL/PF 4 MG/2 ML 2012-10-17 2299-12-31 2 1 MG ML
J2405 00703722104 ONDANSETRON HCL ONDANSETRON HCL/PF 4MG/2ML 2007-07-01 2299-12-31 2 1 MG ML
J2405 00703722601 ONDANSETRON HCL ONDANSETRON HCL 2 MG/ML 2007-07-01 2299-12-31 2 1 MG ML
J2405 00703722603 ONDANSETRON HCL ONDANSETRON HCL 2 MG/ML 2007-07-01 2299-12-31 2 1 MG ML
J2405 00781301072 ONDANSETRON HCL ONDANSETRON HCL/PF 4MG/2ML 2009-01-01 2299-12-31 2 1 MG ML
J2405 00781301095 ONDANSETRON HCL ONDANSETRON HCL/PF 4MG/2ML 2009-01-01 2299-12-31 2 1 MG ML
J2405 23155016831 ONDANSETRON HCL ONDANSETRON HCL 2 MG/ML 2012-08-01 2299-12-31 2 1 MG ML
J2405 23155019631 ONDANSETRON HCL ONDANSETRON HCL/PF 4 MG/2 ML 2014-04-03 2299-12-31 2 1 MG ML
J2405 23155019642 ONDANSETRON HCL ONDANSETRON HCL/PF 4 MG/2 ML 2013-03-01 2299-12-31 2 1 MG ML
J2405 23155019643 ONDANSETRON HCL ONDANSETRON HCL/PF 4 MG/2 ML 2013-06-19 2299-12-31 2 1 MG ML
J2405 23155037731 ONDANSETRON HCL ONDANSETRON HCL 2 MG/ML 2014-06-12 2299-12-31 2 1 MG ML
J2405 23155037831 ONDANSETRON HCL ONDANSETRON HCL/PF 4 MG/2 ML 2013-06-19 2299-12-31 2 1 MG ML
J2405 23155037841 ONDANSETRON HCL ONDANSETRON HCL/PF 4 MG/2 ML 2013-06-19 2299-12-31 2 1 MG ML
J2405 23155037842 ONDANSETRON HCL ONDANSETRON HCL/PF 4 MG/2 ML 2013-06-19 2299-12-31 2 1 MG ML
J2405 23155054931 ONDANSETRON HCL ONDANSETRON HCL 2 MG/ML 2017-04-01 2299-12-31 2 1 MG ML
J2405 25021077702 ONDANSETRON HCL ONDANSETRON HCL/PF 4 MG/2 ML 2012-11-19 2299-12-31 2 1 MG ML
J2405 25021078220 ONDANSETRON HCL ONDANSETRON HCL 2 MG/ML 2012-08-29 2299-12-31 2 1 MG ML
J2405 55150012502 ONDANSETRON HCL ONDANSETRON HCL/PF 4 MG/2 ML 2013-04-02 2299-12-31 2 1 MG ML
J2405 55150012620 ONDANSETRON HCL ONDANSETRON HCL 2 MG/ML 2013-04-02 2299-12-31 2 1 MG ML
J2405 55390012101 ONDANSETRON HCL ONDANSETRON HCL 2 MG/ML 2007-07-01 2299-12-31 2 1 MG ML
J2405 62756018101 ONDANSETRON HCL ONDANSETRON HCL/PF 4MG/2ML 2007-07-01 2299-12-31 2 1 MG ML
J2405 62756018201 ONDANSETRON HCL ONDANSETRON HCL 2 MG/ML 2007-07-01 2299-12-31 2 1 MG ML
J2405 63323037302 ONDANSETRON HCL ONDANSETRON HCL/PF 4MG/2ML 2007-07-01 2299-12-31 2 1 MG ML
J2405 63323037420 ONDANSETRON HCL ONDANSETRON HCL 2 MG/ML 2007-07-01 2299-12-31 2 1 MG ML
J2405 65293037325 ONDANSETRON HCL ONDANSETRON HCL/PF 4 MG/2 ML 2012-12-01 2299-12-31 2 1 MG ML
J2405 65293037401 ONDANSETRON HCL ONDANSETRON HCL 2 MG/ML 2012-12-01 2299-12-31 2 1 MG ML
J2405 67457044000 ONDANSETRON HCL ONDANSETRON HCL/PF 4 MG/2 ML 2013-06-19 2299-12-31 2 1 MG ML
J2405 67457044022 ONDANSETRON HCL ONDANSETRON HCL/PF 4 MG/2 ML 2013-06-19 2299-12-31 2 1 MG ML
J2405 67457044120 ONDANSETRON HCL ONDANSETRON HCL 2 MG/ML 2014-12-22 2299-12-31 2 1 MG ML
J2405 76045010320 ONDANSETRON HCL ONDANSETRON HCL/PF 4 MG/2 ML 2013-08-20 2299-12-31 2 1 MG ML
Page 12 of 26
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Jcode NDC Brand Name Generic Name Strength Effective Begin
Date
Effective End
Date
Conversion
Factor
Jcode Billing Units NDC
Billing
Units
J2407 65293001501 ORBACTIV ORITAVANCIN DIPHOSPHATE 400 MG 2016-01-01 2299-12-31 40 10 MG EA
J2407 65293001503 ORBACTIV ORITAVANCIN DIPHOSPHATE 400 MG 2016-01-01 2299-12-31 40 10 MG EA
J2425 66658011201 KEPIVANCE PALIFERMIN 6.25 MG 2012-08-07 2299-12-31 125 50 MCG EA
J2425 66658011203 KEPIVANCE PALIFERMIN 6.25 MG 2012-07-31 2299-12-31 125 50 MCG EA
J2425 66658011206 KEPIVANCE PALIFERMIN 6.25 MG 2010-09-10 2299-12-31 125 50 MCG EA
J2426 50458056001 INVEGA SUSTENNA PALIPERIDONE PALMITATE 39MG/0.25 ML 2012-01-01 2299-12-31 156 1 MG ML
J2426 50458056101 INVEGA SUSTENNA PALIPERIDONE PALMITATE 78MG/0.5 ML 2012-01-01 2299-12-31 156 1 MG ML
J2426 50458056201 INVEGA SUSTENNA PALIPERIDONE PALMITATE 117MG/0.75 ML 2012-01-01 2299-12-31 156 1 MG ML
J2426 50458056301 INVEGA SUSTENNA PALIPERIDONE PALMITATE 156 MG/ML 2012-01-01 2299-12-31 156 1 MG ML
J2426 50458056401 INVEGA SUSTENNA PALIPERIDONE PALMITATE 234 MG/1.5 ML 2012-01-01 2299-12-31 156 1 MG ML
J2426 50458060601 INVEGA TRINZA PALIPERIDONE PALMITATE 273MG/.875 2015-07-01 2299-12-31 312 MG ML
J2426 50458060701 INVEGA TRINZA PALIPERIDONE PALMITATE 410/1.315 2015-07-01 2299-12-31 312 MG ML
J2426 50458060801 INVEGA TRINZA PALIPERIDONE PALMITATE 546MG/1.75 2015-07-01 2299-12-31 312 MG ML
J2426 50458060901 INVEGA TRINZA PALIPERIDONE PALMITATE 819/2.625 2015-07-01 2299-12-31 312 MG ML
J2469 16729036566 PALONOSETRON HCL PALONOSETRON HCL 0.25 MG/5 ML 2018-07-01 2299-12-31 2 25 MCG ML
J2469 62856079701 ALOXI PALONOSETRON HCL 0.25MG/5ML 2009-04-01 2299-12-31 2 25 MCG ML
J2503 68782000102 MACUGEN PEGAPTANIB SODIUM 0.3MG/90 2008-06-13 2299-12-31 11.11111 0.3 MG ML
J2504 57665000101 ADAGEN PEGADEMASE BOVINE 250 UNIT/1 2007-07-01 2299-12-31 10 25 UNITS ML
J2505 55513019001 NEULASTA PEGFILGRASTIM 6MG/0.6ML 2007-07-01 2299-12-31 1.66666 6 MG ML
J2505 55513019201 NEULASTA PEGFILGRASTIM 6MG/0.6ML 2015-01-16 2299-12-31 1.66666 6 MG ML
J2507 54396080101 KRYSTEXXA PEGLOTICASE 8 MG/ML 2012-01-01 2016-06-01 8 1 MG ML
J2550 00641092821 PROMETHAZINE HCL PROMETHAZINE HCL 25 MG/ML 2016-04-01 2299-12-31 0.5 50 MG ML
J2550 00641092921 PROMETHAZINE HCL PROMETHAZINE HCL 50 MG/ML 2016-04-01 2299-12-31 1 50 MG ML
J2550 00641094835 PROMETHAZINE HCL PROMETHAZINE HCL 25 MG/ML 2016-04-01 2299-12-31 0.5 50 MG ML
J2550 00641094935 PROMETHAZINE HCL PROMETHAZINE HCL 50 MG/ML 2016-04-01 2299-12-31 1 50 MG ML
J2550 00641095521 PROMETHAZINE HCL PROMETHAZINE HCL 25 MG/ML 2016-04-01 2299-12-31 0.5 50 MG ML
J2550 00641095621 PROMETHAZINE HCL PROMETHAZINE HCL 50 MG/ML 2016-04-01 2299-12-31 1 50 MG ML
J2550 00641095625 PROMETHAZINE HCL PROMETHAZINE HCL 50 MG/ML 2016-04-01 2299-12-31 1 50 MG ML
J2550 00641149531 PROMETHAZINE HCL PROMETHAZINE HCL 25 MG/ML 2016-04-01 2299-12-31 0.5 50 MG ML
J2550 00641149535 PROMETHAZINE HCL PROMETHAZINE HCL 25 MG/ML 2016-04-01 2299-12-31 0.5 50 MG ML
J2550 00641149631 PROMETHAZINE HCL PROMETHAZINE HCL 50 MG/ML 2016-04-01 2299-12-31 1 50 MG ML
J2550 00641149635 PROMETHAZINE HCL PROMETHAZINE HCL 50 MG/ML 2016-04-01 2299-12-31 1 50 MG ML
J2550 00641608201 PHENERGAN PROMETHAZINE HCL 25 MG/ML 2016-04-01 2299-12-31 0.5 50 MG ML
J2550 00641608225 PHENERGAN PROMETHAZINE HCL 25 MG/ML 2016-04-01 2299-12-31 0.5 50 MG ML
J2550 00641608301 PHENERGAN PROMETHAZINE HCL 50 MG/ML 2016-04-01 2299-12-31 1 50 MG ML
J2550 00641608325 PHENERGAN PROMETHAZINE HCL 50 MG/ML 2016-04-01 2299-12-31 1 50 MG ML
J2550 00641608401 PHENERGAN PROMETHAZINE HCL 25 MG/ML 2016-04-01 2299-12-31 0.5 50 MG ML
J2550 00641608425 PHENERGAN PROMETHAZINE HCL 25 MG/ML 2016-04-01 2299-12-31 0.5 50 MG ML
J2550 00641608501 PHENERGAN PROMETHAZINE HCL 50 MG/ML 2016-04-01 2299-12-31 1 50 MG ML
J2550 00641608525 PHENERGAN PROMETHAZINE HCL 50 MG/ML 2016-04-01 2299-12-31 1 50 MG ML
J2550 39822552502 PROMETHAZINE HCL PROMETHAZINE HCL 25 MG/ML 2016-04-01 2299-12-31 0.5 50 MG ML
J2550 39822552503 PROMETHAZINE HCL PROMETHAZINE HCL 25 MG/ML 2016-04-01 2299-12-31 0.5 50 MG ML
J2550 39822555005 PROMETHAZINE HCL PROMETHAZINE HCL 50 MG/ML 2016-04-01 2299-12-31 1 50 MG ML
J2550 39822555006 PROMETHAZINE HCL PROMETHAZINE HCL 50 MG/ML 2016-04-01 2299-12-31 1 50 MG ML
J2704 00409469924 PROPOFOL PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 00409469930 PROPOFOL PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 00409469933 PROPOFOL PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 00409469961 PROPOFOL PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 00409469962 PROPOFOL PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 00409469963 PROPOFOL PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 00703285801 PROPOFOL PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 00703285809 PROPOFOL PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 00703285901 PROPOFOL PROPOFOL 10 MG/ML 2015-01-01 2016-03-31 1 10 MG ML
J2704 00703285903 PROPOFOL PROPOFOL 10 MG/ML 2015-01-01 2016-03-31 1 10 MG ML
J2704 25021060820 PROPOFOL PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 25021060850 PROPOFOL PROPOFOL 10 MG/ML 2015-03-23 2299-12-31 1 10 MG ML
J2704 25021060851 PROPOFOL PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 63323026910 DIPRIVAN PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 63323026929 DIPRIVAN PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 63323026937 DIPRIVAN PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 63323026950 DIPRIVAN PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 63323026957 DIPRIVAN PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 63323026959 DIPRIVAN PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 63323026965 DIPRIVAN PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
Page 13 of 26
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Jcode NDC Brand Name Generic Name Strength Effective Begin
Date
Effective End
Date
Conversion
Factor
Jcode Billing Units NDC
Billing
Units
J2704 63323026967 DIPRIVAN PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 63323026969 DIPRIVAN PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 63323026970 DIPRIVAN PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 63323026977 DIPRIVAN PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 63323026978 DIPRIVAN PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 63323026994 DIPRIVAN PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 63323027025 PROPOFOL PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 63323027026 PROPOFOL PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 63323027050 PROPOFOL PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 63323027057 PROPOFOL PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 63323027065 PROPOFOL PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 63323027067 PROPOFOL PROPOFOL 10 MG/ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 63323029730 PROPOVEN PROPOFOL/PF 200MG/20ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 63323029750 PROPOVEN PROPOFOL/PF 500MG/50ML 2015-01-01 2299-12-31 1 10 MG ML
J2704 63323029766 PROPOVEN PROPOFOL/PF 1000MG/100 2015-01-01 2299-12-31 1 10 MG ML
J2778 50242008001 LUCENTIS RANIBIZUMAB 0.5 MG/0.05 ML 2011-01-01 2018-05-15 100 0.1 MG ML
J2778 50242008002 LUCENTIS 0.5 MG/0.05 ML SOLNRANIBIZUMAB 0.5 MG/0.05 ML 2017-04-20 2299-12-31 100 0.1 MG ML
J2778 50242008003 LUCENTIS 0.5 MG/0.05 ML SOSYRANIBIZUMAB 0.5 MG/0.05 ML 2017-01-05 2299-12-31 100 0.1 MG ML
J2778 50242008201 LUCENTIS RANIBIZUMAB 0.3MG/0.05 2012-08-10 2018-05-15 60 0.1 MG ML
J2778 50242008202 LUCENTIS 0.3 MG/0.05 ML SOLNRANIBIZUMAB 0.3 MG/0.05 ML 2017-04-20 2299-12-31 60 0.1 MG ML
J2778 50242008203 LUCENTIS 0.3 MG SYRINGE RANIBIZUMAB 0.3 MG/0.05 ML 2018-04-01 2299-12-31 60 0.1 MG ML
J2780 24987036210 ZANTAC RANITIDINE HCL 50 MG/2 ML 2014-12-01 2299-12-31 1 25 MG ML
J2780 24987036301 ZANTAC RANITIDINE HCL 25 MG/ML 2014-11-25 2299-12-31 1 25 MG ML
J2780 24987036401 ZANTAC RANITIDINE HCL 25 MG/ML 2014-11-25 2299-12-31 1 25 MG ML
J2780 68382042202 RANITIDINE HCL RANITIDINE HCL 50 MG/2 ML 2014-11-25 2299-12-31 1 25 MG ML
J2780 68382042306 RANITIDINE HCL RANITIDINE HCL 25 MG/ML 2014-11-25 2299-12-31 1 25 MG ML
J2783 00024515010 ELITEK RASBURICASE 1.5 MG 2014-01-01 2299-12-31 3 0.5 MG EA
J2783 00024515011 ELITEK RASBURICASE 1.5 MG 2014-02-18 2299-12-31 3 0.5 MG EA
J2783 00024515175 ELITEK RASBURICASE 7.5 MG 2014-01-01 2299-12-31 15 0.5 MG EA
J2786 59310061031 CINQAIR RESLIZUMAB 10 MG/ML 2017-01-01 2299-12-31 10 1 MG ML
J2788 00562780600 MICRHOGAM ULTRA-
FILTERED PLUS
RHO(D) IMMUNE GLOBULIN 250 UNIT 2014-08-03 2299-12-31 1 50 MCG (250 UNITS) EA
J2788 13533066106 HYPERRHO S-D RHO(D) IMMUNE GLOBULIN 250 UNIT 2014-07-01 2299-12-31 1 50 MCG (250 UNITS) EA
J2788 13533066160 HYPERRHO S-D RHO(D) IMMUNE GLOBULIN 250 UNIT 2014-07-01 2299-12-31 1 50 MCG (250 UNITS) EA
J2790 00562780500 RHOGAM ULTRA-FILTERED
PLUS
RHO(D) IMMUNE GLOBULIN 1500 UNIT 2014-08-01 2299-12-31 1 300 MCG (1500
UNITS)
EA
J2790 00562780501 RHOGAM PLUS RHO (D) IMMUNE GLOBULIN 1500 UNIT 2013-01-18 2299-12-31 1 300 MCG (1500
UNITS)
EA
J2790 00562780505 RHOGAM PLUS RHO (D) IMMUNE GLOBULIN 1500 UNIT 2013-01-18 2299-12-31 1 300 MCG (1500
UNITS)
EA
J2790 00562780525 RHOGAM PLUS RHO (D) IMMUNE GLOBULIN 1500 UNIT 2013-01-18 2299-12-31 1 300 MCG (1500
UNITS)
EA
J2790 13533063102 HYPERRHO S-D RHO(D) IMMUNE GLOBULIN 300 MCG 2012-08-25 2299-12-31 1 300 MCG ML
J2790 13533063110 HYPERRHO S-D RHO(D) IMMUNE GLOBULIN 1500 UNIT 2014-10-15 2299-12-31 1 300 MCG (1500
UNITS)
EA
J2790 13533063120 HYPERRHO S-D RHO(D) IMMUNE GLOBULIN 1500 UNIT 2014-10-24 2299-12-31 1 300 MCG (1500
UNITS)
EA
J2791 44206030001 RHOPHYLAC RHO(D) IMMUNE GLOBULIN 300MCG/2ML 2008-01-01 2299-12-31 1.5 100 UNITS ML
J2791 44206030010 RHOPHYLAC RHO(D) IMMUNE GLOBULIN 300MCG/2ML 2008-01-01 2299-12-31 1.5 100 UNITS ML
J2792 00944296703 WINRHO SDF RHO(D) IMMUNE
GLOBULIN/MALTOSE
1500/1.3ML 2007-07-01 2299-12-31 11.53846 100 UNITS ML
J2792 00944296705 WINRHO SDF RHO(D) IMMUNE
GLOBULIN/MALTOSE
5000/4.4ML 2007-07-01 2299-12-31 11.3636 100 UNITS ML
J2792 00944296707 WINRHO SDF RHO(D) IMMUNE
GLOBULIN/MALTOSE
2500/2.2ML 2007-07-01 2299-12-31 11.3636 100 UNITS ML
J2792 00944296709 WINRHO SDF RHO(D) IMMUNE
GLOBULIN/MALTOSE
15000/13ML 2007-07-01 2299-12-31 11.53846 100 UNITS ML
J2792 53270300001 WINRHO SDF RHO(D) IMMUNE
GLOBULIN/MALTOSE
15000/13ML 2010-06-01 2299-12-31 11.53846 100 UNITS ML
J2792 53270310001 WINRHO SDF RHO(D) IMMUNE
GLOBULIN/MALTOSE
5000/4.4ML 2010-06-01 2299-12-31 11.3636 100 UNITS ML
J2792 53270330001 WINRHO SDF RHO(D) IMMUNE
GLOBULIN/MALTOSE
1500/1.3ML 2010-06-01 2299-12-31 11.53846 100 UNITS ML
J2792 53270350001 WINRHO SDF RHO(D) IMMUNE
GLOBULIN/MALTOSE
2500/2.2ML 2010-06-01 2299-12-31 11.3636 100 UNITS ML
J2794 50458030611 RISPERDAL CONSTA RISPERIDONE
MICROSPHERES
25 MG/2 ML 2007-07-01 2299-12-31 50 0.5 MG EA
J2794 50458030711 RISPERDAL CONSTA RISPERIDONE
MICROSPHERES
37.5MG/2ML 2007-07-01 2299-12-31 75 0.5 MG EA
J2794 50458030811 RISPERDAL CONSTA RISPERIDONE
MICROSPHERES
50 MG/2 ML 2007-07-01 2299-12-31 100 0.5 MG EA
J2794 50458030911 RISPERDAL CONSTA RISPERIDONE
MICROSPHERES
12.5MG/2ML 2007-07-01 2299-12-31 25 0.5 MG EA
J2796 55513022101 NPLATE ROMIPLOSTIM 250 MCG 2010-01-01 2299-12-31 25 10 MCG EA
J2796 55513022201 NPLATE ROMIPLOSTIM 500 MCG 2010-01-01 2299-12-31 50 10 MCG EA
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Jcode NDC Brand Name Generic Name Strength Effective Begin
Date
Effective End
Date
Conversion
Factor
Jcode Billing Units NDC
Billing
Units
J2820 00024584301 LEUKINE SARGRAMOSTIM 250 MCG 2013-12-04 2299-12-31 5 50 MCG EA
J2820 00024584305 LEUKINE SARGRAMOSTIM 250 MCG 2013-10-31 2299-12-31 5 50 MCG EA
J2860 57894042001 SYLVANT SILTUXIMAB 100 MG VIAL 2016-01-01 2299-12-31 10 10 MG EA
J2860 57894042101 SYLVANT SILTUXIMAB 400 MG VIAL 2016-01-01 2299-12-31 40 10 MG EA
J2916 00024279210 FERRLECIT SODIUM FERRIC GLUCONATE 12.5 MG/ML 2017-01-01 2299-12-31 1 12.5 MG ML
J2916 00024279410 FERRLECIT SODIUM FERRIC GLUCONATE 12.5 MG/ML 2017-01-01 2299-12-31 1 12.5 MG ML
J2916 00143957001 SODIUM FERRIC GLUCONATESODIUM FERRIC GLUCONATE 12.5 MG/ML 2017-01-01 2299-12-31 1 12.5 MG ML
J2916 00143957010 SODIUM FERRIC GLUCONATESODIUM FERRIC GLUCONATE 12.5 MG/ML 2017-01-01 2299-12-31 1 12.5 MG ML
J2916 00591014926 SODIUM FERRIC GLUCONATESODIUM FERRIC GLUCONATE 12.5 MG/ML 2017-01-01 2299-12-31 1 12.5 MG ML
J2916 00591014987 SODIUM FERRIC GLUCONATESODIUM FERRIC GLUCONATE 12.5 MG/ML 2017-01-01 2299-12-31 1 12.5 MG ML
J2916 00591250826 SODIUM FERRIC GLUCONATESODIUM FERRIC GLUCONATE 12.5 MG/ML 2017-01-01 2299-12-31 1 12.5 MG ML
J2916 00591250887 SODIUM FERRIC GLUCONATESODIUM FERRIC GLUCONATE 12.5 MG/ML 2017-01-01 2299-12-31 1 12.5 MG ML
J2920 00009003928 SOLU-MEDROL 40 MG VIAL METHYLPREDNISOLONE SODIUM SUCCINATE40 MG 2018-07-01 2299-12-31 1 40 MG EA
J2930 00009004722 METHYLPREDNISOLONE 125 MGMETHYLPREDNISOLONE SOD
SUCC
125 MG 2015-07-01 2299-12-31 1 125 MG EA
J2930 00009069801 SOLU-MEDROL METHYLPREDNISOLONE SOD
SUCC
1000 MG 2014-11-25 2299-12-31 8 125 MG EA
J2930 00009075801 SOLU-MEDROL METHYLPREDNISOLONE SOD
SUCC
500 MG 2014-11-25 2299-12-31 4 125 MG EA
J2930 00009079601 SOLU-MEDROL METHYLPREDNISOLONE SOD
SUCC
2 G 2014-11-25 2299-12-31 16 125 MG EA
J2930 63323025503 METHYLPREDNISOLONE
SOD SUCC
METHYLPREDNISOLONE SOD
SUCC
40 MG 2014-11-25 2299-12-31 0.32 125 MG EA
J2930 63323025803 METHYLPREDNISOLONE
SOD SUCC
METHYLPREDNISOLONE SOD
SUCC
125 MG 2014-11-25 2299-12-31 1 125 MG EA
J2930 63323026530 METHYLPREDNISOLONE
SOD SUCC
METHYLPREDNISOLONE SOD
SUCC
1000 MG 2014-11-25 2299-12-31 8 125 MG EA
J2930 70121100105 METHYLPREDNISOLONE SODIUM SUCCINATEMETHYLPREDNISOLONE SODIUM SUCCINATE125 MG 2018-07-01 2299-12-31 1 125 MG EA
J3060 00069010601 ELELYSO TALIGLUCERASE ALFA 200 UNITS 2014-01-01 2299-12-31 20 10 UNITS EA
J3090 67919004001 SIVEXTRO TEDIZOLID 200 MG VIAL 2016-01-01 2299-12-31 200 1 MG EA
J3095 52118000101 VIBATIV TELAVANCIN 750 MG 2015-01-01 2299-12-31 75 10 MG EA
J3095 52118000201 VIBATIV TELAVANCIN 250 MG 2015-01-01 2299-12-31 25 10 MG EA
J3240 58468003001 THYROGEN THYROTROPIN ALFA 1.1 MG 2014-11-05 2299-12-31 1 1.1 MG EA
J3240 58468184904 THYROGEN THYROTROPIN ALFA 1.1MG 2007-07-01 2017-03-31 1 1.1 MG EA
J3262 50242013501 ACTEMRA TOCILIZUMAB 80 MG/4 ML 2012-01-01 2299-12-31 20 1 MG ML
J3262 50242013601 ACTEMRA TOCILIZUMAB 200MG/10ML 2012-01-01 2299-12-31 20 1 MG ML
J3262 50242013701 ACTEMRA TOCILIZUMAB 400MG/20ML 2012-01-01 2299-12-31 20 1 MG ML
J3262 50242013801 ACTEMRA TOCILIZUMAB 162 MG/0.9 2013-10-28 2299-12-31 180 1 MG ML
J3300 00065054301 TRIESENCE TRIAMCINOLONE
ACETONIDE/PF
40 MG/ML 2009-01-01 2299-12-31 1 1 MG EA
J3301 00003029305 KENALOG-40 TRIAMCINOLONE ACETONIDE 40 MG/ML 2010-01-01 2299-12-31 4 10 MG ML
J3301 00003029320 KENALOG-40 TRIAMCINOLONE ACETONIDE 40 MG/ML 2010-01-01 2299-12-31 4 10 MG ML
J3301 00003029328 KENALOG-40 TRIAMCINOLONE ACETONIDE 40 MG/ML 2010-01-01 2299-12-31 4 10 MG ML
J3301 00003049420 KENALOG-10 TRIAMCINOLONE ACETONIDE 10 MG/ML 2010-01-01 2299-12-31 1 10 MG ML
J3303 00781308475 ARISTOSPAN TRIAMCINOLONE
HEXACETONIDE
5 MG/ML 2012-05-26 2299-12-31 1 5 MG ML
J3303 00781308571 ARISTOSPAN TRIAMCINOLONE
HEXACETONIDE
20 MG/ML 2012-05-26 2016-03-31 4 5 MG ML
J3303 00781308575 ARISTOSPAN TRIAMCINOLONE
HEXACETONIDE
20 MG/ML 2012-05-26 2299-12-31 4 5 MG ML
J3304 70801000301 ZILRETTA TRIAMCINOLONE ACETONIDE 32 MG 2019-01-01 2299-12-31 32 1 MG EA
J3315 52544009276 TRELSTAR TRIPTORELIN 22.5 MG 2010-04-15 2299-12-31 6 3.75 MG EA
J3315 52544015302 TRELSTAR DEPOT TRIPTORELIN 3.75 MG 2007-07-01 2299-12-31 1 3.75 MG EA
J3315 52544015402 TRELSTAR LA TRIPTORELIN 11.25 MG 2007-07-01 2299-12-31 3 3.75 MG EA
J3315 52544015602 TRELSTAR TRIPTORELIN 22.5 MG 2010-04-15 2299-12-31 6 3.75 MG EA
J3315 52544018876 TRELSTAR TRIPTORELIN 11.25 MG 2008-06-02 2299-12-31 3 3.75 MG EA
J3315 52544018976 TRELSTAR TRIPTORELIN 3.75 MG 2008-06-02 2299-12-31 1 3.75 MG EA
J3357 57894006003 STELARA USTEKINUMAB 45MG/0.5 ML 2012-01-01 2299-12-31 90 1 MG ML
J3357 57894006103 STELARA USTEKINUMAB 90MG/ML 2012-01-01 2299-12-31 90 1 MG ML
J3370 00409433201 VANCOMYCIN HCL VANCOMYCIN HCL 500 MG 2015-01-01 2299-12-31 1 500 MG EA
J3370 00409433249 VANCOMYCIN HCL VANCOMYCIN HCL 500 MG 2015-01-01 2016-01-01 1 500 MG EA
J3370 00409650901 VANCOMYCIN HCL VANCOMYCIN HCL 5 G 2015-10-01 2299-12-31 10 500 MG EA
J3370 00409651001 VANCOMYCIN HCL VANCOMYCIN HCL 10 G 2015-10-01 2299-12-31 20 500 MG EA
J3370 00409653101 VANCOMYCIN HCL VANCOMYCIN HCL 750 MG 2015-10-01 2299-12-31 1.5 500 MG EA
J3370 00409653102 VANCOMYCIN HCL VANCOMYCIN HCL 750 MG 2015-10-01 2299-12-31 1.5 500 MG EA
J3370 00409653301 VANCOMYCIN HCL VANCOMYCIN HCL 1 G 2015-10-01 2299-12-31 2 500 MG EA
J3370 00409653361 VANCOMYCIN HCL VANCOMYCIN HCL 1 G 2015-10-01 2299-12-31 2 500 MG EA
J3370 00409653401 VANCOMYCIN HCL VANCOMYCIN HCL 500 MG 2015-01-01 2299-12-31 1 500 MG EA
J3370 00409653501 VANCOMYCIN HCL VANCOMYCIN HCL 1 G 2015-10-01 2299-12-31 2 500 MG EA
J3370 25021015799 VANCOMYCIN HCL VANCOMYCIN HCL 5 G 2015-10-01 2299-12-31 10 500 MG EA
J3370 25021015899 VANCOMYCIN HCL VANCOMYCIN HCL 10 G 2015-10-01 2299-12-31 20 500 MG EA
J3370 63323022110 VANCOMYCIN HCL VANCOMYCIN HCL 500 MG 2015-01-01 2299-12-31 1 500 MG EA
J3370 63323028420 VANCOMYCIN HCL VANCOMYCIN HCL 1 G 2015-10-01 2299-12-31 2 500 MG EA
J3370 63323029561 VANCOMYCIN HCL VANCOMYCIN HCL 5 G 2015-10-01 2299-12-31 2 500 MG EA
J3370 63323031461 VANCOMYCIN HCL VANCOMYCIN HCL 10 G 2015-10-01 2299-12-31 2 500 MG EA
Page 15 of 26
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Jcode NDC Brand Name Generic Name Strength Effective Begin
Date
Effective End
Date
Conversion
Factor
Jcode Billing Units NDC
Billing
Units
J3370 67457033950 VANCOMYCIN HCL VANCOMYCIN HCL 500 MG 2015-01-01 2299-12-31 1 500 MG EA
J3370 67457034001 VANCOMYCIN HCL VANCOMYCIN HCL 1 G 2015-10-01 2299-12-31 1 500 MG EA
J3370 67457034105 VANCOMYCIN HCL VANCOMYCIN HCL 5 G 2015-10-01 2299-12-31 10 500 MG EA
J3370 67457034210 VANCOMYCIN HCL VANCOMYCIN HCL 10 G 2015-10-01 2299-12-31 20 500 MG EA
J3370 67457061110 VANCOMYCIN HCL VANCOMYCIN HCL 500 MG 2015-07-07 2299-12-31 1 500 MG EA
J3370 67457061220 VANCOMYCIN HCL VANCOMYCIN HCL 1 G 2015-10-01 2299-12-31 2 500 MG EA
J3370 67457061310 VANCOMYCIN HCL VANCOMYCIN HCL 5 G 2015-10-01 2299-12-31 10 500 MG EA
J3370 67457061410 VANCOMYCIN HCL VANCOMYCIN HCL 10 G 2015-10-01 2299-12-31 20 500 MG EA
J3370 63323022116 VANCOMYCIN HCL VANCOMYCIN HCL 500MG 2015-08-27 2299-12-31 1 500 MG EA
J3380 64764030020 ENTYVIO VEDOLIZUMAB 300 MG 2016-01-01 2299-12-31 300 1 MG EA
J3385 54092070104 VPRIV VELAGLUCERASE ALFA 400 UNITS 2011-01-01 2299-12-31 4 100 UNITS EA
J3396 00187560015 VISUDYNE VERTEPORFIN 15 MG 2013-09-03 2299-12-31 150 0.1 MG EA
J3415 63323018001 PYRIDOXINE HCL PYRIDOXINE HCL 100 MG/ML 2007-07-01 2299-12-31 1 100 MG ML
J3420 00143961901 CYANOCOBALAMIN CYANOCOBALAMIN 1000 MCG/ML 2016-04-01 2299-12-31 1 1000 MCG ML
J3420 00143961910 CYANOCOBALAMIN CYANOCOBALAMIN 1000 MCG/ML 2016-04-01 2299-12-31 1 1000 MCG ML
J3420 00143962001 CYANOCOBALAMIN CYANOCOBALAMIN 1000 MCG/ML 2016-04-01 2299-12-31 1 1000 MCG ML
J3420 00143962010 CYANOCOBALAMIN CYANOCOBALAMIN 1000 MCG/ML 2016-04-01 2299-12-31 1 1000 MCG ML
J3420 00143962101 CYANOCOBALAMIN CYANOCOBALAMIN 1000 MCG/ML 2016-04-01 2299-12-31 1 1000 MCG ML
J3420 00143962125 CYANOCOBALAMIN CYANOCOBALAMIN 1000 MCG/ML 2016-04-01 2299-12-31 1 1000 MCG ML
J3420 00517003125 CYANOCOBALAMIN CYANOCOBALAMIN 1000 MCG/ML 2016-04-01 2299-12-31 1 1000 MCG ML
J3420 00517003225 CYANOCOBALAMIN CYANOCOBALAMIN 1000 MCG/ML 2016-04-01 2299-12-31 1 1000 MCG ML
J3420 00517013005 CYANOCOBALAMIN CYANOCOBALAMIN 1000 MCG/ML 2016-04-01 2299-12-31 1 1000 MCG ML
J3420 54569638000 CYANOCOBALAMIN CYANOCOBALAMIN 1000 MCG/ML 2017-01-14 2299-12-31 1 1000 MCG ML
J3420 54868076201 CYANOCOBALAMIN CYANOCOBALAMIN 1000 MCG/ML 2016-04-01 2299-12-31 1 1000 MCG ML
J3420 63323004401 CYANOCOBALAMIN CYANOCOBALAMIN 1000 MCG/ML 2016-04-01 2299-12-31 1 1000 MCG ML
J3420 67457039910 CYANOCOBALAMIN CYANOCOBALAMIN 1000 MCG/ML 2017-07-06 2299-12-31 1 1000 MCG ML
J3420 67457039925 CYANOCOBALAMIN CYANOCOBALAMIN 1000 MCG/ML 2017-07-06 2299-12-31 1 1000 MCG ML
J3420 67457040005 CYANOCOBALAMIN CYANOCOBALAMIN 1000 MCG/ML 2017-07-06 2299-12-31 1 1000 MCG ML
J3420 67457040031 CYANOCOBALAMIN CYANOCOBALAMIN 1000 MCG/ML 2017-07-06 2299-12-31 1 1000 MCG ML
J3420 70069000501 CYANOCOBALAMIN CYANOCOBALAMIN 1000 MCG/ML 2017-03-13 2299-12-31 1 1000 MCG ML
J3420 70069000510 CYANOCOBALAMIN CYANOCOBALAMIN 1000 MCG/ML 2017-03-13 2299-12-31 1 1000 MCG ML
J3420 70069017201 CYANOCOBALAMIN CYANOCOBALAMIN 1000 MCG/ML 2017-07-31 2299-12-31 1 1000 MCG ML
J3420 70069017210 CYANOCOBALAMIN CYANOCOBALAMIN 1000 MCG/ML 2017-07-31 2299-12-31 1 1000 MCG ML
J3430 00409915701 VITAMIN K AMPULE (1 MG) PHYTONADIONE (VITAMIN K-1) 1 MG/0.5 ML 2018-01-01 2299-12-31 2 1 MG ML
J3430 00409915725 VITAMIN K AMPULE (1 MG) PHYTONADIONE (VITAMIN K-1) 1 MG/0.5 ML 2018-01-01 2299-12-31 2 1 MG ML
J3430 00409915801 VITAMIN K AMPULE (10 MG) PHYTONADIONE (VITAMIN K-1) 10 MG/ML 2018-01-01 2299-12-31 10 1 MG ML
J3430 00409915825 VITAMIN K AMPULE (10 MG) PHYTONADIONE (VITAMIN K-1) 10 MG/ML 2018-01-01 2299-12-31 10 1 MG ML
J3430 76329124001 PHYTONADIONE SYRINGE PHYTONADIONE (VITAMIN K-1) 1 MG/0.5 ML 2018-01-01 2299-12-31 2 1 MG ML
J3489 00078038725 ZOMETA ZOLEDRONIC
ACID/MANNITOL&WATER
4 MG/5ML 2014-01-01 2299-12-31 0.8 1 MG ML
J3489 00078043561 RECLAST ZOLEDRONIC
ACID/MANNITOL/WATER
5MG/100ML 2014-01-01 2299-12-31 0.05 1 MG ML
J3489 00078059061 ZOMETA ZOLEDRONIC
ACID/MANNITOL&WATER
4 MG/100ML 2014-01-01 2299-12-31 0.04 1 MG ML
J3489 00143964201 ZOLEDRONIC ACID ZOLEDRONIC ACID 4 MG/5 ML 2014-01-01 2299-12-31 0.8 1 MG ML
J3489 23155017031 ZOLEDRONIC ACID ZOLEDRONIC ACID 4 MG/5 ML 2014-01-01 2299-12-31 0.8 1 MG ML
J3489 23155018631 ZOLEDRONIC ACID ZOLEDRONIC
ACID/MANNITOL&WATER
5 MG/100ML 2014-01-01 2299-12-31 0.05 1 MG ML
J3489 25021080166 ZOLEDRONIC ACID ZOLEDRONIC ACID 4 MG/5 ML 2014-01-01 2299-12-31 0.8 1 MG ML
J3489 25021082682 ZOLEDRONIC ACID ZOLEDRONIC
ACID/MANNITOL&WATER
4 MG/100ML 2014-01-01 2299-12-31 0.04 1 MG ML
J3489 25021083082 ZOLEDRONIC ACID ZOLEDRONIC
ACID/MANNITOL&WATER
5 MG/100ML 2014-01-01 2299-12-31 0.05 1 MG ML
J3489 42023015101 ZOLEDRONIC ACID ZOLEDRONIC ACID 4 MG/5ML 2014-01-01 2299-12-31 0.8 1 MG ML
J3489 42023015101 ZOLEDRONIC ACID ZOLEDRONIC ACID 4 MG/5 ML 2014-01-01 2299-12-31 0.8 1 MG ML
J3489 42023016301 ZOLEDRONIC ACID ZOLEDRONIC
ACID/MANNITOL&WATER
5 MG/100ML 2014-01-01 2299-12-31 0.05 1 MG ML
J3489 42023016301 ZOLEDRONIC ACID ZOLEDRONIC
ACID/MANNITOL&WATER
5 MG/100ML 2014-01-02 2299-12-31 0.05 1 MG ML
J3489 43598033011 ZOLEDRONIC ACID ZOLEDRONIC ACID 4 MG/5 ML 2014-01-01 2299-12-31 0.8 1 MG ML
J3489 43598033111 ZOLEDRONIC ACID ZOLEDRONIC
ACID/MANNITOL&WATER
5 MG/100ML 2014-01-01 2299-12-31 0.05 1 MG ML
J3489 45963044055 ZOLEDRONIC ACID ZOLEDRONIC ACID 4 MG/5 ML 2015-01-13 2299-12-31 0.8 1 MG ML
J3489 47335003540 ZOLEDRONIC ACID ZOLEDRONIC ACID 4 MG/5 ML 2014-01-01 2299-12-31 0.8 1 MG ML
J3489 47335096241 ZOLEDRONIC ACID ZOLEDRONIC ACID 4 MG 2014-01-01 2299-12-31 4 1 MG EA
J3489 55111068507 ZOLEDRONIC ACID ZOLEDRONIC ACID 4 MG/5ML 2014-01-01 2299-12-31 0.8 1 MG ML
J3489 55111068507 ZOLEDRONIC ACID ZOLEDRONIC ACID 4 MG/5 ML 2014-01-01 2299-12-31 0.8 1 MG ML
J3489 55111068852 ZOLEDRONIC ACID ZOLEDRONIC
ACID/MANNITOL&WATER
5 MG/100ML 2014-01-01 2299-12-31 0.05 1 MG ML
J3489 60505611000 ZOLEDRONIC ACID ZOLEDRONIC ACID 4 MG/5 ML 2014-01-01 2299-12-31 0.8 1 MG ML
J3489 63323096198 ZOLEDRONIC ACID ZOLEDRONIC ACID 4 MG/5 ML 2015-01-27 2299-12-31 0.8 1 MG ML
J3489 67457039054 ZOLEDRONIC ACID ZOLEDRONIC ACID 4 MG/5 ML 2015-01-27 2299-12-31 0.8 1 MG ML
J3490 00338519741 FAMOTIDINE 20 MG PIGGYBACKFAMOTIDINE IN NACL,ISO-OSM/PF20MG/50ML 2017-01-01 2299-12-31 1 1 ML
J3490 00641602110 FAMOTIDINE 200 MG/20 ML VIALFAMOTIDINE 10MG/ML 2017-01-01 2299-12-31 1 1 ML
Page 16 of 26
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Jcode NDC Brand Name Generic Name Strength Effective Begin
Date
Effective End
Date
Conversion
Factor
Jcode Billing Units NDC
Billing
Units
J3490 00641602225 FAMOTIDINE 20 MG/2 ML VIALFAMOTIDINE/PF 20 MG/2 ML 2017-01-01 2299-12-31 1 1 ML
J3490 00641602325 FAMOTIDINE 40 MG/4 ML VIALFAMOTIDINE 10MG/ML 2017-01-01 2299-12-31 1 1 ML
J3490 55390002601 FAMOTIDINE 500 MG/50 ML VIALFAMOTIDINE 10MG/ML 2017-01-01 2299-12-31 1 1 ML
J3490 55390002701 FAMOTIDINE 200 MG/20 ML VIALFAMOTIDINE 10MG/ML 2017-01-01 2299-12-31 1 1 ML
J3490 55390002810 FAMOTIDINE 40 MG/4 ML VIALFAMOTIDINE 10MG/ML 2017-01-01 2299-12-31 1 1 ML
J3490 55390002910 FAMOTIDINE 20 MG/2 ML VIALFAMOTIDINE/PF 20 MG/2 ML 2017-01-01 2299-12-31 1 1 ML
J3490 63323073809 FAMOTIDINE 10 MG/ML VIAL FAMOTIDINE 10MG/ML 2017-01-01 2299-12-31 1 1 ML
J3490 63323073820 FAMOTIDINE 10 MG/ML VIAL FAMOTIDINE 10MG/ML 2017-01-01 2299-12-31 1 1 ML
J3490 63323073912 FAMOTIDINE 20 MG/2 ML VIALFAMOTIDINE/PF 20 MG/2 ML 2017-01-01 2299-12-31 1 1 ML
J3490 63323073916 FAMOTIDINE 20 MG/2 ML VIALFAMOTIDINE/PF 20 MG/2 ML 2017-01-01 2299-12-31 1 1 ML
J3490 67457043322 FAMOTIDINE 20 MG/2 ML VIALFAMOTIDINE/PF 20 MG/2 ML 2017-01-01 2299-12-31 1 1 ML
J3490 67457044843 FAMOTIDINE 40 MG/4 ML VIALFAMOTIDINE 10 MG/ML 2017-01-01 2299-12-31 1 1 ML
J3490 67457045720 FAMOTIDINE 200 MG/20 ML VIALFAMOTIDINE 10 MG/ML 2017-01-01 2299-12-31 1 1 ML
J3590 13533063601 HYPERHEP B S-D HEPATITIS B IMMUNE
GLOBULIN
220 UNIT/1 2009-12-16 2299-12-31 1 1 EA
J3590 13533063602 HYPERHEP B S-D HEPATITIS B IMMUNE
GLOBULIN
220 UNIT/1 2009-12-16 2299-12-31 1 1 EA
J3590 13533063603 HYPERHEP B S-D HEPATITIS B IMMUNE
GLOBULIN
110/0.5ML 2009-12-16 2299-12-31 1 1 EA
J3590 13533063605 HYPERHEP B S-D HEPATITIS B IMMUNE
GLOBULIN
220/ML (5) 2009-12-16 2299-12-31 1 1 EA
J3590 59730420201 NABI-HB HEPATITIS B IMMUNE
GLOBULIN
>312/ML 2009-12-16 2299-12-31 1 1 EA
J3590 59730420301 NABI-HB HEPATITIS B IMMUNE
GLOBULIN
>1560/5ML 2009-12-16 2299-12-31 1 1 EA
J7030 00264780000 SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE 0.9 % 2015-10-01 2299-12-31 0.001 1000 CC ML
J7030 00264780009 SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE 0.9 % 2015-10-01 2299-12-31 0.001 1000 CC ML
J7030 00338004904 SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE 0.9 % 2015-10-01 2299-12-31 0.001 1000 CC ML
J7030 00409798309 SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE 0.9 % 2015-10-01 2299-12-31 0.001 1000 CC ML
J7030 63323062310 SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE 0.9 % 2015-10-01 2299-12-31 0.001 1000 CC ML
J7040 00264400155 SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE 0.9 % 2014-11-25 2016-09-30 0.002 500 ML ML
J7040 00264780010 SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE 0.9 % 2014-11-25 2299-12-31 0.002 500 ML ML
J7040 00264999910 SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE 0.9 % 2014-12-01 2299-12-31 0.002 500 ML ML
J7040 00338004903 SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE 0.9 % 2014-11-25 2299-12-31 0.002 500 ML ML
J7040 00338630403 SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE 0.9 % 2014-11-25 2299-12-31 0.002 500 ML ML
J7040 00409798303 SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE 0.9 % 2014-11-25 2299-12-31 0.002 500 ML ML
J7040 00409798330 SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE 0.9 % 2014-11-25 2299-12-31 0.002 500 ML ML
J7040 00409798355 SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE 0.9 % 2014-11-25 2299-12-31 0.002 500 ML ML
J7040 63323062351 SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE 0.9 % 2014-11-25 2299-12-31 0.002 500 ML ML
J7040 63323062359 SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE 0.9 % 2014-11-25 2299-12-31 0.002 500 ML ML
J7050 00264780020 SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE 0.9 % 2014-11-25 2299-12-31 0.004 250 ML ML
J7050 00338004902 SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE 0.9 % 2014-11-25 2299-12-31 0.004 250 ML ML
J7050 00338630402 SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE 0.9 % 2014-11-25 2299-12-31 0.004 250 ML ML
J7050 00338954201 SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE 0.9 % 2014-08-15 2299-12-31 0.004 250 ML ML
J7050 00409710102 SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE 0.9 % 2014-11-25 2299-12-31 0.004 250 ML ML
J7050 00409710104 SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE 0.9 % 2015-01-22 2299-12-31 0.004 250 ML ML
J7050 00409798302 SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE 0.9 % 2014-11-25 2299-12-31 0.004 250 ML ML
J7050 00409798325 SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE 0.9 % 2014-11-25 2299-12-31 0.004 250 ML ML
J7050 00409798353 SODIUM CHLORIDE 0.9 % SODIUM CHLORIDE 0.9 % 2014-11-25 2299-12-31 0.004 250 ML ML
J7178 63833089151 RIASTAP FIBRINOGEN 900-1300 MG 2013-01-01 2299-12-31 1 1 MG EA
J7180 63833051802 CORIFACT FACTOR XIII 1000-1600 2012-01-01 2299-12-31 1 1 UNIT EA
J7181 00169701301 TRETTEN FACTOR XIII A-
SUBUNIT,RECOMB
2500 UNIT 2015-01-01 2299-12-31 1 1 UNIT EA
J7181 00169711311 TRETTEN FACTOR XIII A-
SUBUNIT,RECOMB
2500 UNIT 2015-01-01 2299-12-31 1 1 UNIT EA
J7183 67467018101 WILATE AHF,HUMAN/VWF,HUMAN 450-450 2012-01-01 2299-12-31 1 1 UNIT EA
J7183 67467018102 WILATE AHF,HUMAN/VWF,HUMAN 900-900 2012-01-01 2299-12-31 1 1 UNIT EA
J7183 67467018201 WILATE AHF,HUMAN/VWF,HUMAN 500-500 2012-01-01 2017-04-01 1 1 UNIT EA
J7183 67467018202 WILATE AHF,HUMAN/VWF,HUMAN 1K-1K UNIT 2012-01-01 2017-04-01 1 1 UNIT EA
J7183 68982018201 WILATE ANTIHEMOPHILIC
FACTOR/VWF
500-500 2016-04-01 2299-12-31 1 1 IU EA
J7183 68982018202 WILATE ANTIHEMOPHILIC
FACTOR/VWF
1K-1K UNIT 2016-04-01 2299-12-31 1 1 IU EA
J7185 58394001201 XYNTHA ANTIHEMOPH.FVIII PLAS/ALB
FREE
250 (+/-) 2012-05-26 2299-12-31 1 1 UNIT EA
J7185 58394001301 XYNTHA ANTIHEMOPH.FVIII PLAS/ALB
FREE
500 (+/-) 2012-05-26 2299-12-31 1 1 UNIT EA
J7185 58394001401 XYNTHA ANTIHEMOPH.FVIII PLAS/ALB
FREE
1000 (+/-) 2012-05-26 2299-12-31 1 1 UNIT EA
J7185 58394001501 XYNTHA ANTIHEMOPH.FVIII PLAS/ALB
FREE
2000 (+/-) 2012-05-26 2299-12-31 1 1 UNIT EA
J7185 58394001603 XYNTHA ANTIHEMOPH.FVIII PLAS/ALB
FREE
3000 (+/-) 2012-05-26 2299-12-31 1 1 UNIT EA
J7185 58394002203 XYNTHA SOLOFUSE ANTIHEMOPH.FVIII PLAS/ALB
FREE
250 (+/-) 2012-05-26 2299-12-31 1 1 UNIT EA
J7185 58394002303 XYNTHA SOLOFUSE ANTIHEMOPH.FVIII PLAS/ALB
FREE
500 (+/-) 2012-05-26 2299-12-31 1 1 UNIT EA
J7185 58394002403 XYNTHA SOLOFUSE ANTIHEMOPH.FVIII PLAS/ALB
FREE
1000 (+/-) 2012-05-26 2299-12-31 1 1 UNIT EA
J7185 58394002503 XYNTHA SOLOFUSE ANTIHEMOPH.FVIII PLAS/ALB
FREE
2000 (+/-) 2012-05-26 2299-12-31 1 1 UNIT EA
J7186 68516460101 ALPHANATE AHF,HUMAN/VWF,HUMAN 250 (100) 2012-01-01 2299-12-31 1 1 UNIT EA
J7186 68516460201 ALPHANATE AHF,HUMAN/VWF,HUMAN 500 (200) 2012-01-01 2299-12-31 1 1 UNIT EA
Page 17 of 26
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Jcode NDC Brand Name Generic Name Strength Effective Begin
Date
Effective End
Date
Conversion
Factor
Jcode Billing Units NDC
Billing
Units
J7186 68516460302 ALPHANATE AHF,HUMAN/VWF,HUMAN 1000 (400) 2012-01-01 2299-12-31 1 1 UNIT EA
J7186 68516460402 ALPHANATE AHF,HUMAN/VWF,HUMAN 1500 (600) 2012-01-01 2299-12-31 1 1 UNIT EA
J7186 68516460902 ALPHANATE ANTIHEMOPHILIC
FACTOR/VWF
2000 (800) 2014-09-04 2299-12-31 1 1 UNIT EA
J7186 68516461002 ALPHANATE ANTIHEMOPHILIC
FACTOR/VWF
2000 (800) 2014-09-04 2299-12-31 1 1 UNIT EA
J7187 63833061502 HUMATE-P AHF,HUMAN/VWF,HUMAN 250-600 2012-01-01 2299-12-31 1 1 UNIT EA
J7187 63833061602 HUMATE-P AHF,HUMAN/VWF,HUMAN 500-1200 U 2012-01-01 2299-12-31 1 1 UNIT EA
J7187 63833061702 HUMATE-P AHF,HUMAN/VWF,HUMAN 1000-2400 2012-01-01 2299-12-31 1 1 UNIT EA
J7189 00169720101 NOVOSEVEN RT COAGULATION FACTOR
VIIA,RECOMB
1 MG 2013-04-26 2299-12-31 1000 1 MCG EA
J7189 00169720201 NOVOSEVEN RT COAGULATION FACTOR
VIIA,RECOMB
2 MG 2013-04-26 2299-12-31 2000 1 MCG EA
J7189 00169720501 NOVOSEVEN RT COAGULATION FACTOR
VIIA,RECOMB
5 MG 2013-04-26 2299-12-31 5000 1 MCG EA
J7189 00169720801 NOVOSEVEN RT COAGULATION FACTOR
VIIA,RECOMB
8 MG 2013-04-26 2299-12-31 8000 1 MCG EA
J7190 00053763302 MONOCLATE-P ANTIHEMOPHILIC
FACTOR,HUMAN
1000 (+/-) 2011-01-17 2299-12-31 1 1 UNIT EA
J7190 00053763402 MONOCLATE-P ANTIHEMOPHILIC
FACTOR,HUMAN
1500 (+/-) 2011-01-17 2299-12-31 1 1 UNIT EA
J7190 00944293001 HEMOFIL M ANTIHEMOPHILIC
FACTOR,HUMAN
220-400 U 2008-06-25 2299-12-31 1 1 UNIT EA
J7190 00944293101 HEMOFIL M ANTIHEMOPHILIC
FACTOR,HUMAN
401-800 U 2008-06-25 2299-12-31 1 1 UNIT EA
J7190 00944293201 HEMOFIL M ANTIHEMOPHILIC
FACTOR,HUMAN
801-1700 U 2008-06-25 2299-12-31 1 1 UNIT EA
J7190 00944293301 HEMOFIL M ANTIHEMOPHILIC
FACTOR,HUMAN
1701-2000 2008-06-25 2299-12-31 1 1 UNIT EA
J7190 00944394002 HEMOFIL M ANTIHEMOPHILIC FACTOR,
HUMAN
220-400 2013-07-30 2299-12-31 1 1 UNIT EA
J7190 00944394202 HEMOFIL M ANTIHEMOPHILIC FACTOR,
HUMAN
401-800 2013-07-30 2299-12-31 1 1 UNIT EA
J7190 00944394402 HEMOFIL M ANTIHEMOPHILIC FACTOR,
HUMAN
801-1500 2013-07-30 2299-12-31 1 1 UNIT EA
J7190 00944394602 HEMOFIL M ANTIHEMOPHILIC FACTOR,
HUMAN
1501-2000 2013-07-30 2299-12-31 1 1 UNIT EA
J7190 76125025020 KOATE-DVI ANTIHEMOPHILIC
FACTOR,HUMAN
250 (+/-) 2011-12-05 2299-12-31 1 1 UNIT EA
J7190 76125066730 KOATE-DVI ANTIHEMOPHILIC FACTOR,
HUMAN
500 (+/-) 2013-07-22 2299-12-31 1 1 UNIT EA
J7190 76125066750 KOATE-DVI ANTIHEMOPHILIC
FACTOR,HUMAN
1000 (+/-) 2011-12-05 2299-12-31 1 1 UNIT EA
J7190 76125067250 KOATE-DVI ANTIHEMOPHILIC FACTOR,
HUMAN
1000 (+/-) 2015-05-11 2299-12-31 1 1 UNIT EA
J7190 76125067351 KOATE-DVI ANTIHEMOPHILIC FACTOR,
HUMAN
1000 (+/-) 2015-05-11 2299-12-31 1 1 UNIT EA
J7192 00026378225 KOGENATE FS ANTIHEMOPHILIC FACTOR,
HUM REC
250 (+/-) 2013-07-09 2299-12-31 1 1 UNIT EA
J7192 00026378335 KOGENATE FS ANTIHEMOPHILIC FACTOR,
HUM REC
500 (+/-) 2013-07-09 2299-12-31 1 1 UNIT EA
J7192 00026378555 KOGENATE FS ANTIHEMOPHILIC FACTOR,
HUM REC
1000 (+/-) 2013-07-09 2299-12-31 1 1 UNIT EA
J7192 00026378665 KOGENATE FS ANTIHEMOPHILIC FACTOR,
HUM REC
2000 (+/-) 2013-07-09 2299-12-31 1 1 UNIT EA
J7192 00026378775 KOGENATE FS ANTIHEMOPHILIC FACTOR,
HUM REC
3000 (+/-) 2013-07-09 2299-12-31 1 1 UNIT EA
J7192 00026379220 KOGENATE FS ANTIHEMOPHILIC FACTOR,
HUM REC
250 (+/-) 2008-07-01 2299-12-31 1 1 UNIT EA
J7192 00026379330 KOGENATE FS ANTIHEMOPHILIC FACTOR,
HUM REC
500 (+/-) 2008-07-01 2299-12-31 1 1 UNIT EA
J7192 00026379550 KOGENATE FS ANTIHEMOPHILIC FACTOR,
HUM REC
1000 (+/-) 2008-07-01 2299-12-31 1 1 UNIT EA
J7192 00026379660 KOGENATE FS ANTIHEMOPHILIC FACTOR,
HUM REC
2000 (+/-) 2007-07-02 2299-12-31 1 1 UNIT EA
J7192 00026379770 KOGENATE FS ANTIHEMOPHILIC FACTOR,
HUM REC
3000 (+/-) 2009-07-31 2299-12-31 1 1 UNIT EA
J7192 00053813102 HELIXATE FS ANTIHEMOPHILIC FACTOR,
HUM REC
250 (+/-) 2009-12-15 2299-12-31 1 1 UNIT EA
J7192 00053813202 HELIXATE FS ANTIHEMOPHILIC FACTOR,
HUM REC
500 (+/-) 2009-12-15 2299-12-31 1 1 UNIT EA
J7192 00053813302 HELIXATE FS ANTIHEMOPHILIC FACTOR,
HUM REC
1000 (+/-) 2009-12-15 2299-12-31 1 1 UNIT EA
J7192 00053813402 HELIXATE FS ANTIHEMOPHILIC FACTOR,
HUM REC
2000 (+/-) 2009-12-15 2299-12-31 1 1 UNIT EA
J7192 00053813502 HELIXATE FS ANTIHEMOPHILIC FACTOR,
HUM REC
3000 (+/-) 2009-09-10 2299-12-31 1 1 UNIT EA
J7192 00944284110 RECOMBINATE ANTIHEMOPHILIC FACTOR,
HUM REC
250 (+/-) 2011-01-24 2299-12-31 1 1 UNIT EA
J7192 00944284210 RECOMBINATE ANTIHEMOPHILIC FACTOR,
HUM REC
500 (+/-) 2011-01-24 2299-12-31 1 1 UNIT EA
J7192 00944284310 RECOMBINATE ANTIHEMOPHILIC FACTOR,
HUM REC
1000 (+/-) 2011-01-24 2299-12-31 1 1 UNIT EA
J7192 00944284410 RECOMBINATE ANTIHEMOPHILIC FACTOR,
HUM REC
1500 (+/-) 2011-01-24 2299-12-31 1 1 UNIT EA
J7192 00944284510 RECOMBINATE ANTIHEMOPHILIC FACTOR,
HUM REC
2000 (+/-) 2011-01-24 2299-12-31 1 1 UNIT EA
J7192 00944292102 ADVATE ANTIHEMOPH.FVIII PLAS/ALB
FREE
250 (+/-) 2012-02-21 2299-12-31 1 1 UNIT EA
J7192 00944292202 ADVATE ANTIHEMOPH.FVIII PLAS/ALB
FREE
500 (+/-) 2012-02-21 2299-12-31 1 1 UNIT EA
J7192 00944292302 ADVATE ANTIHEMOPH.FVIII PLAS/ALB
FREE
1000 (+/-) 2012-02-21 2299-12-31 1 1 UNIT EA
J7192 00944292402 ADVATE ANTIHEMOPH.FVIII PLAS/ALB
FREE
1500 (+/-) 2012-02-21 2299-12-31 1 1 UNIT EA
J7192 00944294110 ADVATE L ANTIHEMOPH.FVIII PLAS/ALB
FREE
250 (+/-) 2007-07-01 2299-12-31 1 1 UNIT EA
J7192 00944294210 ADVATE M ANTIHEMOPH.FVIII PLAS/ALB
FREE
500 (+/-) 2007-07-01 2299-12-31 1 1 UNIT EA
J7192 00944294310 ADVATE H ANTIHEMOPH.FVIII PLAS/ALB
FREE
1000 (+/-) 2007-07-01 2299-12-31 1 1 UNIT EA
J7192 00944294410 ADVATE SH ANTIHEMOPH.FVIII PLAS/ALB
FREE
1500 (+/-) 2007-07-01 2299-12-31 1 1 UNIT EA
J7192 00944294510 ADVATE UH ANTIHEMOPH.FVIII PLAS/ALB
FREE
2000 (+/-) 2007-07-01 2299-12-31 1 1 UNIT EA
J7192 00944294610 ADVATE ANTIHEMOPH.FVIII PLAS/ALB
FREE
3000 (+/-) 2007-07-05 2299-12-31 1 1 UNIT EA
J7192 00944294810 ADVATE ANTIHEMOPH.FVIII PLAS/ALB
FREE
4000 (+/-) 2012-07-16 2299-12-31 1 1 UNIT EA
J7192 00944296010 ADVATE ANTIHEMOPH.FVIII PLAS/ALB
FREE
250 (+/-) 2012-07-16 2299-12-31 1 1 UNIT EA
J7192 00944296110 ADVATE ANTIHEMOPH.FVIII PLAS/ALB
FREE
500 (+/-) 2012-07-16 2299-12-31 1 1 UNIT EA
J7192 00944296210 ADVATE ANTIHEMOPH.FVIII PLAS/ALB
FREE
1000 (+/-) 2012-07-16 2299-12-31 1 1 UNIT EA
J7192 00944296310 ADVATE ANTIHEMOPH.FVIII PLAS/ALB
FREE
1500 (+/-) 2012-07-16 2299-12-31 1 1 UNIT EA
J7192 00944296410 ADVATE ANTIHEMOPH.FVIII PLAS/ALB
FREE
2000 (+/-) 2012-07-16 2299-12-31 1 1 UNIT EA
J7192 00944296510 ADVATE ANTIHEMOPH.FVIII PLAS/ALB
FREE
3000 (+/-) 2012-07-16 2299-12-31 1 1 UNIT EA
J7192 00944304510 ADVATE ANTIHEMOPH.FVIII PLAS/ALB
FREE
2000 (+/-) 2014-05-15 2299-12-31 1 1 UNIT EA
Page 18 of 26
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Jcode NDC Brand Name Generic Name Strength Effective Begin
Date
Effective End
Date
Conversion
Factor
Jcode Billing Units NDC
Billing
Units
J7192 00944304610 ADVATE ANTIHEMOPH.FVIII PLAS/ALB
FREE
3000 (+/-) 2014-05-15 2299-12-31 1 1 UNIT EA
J7192 00944304710 ADVATE ANTIHEMOPH.FVIII PLAS/ALB
FREE
4000 (+/-) 2014-05-15 2299-12-31 1 1 UNIT EA
J7192 00944305102 ADVATE ANTIHEMOPH.FVIII PLAS/ALB
FREE
250 (+/-) 2014-05-15 2299-12-31 1 1 UNIT EA
J7192 00944305202 ADVATE ANTIHEMOPH.FVIII PLAS/ALB
FREE
500 (+/-) 2014-05-15 2299-12-31 1 1 UNIT EA
J7192 00944305302 ADVATE ANTIHEMOPH.FVIII PLAS/ALB
FREE
1000 (+/-) 2014-05-15 2299-12-31 1 1 UNIT EA
J7192 00944305402 ADVATE ANTIHEMOPH.FVIII PLAS/ALB
FREE
1500 (+/-) 2014-05-15 2299-12-31 1 1 UNIT EA
J7193 00053623302 MONONINE FACTOR IX 1000 (+/-) 2011-05-02 2299-12-31 1 1 UNIT EA
J7193 68516360102 ALPHANINE SD FACTOR IX 500 (+/-) 2010-04-22 2299-12-31 1 1 UNIT EA
J7193 68516360202 ALPHANINE SD FACTOR IX 1000 (+/-) 2010-04-22 2299-12-31 1 1 UNIT EA
J7193 68516360302 ALPHANINE SD FACTOR IX 1500 (+/-) 2010-04-22 2299-12-31 1 1 UNIT EA
J7193 68516360402 ALPHANINE SD FACTOR IX 500 (+/-) 2014-01-07 2299-12-31 1 1 UNIT EA
J7193 68516360502 ALPHANINE SD FACTOR IX 1000 (+/-) 2014-01-07 2299-12-31 1 1 UNIT EA
J7193 68516360602 ALPHANINE SD FACTOR IX 1500 (+/-) 2014-01-07 2299-12-31 1 1 UNIT EA
J7194 64193044502 BEBULIN FACTOR IX COMPLEX HUMAN 700 (+/-)U 2011-05-20 2299-12-31 1 1 UNIT EA
J7194 68516320101 PROFILNINE SD FACTOR IX COMPLEX HUMAN 500 (+/-) 2010-04-22 2299-12-31 1 1 UNIT EA
J7194 68516320202 PROFILNINE SD FACTOR IX COMPLEX HUMAN 1000 (+/-) 2010-04-22 2299-12-31 1 1 UNIT EA
J7194 68516320302 PROFILNINE SD FACTOR IX COMPLEX HUMAN 1500 (+/-) 2010-04-22 2299-12-31 1 1 UNIT EA
J7194 68516320401 PROFILNINE SD FACTOR IX COMPLEX HUMAN 500 (+/-) 2014-01-03 2299-12-31 1 1 UNIT EA
J7194 68516320502 PROFILNINE SD FACTOR IX COMPLEX HUMAN 1000 (+/-) 2014-01-06 2299-12-31 1 1 UNIT EA
J7194 68516320602 PROFILNINE SD FACTOR IX COMPLEX HUMAN 1500 (+/-) 2014-01-06 2299-12-31 1 1 UNIT EA
J7198 64193022302 FEIBA NF ANTI-INHIBITOR COAGULANT
COMP.
400-650 U 2010-04-28 2299-12-31 1 1 UNIT EA
J7198 64193022502 FEIBA NF ANTI-INHIBITOR COAGULANT
COMP.
1750-3250 2010-04-28 2299-12-31 1 1 UNIT EA
J7198 64193042302 FEIBA NF ANTI-INHIBITOR COAGULANT
COMP.
400-650 U 2013-04-10 2299-12-31 1 1 UNIT EA
J7198 64193042402 FEIBA NF ANTI-INHIBITOR COAGULANT
COMP.
651-1200 U 2013-04-10 2299-12-31 1 1 UNIT EA
J7198 64193042502 FEIBA NF ANTI-INHIBITOR COAGULANT
COMP.
1750-3250 2013-04-10 2299-12-31 1 1 UNIT EA
J7296 50419042401 KYLEENA 19.5 MG IUD LEVONORGESTREL 19.5 MG 2018-01-01 2299-12-31 1 19.5 MG EA
J7297 00023585801 LILETTA (52 MG) 18.6 MCG/DAY IUDLEVONORGESTREL 52 MG 2017-01-01 2299-12-31 1 52 MG EA
J7297 52544003554 LILETTA LEVONORGESTREL 18.6MCG/24 2016-01-01 2299-12-31 1 52 MG EA
J7298 50419042101 MIRENA LEVONORGESTREL 20MCG/24HR 2016-01-01 2299-12-31 1 52 MG EA
J7298 50419042301 MIRENA LEVONORGESTREL 20MCG/24HR 2016-01-01 2299-12-31 1 52 MG EA
J7301 50419042201 SKYLA LEVONORGESTREL 14MCG/24HR 2014-01-01 2299-12-31 EA 13.5 MG EA
J7312 00023334807 OZURDEX DEXAMETHASONE 0.7MG 2012-01-01 2299-12-31 7 0.1 MG EA
J7313 68611019002 ILUVIEN FLUOCINOLONE ACETONIDE 0.19 MG 2017-04-01 2299-12-31 19 0.01 MG EA
J7316 24856000100 JETREA OCRIPLASMIN/PF 2.5 MG/ML 2014-01-01 2299-12-31 20 0.125 MG ML
J7325 58468009001 SYNVISC HYLAN G-F 20 16MG/2ML 2010-01-01 2017-12-31 8 1 MG ML
J7325 58468009003 SYNVISC-ONE HYLAN G-F 20 48 MG/6 ML 2010-01-01 2017-12-31 8 1 MG ML
J7327 59676082001 MONOVISC HYALURONATE SODIUM,
STABILIZED
88 MG/4ML 2015-01-01 2299-12-31 22 EA ML
J7342 69251020101 OTIPRIO CIPROFLOXACIN 0.06 2018-07-01 2299-12-31 1 6 MG ML
J7511 58468008001 THYMOGLOBULIN LYMPHOCYTE IMMU
GLOB.,RABBIT
25 MG 2007-07-01 2299-12-31 1 25 MG EA
J7516 00078010901 SANDIMMUNE CYCLOSPORINE 250 MG/5ML 2007-07-01 2299-12-31 0.2 250 MG ML
J7516 00078010961 SANDIMMUNE CYCLOSPORINE 250 MG/5ML 2012-12-06 2299-12-31 0.2 250 MG ML
J7525 00469301601 PROGRAF TACROLIMUS ANHYDROUS 5 MG/ML 2007-07-01 2299-12-31 1 5 MG ML
J7620 00093672373 IPRATROPIUM-ALBUTEROL IPRATROPIUM-ALBUTEROL 3 MG/ML 2017-01-01 2299-12-31 0.333 3 MG ML
J7620 00378967130 IPRATROPIUM-ALBUTEROL IPRATROPIUM-ALBUTEROL 3 MG/ML 2017-01-01 2299-12-31 0.333 3 MG ML
J7620 00378967160 IPRATROPIUM-ALBUTEROL IPRATROPIUM-ALBUTEROL 3 MG/ML 2017-01-01 2299-12-31 0.333 3 MG ML
J7620 00378967193 IPRATROPIUM-ALBUTEROL IPRATROPIUM-ALBUTEROL 3 MG/ML 2017-01-01 2299-12-31 0.333 3 MG ML
J7620 00487020101 IPRATROPIUM-ALBUTEROL IPRATROPIUM-ALBUTEROL 3 MG/ML 2017-01-01 2299-12-31 0.333 3 MG ML
J7620 00487020103 IPRATROPIUM-ALBUTEROL IPRATROPIUM-ALBUTEROL 3 MG/ML 2017-01-01 2299-12-31 0.333 3 MG ML
J7620 00487020160 IPRATROPIUM-ALBUTEROL IPRATROPIUM-ALBUTEROL 3 MG/ML 2017-01-01 2299-12-31 0.333 3 MG ML
J7620 00591381739 IPRATROPIUM-ALBUTEROL IPRATROPIUM-ALBUTEROL 3 MG/ML 2017-01-01 2299-12-31 0.333 3 MG ML
J7620 00591381766 IPRATROPIUM-ALBUTEROL IPRATROPIUM-ALBUTEROL 3 MG/ML 2017-01-01 2299-12-31 0.333 3 MG ML
J7620 00781714651 IPRATROPIUM-ALBUTEROL IPRATROPIUM-ALBUTEROL 3 MG/ML 2017-03-15 2299-12-31 0.333 3 MG ML
J7620 00781714663 IPRATROPIUM-ALBUTEROL IPRATROPIUM-ALBUTEROL 3 MG/ML 2017-02-21 2299-12-31 0.333 3 MG ML
J7620 00781714687 IPRATROPIUM-ALBUTEROL IPRATROPIUM-ALBUTEROL 3 MG/ML 2017-03-15 2299-12-31 0.333 3 MG ML
J7620 69097017353 IPRATROPIUM-ALBUTEROL IPRATROPIUM-ALBUTEROL 3 MG/ML 2017-01-01 2299-12-31 0.333 3 MG ML
J7620 69097017364 IPRATROPIUM-ALBUTEROL IPRATROPIUM-ALBUTEROL 3 MG/ML 2017-01-01 2299-12-31 0.333 3 MG ML
J7620 76204060001 IPRATROPIUM-ALBUTEROL IPRATROPIUM-ALBUTEROL 3 MG/ML 2017-01-01 2299-12-31 0.333 3 MG ML
J7620 76204060005 IPRATROPIUM-ALBUTEROL IPRATROPIUM-ALBUTEROL 3 MG/ML 2017-01-01 2299-12-31 0.333 3 MG ML
J7620 76204060012 IPRATROPIUM-ALBUTEROL IPRATROPIUM-ALBUTEROL 3 MG/ML 2017-01-01 2299-12-31 0.333 3 MG ML
J7620 76204060030 IPRATROPIUM-ALBUTEROL IPRATROPIUM-ALBUTEROL 3 MG/ML 2017-01-01 2299-12-31 0.333 3 MG ML
J7620 76204060060 IPRATROPIUM-ALBUTEROL IPRATROPIUM-ALBUTEROL 3 MG/ML 2017-01-01 2299-12-31 0.333 3 MG ML
J7644 00378797052 IPRATROPIUM BROMIDE IPRATROPIUM BROMIDE 0.2 MG/ML 2018-10-01 2299-12-31 0.2 1 MG ML
J7644 00378797055 IPRATROPIUM BROMIDE IPRATROPIUM BROMIDE 0.2 MG/ML 2018-10-01 2299-12-31 0.2 1 MG ML
J7644 00378797091 IPRATROPIUM BROMIDE IPRATROPIUM BROMIDE 0.2 MG/ML 2018-10-01 2299-12-31 0.2 1 MG ML
Page 19 of 26
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Jcode NDC Brand Name Generic Name Strength Effective Begin
Date
Effective End
Date
Conversion
Factor
Jcode Billing Units NDC
Billing
Units
J7644 00378797093 IPRATROPIUM BROMIDE IPRATROPIUM BROMIDE 0.2 MG/ML 2018-10-01 2299-12-31 0.2 1 MG ML
J7644 00487980125 IPRATROPIUM BROMIDE IPRATROPIUM BROMIDE 0.2 MG/ML 2018-10-01 2299-12-31 0.2 1 MG ML
J7644 00487980130 IPRATROPIUM BROMIDE IPRATROPIUM BROMIDE 0.2 MG/ML 2018-10-01 2299-12-31 0.2 1 MG ML
J7644 00487980160 IPRATROPIUM BROMIDE IPRATROPIUM BROMIDE 0.2 MG/ML 2018-10-01 2299-12-31 0.2 1 MG ML
J7644 00591379830 IPRATROPIUM BROMIDE IPRATROPIUM BROMIDE 0.2 MG/ML 2018-10-01 2299-12-31 0.2 1 MG ML
J7644 00591379860 IPRATROPIUM BROMIDE IPRATROPIUM BROMIDE 0.2 MG/ML 2018-10-01 2299-12-31 0.2 1 MG ML
J7644 00591379883 IPRATROPIUM BROMIDE IPRATROPIUM BROMIDE 0.2 MG/ML 2018-10-01 2299-12-31 0.2 1 MG ML
J7644 00781715729 IPRATROPIUM BROMIDE IPRATROPIUM BROMIDE 0.2 MG/ML 2018-10-01 2299-12-31 0.2 1 MG ML
J7644 00781715764 IPRATROPIUM BROMIDE IPRATROPIUM BROMIDE 0.2 MG/ML 2018-10-01 2299-12-31 0.2 1 MG ML
J7644 60687039483 IPRATROPIUM BROMIDE IPRATROPIUM BROMIDE 0.2 MG/ML 2019-02-06 2299-12-31 0.2 1 MG ML
J7644 65862090525 IPRATROPIUM BROMIDE IPRATROPIUM BROMIDE 0.2 MG/ML 2018-10-01 2299-12-31 0.2 1 MG ML
J7644 65862090530 IPRATROPIUM BROMIDE IPRATROPIUM BROMIDE 0.2 MG/ML 2018-10-01 2299-12-31 0.2 1 MG ML
J7644 65862090560 IPRATROPIUM BROMIDE IPRATROPIUM BROMIDE 0.2 MG/ML 2018-10-01 2299-12-31 0.2 1 MG ML
J7644 76204010001 IPRATROPIUM BROMIDE IPRATROPIUM BROMIDE 0.2 MG/ML 2018-10-01 2299-12-31 0.2 1 MG ML
J7644 76204010025 IPRATROPIUM BROMIDE IPRATROPIUM BROMIDE 0.2 MG/ML 2018-10-01 2299-12-31 0.2 1 MG ML
J7644 76204010030 IPRATROPIUM BROMIDE IPRATROPIUM BROMIDE 0.2 MG/ML 2018-10-01 2299-12-31 0.2 1 MG ML
J7644 76204010060 IPRATROPIUM BROMIDE IPRATROPIUM BROMIDE 0.2 MG/ML 2018-10-01 2299-12-31 0.2 1 MG ML
J7644 00487980101 IPRATROPIUM BROMIDE IPRATROPIUM BROMIDE 0.2 MG/ML 2018-10-01 2299-12-31 0.2 1 MG ML
J9000 00069303020 DOXORUBICIN 10 MG/5 ML VIALDOXORUBICIN HCL 10 MG/5 ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 00069303120 DOXORUBICIN DOXORUBICIN 2 MG/ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 00069303220 DOXORUBICIN DOXORUBICIN 2 MG/ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 00069303320 DOXORUBICIN 150 MG/75 ML VIALDOXORUBICIN HCL 2 MG/ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 00069303420 DOXORUBICIN 200 MG/100 ML VIALDOXORUBICIN HCL 2 MG/ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 00069400405 DOXORUBICIN 10 MG/5 ML VIALDOXORUBICIN HCL 10 MG/5 ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 00069401510 DOXORUBICIN 20 MG/10 ML VIALDOXORUBICIN HCL 20 MG/10ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 00069402625 DOXORUBICIN 50 MG/25 ML VIALDOXORUBICIN HCL 50 MG/25ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 00069403001 DOXORUBICIN 10 MG/5 ML VIALDOXORUBICIN HCL 10 MG/5 ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 00069403101 DOXORUBICIN 20 MG/10 ML VIALDOXORUBICIN HCL 20 MG/10ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 00069403201 DOXORUBICIN 50 MG/25 ML VIALDOXORUBICIN HCL 50 MG/25ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 00069403301 DOXORUBICIN 150 MG/75 ML VIALDOXORUBICIN HCL 2 MG/ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 00069403401 DOXORUBICIN 200 MG/100 ML VIALDOXORUBICIN HCL 2 MG/ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 00069403701 DOXORUBICIN 200 MG/100 ML VIALDOXORUBICIN HCL 2 MG/ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 00143954601 ADRIAMYCIN 200 MG/100 ML VIALDOXORUBICIN HCL 2 MG/ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 00143954701 ADRIAMYCIN 50 MG/25 ML VIALDOXORUBICIN HCL 50 MG/25ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 00143954810 ADRIAMYCIN 20 MG/10 ML VIALDOXORUBICIN HCL 20 MG/10ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 00143954910 ADRIAMYCIN 10 MG/5 ML VIALDOXORUBICIN HCL 10 MG/5 ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 00703504001 DOXORUBICIN 200 MG/100 ML VIALDOXORUBICIN HCL 2 MG/ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 00703504303 DOXORUBICIN 10 MG/5 ML VIALDOXORUBICIN HCL 10 MG/5 ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 00703504601 DOXORUBICIN 50 MG/25 ML VIALDOXORUBICIN HCL 50 MG/25ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 25021020705 DOXORUBICIN 10 MG/5 ML VIALDOXORUBICIN HCL 10 MG/5 ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 25021020725 DOXORUBICIN 50 MG/25 ML VIALDOXORUBICIN HCL 50 MG/25ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 25021020751 DOXORUBICIN 200 MG/100 ML VIALDOXORUBICIN HCL 2 MG/ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 45963073355 DOXORUBICIN 10 MG/5 ML VIALDOXORUBICIN HCL 10 MG/5 ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 45963073357 DOXORUBICIN 20 MG/10 ML VIALDOXORUBICIN HCL 20 MG/10ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 45963073360 DOXORUBICIN 200 MG/100 ML VIALDOXORUBICIN HCL 2 MG/ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 45963073368 DOXORUBICIN 50 MG/25 ML VIALDOXORUBICIN HCL 50 MG/25ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 62756082640 DOXORUBICIN 50 MG/25 ML VIALDOXORUBICIN HCL 50 MG/25ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 63323010161 DOXORUBICIN 200 MG/100 ML VIALDOXORUBICIN HCL 2 MG/ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 63323088305 DOXORUBICIN DOXORUBICIN 2 MG/ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 63323088310 DOXORUBICIN DOXORUBICIN 2 MG/ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 63323088330 DOXORUBICIN DOXORUBICIN 2 MG/ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 67457039354 DOXORUBICIN 10 MG/5 ML VIALDOXORUBICIN HCL 10 MG/5 ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 67457039410 DOXORUBICIN 20 MG/10 ML VIALDOXORUBICIN HCL 20 MG/10ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 67457039525 DOXORUBICIN 50 MG/25 ML VIALDOXORUBICIN HCL 50 MG/25ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 67457039610 DOXORUBICIN 200 MG/100 ML VIALDOXORUBICIN HCL 2 MG/ML 2017-01-01 2299-12-31 0.2 10 MG ML
J9000 67457043650 DOXORUBICIN 50 MG VIAL DOXORUBICIN HCL 50MG 2017-01-01 2299-12-31 0.2 10 MG EA
J9019 57902024901 ERWINAZE ERWINAZE 10,000 UNITS 2013-01-01 2299-12-31 10 1000 UNITS EA
J9019 57902024905 ERWINAZE ERWINAZE 10,000 UNITS 2013-01-01 2299-12-31 10 1000 UNITS EA
J9025 00781325394 AZACITIDINE AZACITIDINE 100 MG 2013-09-20 2299-12-31 100 1 MG EA
J9025 00781925394 AZACITIDINE AZACITIDINE 100 MG 2013-10-10 2299-12-31 100 1 MG EA
J9025 43598030562 AZACITIDINE AZACITIDINE 100 MG 2013-09-19 2299-12-31 100 1 MG EA
J9025 43598046562 AZACITIDINE AZACITIDINE 100 MG 2015-07-02 2299-12-31 100 1 MG EA
J9025 59572010201 VIDAZA AZACITIDINE 100 MG 2009-05-08 2299-12-31 100 1 MG EA
Page 20 of 26
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Jcode NDC Brand Name Generic Name Strength Effective Begin
Date
Effective End
Date
Conversion
Factor
Jcode Billing Units NDC
Billing
Units
J9027 00024586001 CLOLAR CLOFARABINE 20 MG/20ML 2015-02-16 2299-12-31 1 1 MG ML
J9031 00052060202 TICE BCG BCG LIVE 50 MG 2017-04-01 2299-12-31 1 Per instillation EA
J9032 68152010809 BELIODAQ BELINOSTAT 500 MG VIAL 2016-01-01 2299-12-31 50 10 MG EA
J9033 63459034804 BENDEKA BENDAMUSTINE HCL 100 MG/4ML 2015-12-17 2016-12-31 25 1 MG ML
J9033 63459039008 TREANDA BENDAMUSTINE HCL 25 MG 2009-12-31 2299-12-31 25 1 MG EA
J9033 63459039120 TREANDA BENDAMUSTINE HCL 100 MG 2009-01-01 2299-12-31 100 1 MG EA
J9033 63459039502 TREANDA BENDAMUSTINE HCL 45MG/0.5ML 2014-10-24 2017-03-31 90 1 MG ML
J9033 63459039602 TREANDA BENDAMUSTINE HCL 180 MG/2ML 2014-10-24 2017-03-31 90 1 MG ML
J9034 63459034804 BENDEKA BENDAMUSTINE HCL 25 MG/ML 2017-01-01 2299-12-31 25 1 MG ML
J9035 50242006001 AVASTIN BEVACIZUMAB 100MG/4ML 2011-04-01 2299-12-31 2.5 10 MG ML
J9035 50242006101 AVASTIN BEVACIZUMAB 400MG/16ML 2011-04-01 2299-12-31 2.5 10 MG ML
J9039 55513016001 BLINCYTO BLINATUMOMAB 35 MCG 2016-01-01 2299-12-31 35 1 MCG EA
J9042 51144005001 ADCETRIS BRENTUXIMAB VEDOTIN 50 MG 2013-01-01 2299-12-31 50 1 MG EA
J9043 00024582411 JEVTANA CABAZITAXEL 60MG/1.5ML 2012-01-01 2299-12-31 40 1 MG ML
J9045 00703324911 CARBOPLATIN CARBOPLATIN 10 MG/ML 2009-01-01 2017-05-24 0.2 50 MG ML
J9045 00703423901 CARBOPLATIN CARBOPLATIN 10 MG/ML 2014-10-15 2299-12-31 0.2 50 MG ML
J9045 00703424401 CARBOPLATIN CARBOPLATIN 10 MG/ML 2009-01-01 2299-12-31 0.2 50 MG ML
J9045 00703424601 CARBOPLATIN CARBOPLATIN 10 MG/ML 2009-01-01 2299-12-31 0.2 50 MG ML
J9045 00703424801 CARBOPLATIN CARBOPLATIN 10 MG/ML 2009-01-01 2299-12-31 0.2 50 MG ML
J9045 00703424891 CARBOPLATIN CARBOPLATIN 10 MG/ML 2015-05-20 2299-12-31 0.2 50 MG ML
J9045 25021020205 CARBOPLATIN CARBOPLATIN 10 MG/ML 2013-10-25 2299-12-31 0.2 50 MG ML
J9045 25021020215 CARBOPLATIN CARBOPLATIN 10 MG/ML 2013-10-25 2299-12-31 0.2 50 MG ML
J9045 25021020245 CARBOPLATIN CARBOPLATIN 10 MG/ML 2013-10-25 2299-12-31 0.2 50 MG ML
J9045 25021020251 CARBOPLATIN CARBOPLATIN 10 MG/ML 2013-10-25 2299-12-31 0.2 50 MG ML
J9045 47335015040 CARBOPLATIN CARBOPLATIN 10 MG/ML 2014-11-17 2299-12-31 0.2 50 MG ML
J9045 47335015140 CARBOPLATIN CARBOPLATIN 10 MG/ML 2014-11-17 2299-12-31 0.2 50 MG ML
J9045 47335028440 CARBOPLATIN CARBOPLATIN 10 MG/ML 2014-11-17 2299-12-31 0.2 50 MG ML
J9045 47335030040 CARBOPLATIN CARBOPLATIN 10 MG/ML 2014-11-17 2299-12-31 0.2 50 MG ML
J9045 61703033918 CARBOPLATIN CARBOPLATIN 10 MG/ML 2009-01-01 2299-12-31 0.2 50 MG ML
J9045 61703033922 CARBOPLATIN CARBOPLATIN 10 MG/ML 2009-01-01 2299-12-31 0.2 50 MG ML
J9045 61703033950 CARBOPLATIN CARBOPLATIN 10 MG/ML 2009-01-01 2299-12-31 0.2 50 MG ML
J9045 61703033956 CARBOPLATIN CARBOPLATIN 10 MG/ML 2009-01-01 2299-12-31 0.2 50 MG ML
J9045 61703033962 CARBOPLATIN CARBOPLATIN 10 MG/ML 2009-01-01 2299-12-31 0.2 50 MG ML
J9045 63323016721 CARBOPLATIN CARBOPLATIN 150 MG 2009-01-01 2299-12-31 3 50 MG EA
J9045 63323017205 CARBOPLATIN CARBOPLATIN 10 MG/ML 2009-09-28 2299-12-31 0.2 50 MG ML
J9045 63323017215 CARBOPLATIN CARBOPLATIN 10 MG/ML 2009-09-28 2299-12-31 0.2 50 MG ML
J9045 63323017245 CARBOPLATIN CARBOPLATIN 10 MG/ML 2009-01-01 2299-12-31 0.2 50 MG ML
J9045 63323017260 CARBOPLATIN CARBOPLATIN 10 MG/ML 2009-01-01 2299-12-31 0.2 50 MG ML
J9045 66758004704 CARBOPLATIN CARBOPLATIN 10 MG/ML 2010-03-29 2299-12-31 0.2 50 MG ML
J9045 67457049154 CARBOPLATIN CARBOPLATIN 10 MG/ML 2014-05-08 2299-12-31 0.2 50 MG ML
J9045 67457049215 CARBOPLATIN CARBOPLATIN 10 MG/ML 2014-05-08 2299-12-31 0.2 50 MG ML
J9045 67457049346 CARBOPLATIN CARBOPLATIN 10 MG/ML 2014-05-08 2299-12-31 0.2 50 MG ML
J9045 67457049461 CARBOPLATIN CARBOPLATIN 10 MG/ML 2014-05-08 2299-12-31 0.2 50 MG ML
J9045 67457060820 CARBOPLATIN CARBOPLATIN 10 MG/ML 2014-12-18 2299-12-31 0.2 50 MG ML
J9047 76075010101 KYPROLIS CARFILZOMIB 60 MG 2014-01-01 2299-12-31 60 1 MG EA
J9047 76075010201 KYPROLIS CARFILZOMIB 30 MG 2016-06-15 2299-12-31 60 1 MG EA
J9055 66733094823 ERBITUX CETUXIMAB 100MG/50ML 2009-01-01 2299-12-31 0.2 10 MG ML
J9055 66733095823 ERBITUX CETUXIMAB 200MG/0.1L 2009-01-01 2299-12-31 0.2 10 MG ML
J9060 00703574711 CISPLATIN CISPLATIN 1 MG/ML 2017-04-01 2299-12-31 0.1 10 MG ML
J9060 00703574811 CISPLATIN CISPLATIN 1 MG/ML 2017-04-01 2299-12-31 0.1 10 MG ML
J9060 16729028811 CISPLATIN CISPLATIN 1 MG/ML 2017-04-01 2299-12-31 0.1 10 MG ML
J9060 16729028838 CISPLATIN CISPLATIN 1 MG/ML 2017-04-01 2299-12-31 0.1 10 MG ML
J9060 44567050901 CISPLATIN CISPLATIN 1 MG/ML 2017-04-01 2299-12-31 0.1 10 MG ML
J9060 44567051001 CISPLATIN CISPLATIN 1 MG/ML 2017-04-01 2299-12-31 0.1 10 MG ML
J9060 44567051101 CISPLATIN CISPLATIN 1 MG/ML 2017-04-01 2299-12-31 0.1 10 MG ML
J9060 47781060925 CISPLATIN CISPLATIN 1 MG/ML 2017-04-01 2299-12-31 0.1 10 MG ML
J9060 47781061023 CISPLATIN CISPLATIN 1 MG/ML 2017-04-01 2299-12-31 0.1 10 MG ML
J9060 63323010351 CISPLATIN CISPLATIN 1 MG/ML 2017-04-01 2299-12-31 0.1 10 MG ML
J9060 63323010364 CISPLATIN CISPLATIN 1 MG/ML 2017-04-01 2299-12-31 0.1 10 MG ML
J9060 63323010365 CISPLATIN CISPLATIN 1 MG/ML 2017-04-01 2299-12-31 0.1 10 MG ML
J9060 67457042410 CISPLATIN CISPLATIN 1 MG/ML 2017-04-01 2299-12-31 0.1 10 MG ML
J9060 67457042551 CISPLATIN CISPLATIN 1 MG/ML 2017-04-01 2299-12-31 0.1 10 MG ML
J9060 68001028324 CISPLATIN CISPLATIN 1 MG/ML 2017-04-01 2299-12-31 0.1 10 MG ML
J9060 68001028327 CISPLATIN CISPLATIN 1 MG/ML 2017-04-01 2299-12-31 0.1 10 MG ML
Page 21 of 26
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Jcode NDC Brand Name Generic Name Strength Effective Begin
Date
Effective End
Date
Conversion
Factor
Jcode Billing Units NDC
Billing
Units
J9060 68001028332 CISPLATIN CISPLATIN 1 MG/ML 2017-04-01 2299-12-31 0.1 10 MG ML
J9060 68001028333 CISPLATIN CISPLATIN 1 MG/ML 2017-04-01 2299-12-31 0.1 10 MG ML
J9070 00781323394 CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE 500 MG 2017-04-01 2299-12-31 5 100 MG EA
J9070 00781324494 CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE 1 GM 2017-04-01 2299-12-31 10 100 MG EA
J9070 00781325594 CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE 2 GM 2017-04-01 2299-12-31 20 100 MG EA
J9070 10019093501 CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE 500 MG 2017-04-01 2299-12-31 5 100 MG EA
J9070 10019093525 CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE 500 MG 2017-04-01 2299-12-31 5 100 MG EA
J9070 10019093601 CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE 1 GM 2017-04-01 2299-12-31 10 100 MG EA
J9070 10019093650 CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE 1 GM 2017-04-01 2299-12-31 10 100 MG EA
J9070 10019093701 CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE 2 GM 2017-04-01 2299-12-31 20 100 MG EA
J9070 10019093710 CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE 2 GM 2017-04-01 2299-12-31 20 100 MG EA
J9070 10019093801 CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE 500 MG 2017-04-01 2299-12-31 5 100 MG EA
J9070 10019093901 CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE 1 GM 2017-04-01 2299-12-31 10 100 MG EA
J9070 10019094201 CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE 2 GM 2017-04-01 2299-12-31 20 100 MG EA
J9070 10019094301 CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE 500 MG 2017-04-01 2299-12-31 5 100 MG EA
J9070 10019094325 CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE 500 MG 2017-04-01 2299-12-31 5 100 MG EA
J9070 10019094401 CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE 1 GM 2017-04-01 2299-12-31 10 100 MG EA
J9070 10019094450 CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE 1 GM 2017-04-01 2299-12-31 10 100 MG EA
J9070 10019094501 CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE 2 GM 2017-04-01 2299-12-31 20 100 MG EA
J9070 10019094510 CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE 2 GM 2017-04-01 2299-12-31 20 100 MG EA
J9070 10019095501 CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE 500 MG 2017-04-01 2299-12-31 5 100 MG EA
J9070 10019095550 CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE 500 MG 2017-04-01 2299-12-31 5 100 MG EA
J9070 10019095601 CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE 1 GM 2017-04-01 2299-12-31 10 100 MG EA
J9070 10019095616 CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE 1 GM 2017-04-01 2299-12-31 10 100 MG EA
J9070 10019095701 CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE 2 GM 2017-04-01 2299-12-31 20 100 MG EA
J9070 10019095711 CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE 2 GM 2017-04-01 2299-12-31 20 100 MG EA
J9120 55292081155 COSMEGEN DACTINOMYCIN 0.5 MG 2013-10-22 2299-12-31 1 0.5 MG EA
J9145 57894050205 DARZALEX DARATUMUMAB 100 MG/5 ML 2019-01-01 2299-12-31 2 10 MG ML
J9145 57894050220 DARZALEX DARATUMUMAB 400 MG/20 ML 2019-01-01 2299-12-31 2 10 MG ML
J9155 55566830102 FIRMAGON DEGARELIX ACETATE 80 MG 10/22/2012 2016-01-31 80 1 MG EA
J9155 55566830301 FIRMAGON DEGARELIX ACETATE 80 MG 2013-08-01 2299-12-31 80 1 MG EA
J9155 55566840301 FIRMAGON DEGARELIX ACETATE 120 MG 2013-08-01 2299-12-31 120 1 MG EA
J9171 00069914122 DOCETAXEL DOCETAXEL 20 MG/2 ML 2014-06-30 2016-04-30 10 1 MG ML
J9171 00069914222 DOCETAXEL DOCETAXEL 80 MG/8 ML 2014-06-30 2016-05-31 10 1 MG ML
J9171 00069914411 DOCETAXEL DOCETAXEL 200MG/20ML 2015-02-23 2299-12-31 10 1 MG ML
J9171 00075800301 TAXOTERE DOCETAXEL 20MG/ML(1) 2010-10-11 2299-12-31 20 1 MG ML
J9171 00075800404 TAXOTERE DOCETAXEL 80 MG/4 ML 2010-10-11 2299-12-31 20 1 MG ML
J9171 00409020102 DOCETAXEL DOCETAXEL 20 MG/2 ML 2011-03-17 2299-12-31 10 1 MG ML
J9171 00409020110 DOCETAXEL DOCETAXEL 80 MG/8 ML 2011-03-17 2299-12-31 10 1 MG ML
J9171 00409020120 DOCETAXEL DOCETAXEL 160MG/16ML 2011-03-17 2299-12-31 10 1 MG ML
J9171 00409020125 DOCETAXEL DOCETAXEL 20 MG/2 ML 2013-09-12 2299-12-31 10 1 MG ML
J9171 00955102001 DOCETAXEL DOCETAXEL 20MG/ML(1) 2011-03-14 2299-12-31 20 1 MG ML
J9171 00955102104 DOCETAXEL DOCETAXEL 80 MG/4 ML 2011-03-14 2299-12-31 20 1 MG ML
J9171 16729023163 DOCETAXEL DOCETAXEL 20MG/ML(1) 2012-07-01 2299-12-31 20 1 MG ML
J9171 16729023164 DOCETAXEL DOCETAXEL 80 MG/4 ML 2012-07-01 2299-12-31 20 1 MG ML
J9171 16729023165 DOCETAXEL DOCETAXEL 160 MG/8ML 2012-07-01 2299-12-31 20 1 MG ML
J9171 16729026763 DOCETAXEL DOCETAXEL 20MG/ML(1) 2013-05-30 2299-12-31 10 1 MG ML
J9171 16729026764 DOCETAXEL DOCETAXEL 80 MG/4 ML 2013-05-30 2299-12-31 10 1 MG ML
J9171 16729026765 DOCETAXEL DOCETAXEL 160 MG/8ML 2013-05-30 2299-12-31 10 1 MG ML
J9171 25021022201 DOCETAXEL DOCETAXEL 20MG/ML(1) 2013-07-18 2299-12-31 10 1 MG ML
J9171 25021022204 DOCETAXEL DOCETAXEL 80 MG/4 ML 2013-07-18 2299-12-31 10 1 MG ML
J9171 25021022207 DOCETAXEL DOCETAXEL 140 MG/7ML 2013-07-19 2299-12-31 20 1 MG ML
J9171 43598025811 DOCETAXEL DOCETAXEL 20MG/ML(1) 2013-07-22 2299-12-31 20 1 MG ML
J9171 43598025940 DOCETAXEL DOCETAXEL 80 MG/4 ML 2013-07-22 2299-12-31 20 1 MG ML
J9171 45963073452 DOCETAXEL DOCETAXEL 80 MG/4 ML 2013-07-22 2299-12-31 20 1 MG ML
J9171 45963073454 DOCETAXEL DOCETAXEL 20MG/ML(1) 2013-07-22 2299-12-31 20 1 MG ML
J9171 45963073474 DOCETAXEL DOCETAXEL 140 MG/7ML 2015-01-13 2016-07-31 20 1 MG ML
J9171 47335028541 DOCEFREZ DOCETAXEL 20 MG 2011-05-12 2299-12-31 20 1 MG EA
J9171 47335028641 DOCEFREZ DOCETAXEL 80 MG 2011-05-12 2299-12-31 80 1 MG EA
J9171 63739093211 DOCETAXEL DOCETAXEL 20MG/ML(1) 2013-07-22 2299-12-31 20 1 MG ML
J9171 63739097117 DOCETAXEL DOCETAXEL 80 MG/4 ML 2013-07-22 2299-12-31 20 1 MG ML
J9171 66758005001 DOCETAXEL DOCETAXEL 20 MG/2 ML 2011-11-08 2299-12-31 10 1 MG ML
J9171 66758005002 DOCETAXEL DOCETAXEL 80 MG/8 ML 2011-11-08 2299-12-31 10 1 MG ML
J9171 66758005003 DOCETAXEL DOCETAXEL 160MG/16ML 2011-11-08 2299-12-31 10 1 MG ML
Page 22 of 26
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Jcode NDC Brand Name Generic Name Strength Effective Begin
Date
Effective End
Date
Conversion
Factor
Jcode Billing Units NDC
Billing
Units
J9171 66758095002 DOCETAXEL DOCETAXEL 20 MG/2 ML 2015-07-22 2299-12-31 10 1 MG ML
J9171 66758095003 DOCETAXEL DOCETAXEL 80 MG/8 ML 2015-07-22 2299-12-31 10 1 MG ML
J9171 66758095004 DOCETAXEL DOCETAXEL 160MG/16ML 2015-07-22 2299-12-31 10 1 MG ML
J9173 00310450012 IMFINZI DURVALUMAB 120 MG/2.4 ML 2019-01-01 2299-12-31 5 10 MG ML
J9173 00310461150 IMFINZI DURVALUMAB 500 MG/10 ML 2019-01-01 2299-12-31 5 10 MG ML
J9179 62856038901 HALAVEN ERIBULIN MESYLATE 1MG/2ML 2012-01-01 2299-12-31 5 0.1 MG ML
J9190 00703301511 ADRUCIL 500 MG/10ML SOLN FLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 00703301513 ADRUCIL 500 MG/10ML SOLN FLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 00703301811 ADRUCIL 2.5 GM/50ML SOLN FLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 00703301812 ADRUCIL 2.5 GM/50ML SOLN FLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 00703301911 ADRUCIL 5 GM/100ML SOLN FLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 00703301912 ADRUCIL 5 GM/100ML SOLN FLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 16729027603 FLUOROURACIL 500 MG/10ML SOLNFLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 16729027605 FLUOROURACIL 1 GM/20ML SOLNFLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 16729027611 FLUOROURACIL 2.5 GM/50ML SOLNFLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 16729027638 FLUOROURACIL 5 GM/100ML SOLNFLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 16729027667 FLUOROURACIL 1 GM/20ML SOLNFLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 16729027668 FLUOROURACIL 500 MG/10ML SOLNFLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 25021021598 FLUOROURACIL 2.5 GM/50ML SOLNFLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 25021021599 FLUOROURACIL 5 GM/100ML SOLNFLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 63323011710 FLUOROURACIL 500 MG/10ML SOLNFLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 63323011718 FLUOROURACIL 500 MG/10ML SOLNFLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 63323011719 FLUOROURACIL 500 MG/10ML SOLNFLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 63323011720 FLUOROURACIL 1 GM/20ML SOLNFLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 63323011728 FLUOROURACIL 1 GM/20ML SOLNFLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 63323011751 FLUOROURACIL 2.5 GM/50ML SOLNFLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 63323011758 FLUOROURACIL 2.5 GM/50ML SOLNFLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 63323011759 FLUOROURACIL 2.5 GM/50ML SOLNFLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 63323011761 FLUOROURACIL 5 GM/100ML SOLNFLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 63323011768 FLUOROURACIL 5 GM/100ML SOLNFLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 63323011769 FLUOROURACIL 5 GM/100ML SOLNFLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 68001026624 FLUOROURACIL 2.5 GM/50ML SOLNFLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 68001026627 FLUOROURACIL 2.5 GM/50ML SOLNFLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 68001026628 FLUOROURACIL 500 MG/10ML SOLNFLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 68001026629 FLUOROURACIL 1 GM/20ML SOLNFLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 68001026630 FLUOROURACIL 500 MG/10ML SOLNFLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 68001026631 FLUOROURACIL 1 GM/20ML SOLNFLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 68001026632 FLUOROURACIL 5 GM/100ML SOLNFLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9190 68001026633 FLUOROURACIL 5 GM/100ML SOLNFLUOROURACIL 50 MG/ML 2017-04-01 2299-12-31 0.1 500 MG ML
J9205 15054004301 ONIVYDE IRINOTECAN LIPOSOMAL 4.3 MG/ML 2017-10-18 2299-12-31 4.3 1 MG ML
J9205 69171039801 ONIVYDE IRINOTECAN LIPOSOMAL 4.3 MG/ML 2017-01-01 2018-10-16 4.3 1 MG ML
J9207 00015191012 IXEMPRA IXABEPILONE 15 MG 2009-01-01 2299-12-31 15 1 MG EA
J9207 00015191113 IXEMPRA IXABEPILONE 45 MG 2009-01-01 2299-12-31 45 1 MG EA
J9217 00074334603 LUPRON DEPOT LEUPROLIDE ACETATE 22.5 MG 2010-03-23 2299-12-31 3 7.5 MG EA
J9217 00074347303 LUPRON DEPOT LEUPROLIDE ACETATE 45 MG 2011-06-18 2299-12-31 6 7.5 MG EA
J9217 00074364203 LUPRON DEPOT LEUPROLIDE ACETATE 7.5 MG 2010-03-23 2299-12-31 1 7.5 MG EA
J9217 00074368303 LUPRON DEPOT LEUPROLIDE ACETATE 30 MG 2010-03-23 2299-12-31 4 7.5 MG EA
J9217 47335093640 LEUPROLIDE ACETATE LEUPROLIDE ACETATE 1 MG/0.2ML 2015-03-06 2299-12-31 0.133 7.5 MG EA
J9217 62935022004 ELIGARD LEUPROLIDE ACETATE 22.5 MG 2014-10-09 2299-12-31 3 7.5 MG EA
J9217 62935022104 ELIGARD LEUPROLIDE ACETATE 22.5 MG 2015-05-11 2299-12-31 3 7.5 MG EA
J9217 62935022205 ELIGARD LEUPROLIDE ACETATE 22.5 MG 2014-08-27 2299-12-31 3 7.5 MG EA
J9217 62935022305 ELIGARD LEUPROLIDE ACETATE 22.5 MG 2015-05-07 2299-12-31 3 7.5 MG EA
J9217 62935030129 ELIGARD LEUPROLIDE ACETATE 30 MG 2014-10-09 2016-05-07 4 7.5 MG EA
J9217 62935030230 ELIGARD LEUPROLIDE ACETATE 30 MG 2014-10-02 2016-05-07 4 7.5 MG EA
J9217 62935030330 ELIGARD LEUPROLIDE ACETATE 30 MG 2015-10-01 2299-12-31 4 7.5 MG EA
J9217 62935045144 ELIGARD LEUPROLIDE ACETATE 45 MG 2014-10-09 2016-05-07 6 7.5 MG EA
J9217 62935045245 ELIGARD LEUPROLIDE ACETATE 45 MG 2014-09-02 2016-05-07 6 7.5 MG EA
J9217 62935045345 ELIGARD LEUPROLIDE ACETATE 45 MG 2015-10-01 2299-12-31 6 7.5 MG EA
J9217 62935075174 ELIGARD LEUPROLIDE ACETATE 7.5 MG 2014-10-09 2016-05-07 1 7.5 MG EA
J9217 62935075275 ELIGARD LEUPROLIDE ACETATE 7.5 MG 2014-09-25 2016-05-07 1 7.5 MG EA
J9217 62935075375 ELIGARD LEUPROLIDE ACETATE 7.5 MG 2015-10-01 2299-12-31 1 7.5 MG EA
J9218 00703401418 LEUPROLIDE ACETATE LEUPROLIDE ACETATE 1MG/0.2ML 2012-01-01 2299-12-31 1 1 MG EA
J9218 00781400332 LEUPROLIDE ACETATE LEUPROLIDE ACETATE 1MG/0.2ML 2013-01-28 2299-12-31 1 1 MG EA
J9218 41616093640 LEUPROLIDE ACETATE LEUPROLIDE ACETATE 1MG/0.2ML 2012-01-01 2016-03-02 1 1 MG EA
Page 23 of 26
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Jcode NDC Brand Name Generic Name Strength Effective Begin
Date
Effective End
Date
Conversion
Factor
Jcode Billing Units NDC
Billing
Units
J9225 67979050001 VANTAS HISTRELIN AC 50 MG 2009-01-01 2299-12-31 1 50 MG EA
J9226 67979000201 SUPPRELIN LA HISTRELIN AC 50 MG 2012-05-26 2299-12-31 1 50 MG EA
J9228 00003232711 YERVOY IPILIMUMAB 50MG/10ML 2012-01-01 2299-12-31 5 1 MG ML
J9228 00003232822 YERVOY IPILIMUMAB 200MG/40ML 2012-01-01 2299-12-31 5 1 MG ML
J9245 68152010900 EVOMELA MELPHALAN 50 MG 2016-04-07 2299-12-31 1 50 MG EA
J9261 00007440101 ARRANON NELARABINE 250MG/50ML 2009-01-01 2299-12-31 0.1 50 MG ML
J9261 00007440106 ARRANON NELARABINE 250MG/50ML 2009-01-01 2299-12-31 0.1 50 MG ML
J9263 00024059010 ELOXATIN OXALIPLATIN 50 MG/10ML 2009-01-01 2016-11-03 10 0.5 MG ML
J9263 00024059120 ELOXATIN OXALIPLATIN 100MG/20ML 2009-01-01 2016-11-03 10 0.5 MG ML
J9263 00703398501 OXALIPLATIN OXALIPLATIN 50 MG/10ML 2009-08-11 2299-12-31 10 0.5 MG ML
J9263 00703398601 OXALIPLATIN OXALIPLATIN 100MG/20ML 2009-08-11 2299-12-31 10 0.5 MG ML
J9263 00781331570 OXALIPLATIN OXALIPLATIN 50 MG/10ML 2015-04-14 2299-12-31 10 0.5 MG ML
J9263 00781331780 OXALIPLATIN OXALIPLATIN 100MG/20ML 2015-04-14 2299-12-31 10 0.5 MG ML
J9263 00955172510 OXALIPLATIN OXALIPLATIN 50 MG/10ML 2014-07-28 2299-12-31 10 0.5 MG ML
J9263 00955172720 OXALIPLATIN OXALIPLATIN 100MG/20ML 2014-07-28 2299-12-31 10 0.5 MG ML
J9263 00955173110 OXALIPLATIN OXALIPLATIN 50 2015-10-01 2299-12-31 10 0.5 MG ML
J9263 00955173320 OXALIPLATIN OXALIPLATIN 100 MG/20 ML 2015-10-01 2299-12-31 10 0.5 MG ML
J9263 25021021120 OXALIPLATIN OXALIPLATIN 50 MG 2012-08-09 2299-12-31 100 0.5 MG EA
J9263 25021021250 OXALIPLATIN OXALIPLATIN 100 MG 2012-08-09 2299-12-31 200 0.5 MG EA
J9263 25021023310 OXALIPLATIN OXALIPLATIN 50 MG/10ML 2014-09-03 2299-12-31 10 0.5 MG ML
J9263 25021023320 OXALIPLATIN OXALIPLATIN 100MG/20ML 2014-09-03 2299-12-31 10 0.5 MG ML
J9263 45963061153 OXALIPLATIN OXALIPLATIN 50 MG 2015-01-13 2299-12-31 100 0.5 MG EA
J9263 45963061159 OXALIPLATIN OXALIPLATIN 100 MG 2015-01-13 2299-12-31 200 0.5 MG EA
J9263 47335004640 OXALIPLATIN OXALIPLATIN 50 MG/10ML 2014-06-13 2299-12-31 10 0.5 MG ML
J9263 47335004740 OXALIPLATIN OXALIPLATIN 100MG/20ML 2014-06-13 2299-12-31 10 0.5 MG ML
J9263 47335017640 OXALIPLATIN OXALIPLATIN 50 MG 2012-08-09 2299-12-31 100 0.5 MG EA
J9263 47335017840 OXALIPLATIN OXALIPLATIN 100 MG 2012-08-09 2299-12-31 200 0.5 MG EA
J9263 61703036318 OXALIPLATIN OXALIPLATIN 50 MG/10ML 2009-08-11 2299-12-31 10 0.5 MG ML
J9263 61703036322 OXALIPLATIN OXALIPLATIN 100MG/20ML 2009-08-13 2299-12-31 10 0.5 MG ML
J9263 63323017530 OXALIPLATIN OXALIPLATIN 50 MG 2010-01-06 2299-12-31 10 0.5 MG ML
J9263 63323017650 OXALIPLATIN OXALIPLATIN 100 MG 2010-01-06 2299-12-31 10 0.5 MG ML
J9263 63323021110 OXALIPLATIN OXALIPLATIN 50 MG/10ML 2014-08-25 2299-12-31 10 0.5 MG ML
J9263 63323021220 OXALIPLATIN OXALIPLATIN 100MG/20ML 2014-08-25 2299-12-31 10 0.5 MG ML
J9263 63323065010 OXALIPLATIN OXALIPLATIN 50 MG/10ML 2009-10-10 2016-07-30 10 0.5 MG ML
J9263 63323065017 OXALIPLATIN OXALIPLATIN 50 MG/10ML 2012-09-07 2299-12-31 10 0.5 MG ML
J9263 63323065020 OXALIPLATIN OXALIPLATIN 100MG/20ML 2009-10-10 2299-12-31 10 0.5 MG ML
J9263 63323065027 OXALIPLATIN OXALIPLATIN 100MG/20ML 2012-09-07 2299-12-31 10 0.5 MG ML
J9263 63323075010 OXALIPLATIN OXALIPLATIN 50 MG/10ML 2015-07-30 2299-12-31 10 0.5 MG ML
J9263 67457044220 OXALIPLATIN OXALIPLATIN 100MG/20ML 2014-05-12 2299-12-31 10 0.5 MG ML
J9263 67457046910 OXALIPLATIN OXALIPLATIN 50 MG/10ML 2014-08-19 2299-12-31 10 0.5 MG ML
J9263 67457047610 OXALIPLATIN OXALIPLATIN 100 MG 2014-09-04 2299-12-31 10 0.5 MG ML
J9264 68817013450 ABRAXANE PACLITAXEL PROTEIN-BOUND 100 MG 2009-01-01 2299-12-31 100 1 MG EA
J9266 54482030101 ONCASPAR PEGASPARGASE 750/ML 2011-10-01 2299-12-31 0.2 VIAL ML
J9267 00015347530 TAXOL PACLITAXEL 30MG/5ML 2015-01-01 2299-12-31 6 1 MG ML
J9267 00015347630 TAXOL PACLITAXEL 100MG/16.7ML 2015-01-01 2299-12-31 6 1 MG ML
J9267 00015347911 TAXOL PACLITAXEL 300MG/50ML 2015-01-01 2299-12-31 6 1 MG ML
J9267 00172375494 ONXOL 30 MG/5 ML VIAL PACLITAXEL 6MG/ML 2015-01-01 2299-12-31 6 1 MG ML
J9267 00703476401 PACLITAXEL 30 MG/5 ML
VIAL
PACLITAXEL 6MG/ML 2015-01-01 2299-12-31 6 1 MG ML
J9267 00703476601 PACLITAXEL 100 MG/16.7 ML
VIAL
PACLITAXEL 6MG/ML 2015-01-01 2299-12-31 6 1 MG ML
J9267 00703476701 PACLITAXEL 150 MG/25 ML
VIAL
PACLITAXEL 6MG/ML 2015-01-01 2299-12-31 6 1 MG ML
J9267 00703476801 PACLITAXEL 300 MG/50 ML
VIAL
PACLITAXEL 6MG/ML 2015-01-01 2299-12-31 6 1 MG ML
J9267 25021021305 PACLITAXEL 30 MG/5 ML
VIAL
PACLITAXEL 6MG/ML 2015-01-01 2299-12-31 6 1 MG ML
J9267 25021021317 PACLITAXEL 100 MG/16.7 ML
VIAL
PACLITAXEL 6MG/ML 2015-01-01 2299-12-31 6 1 MG ML
J9267 25021021350 PACLITAXEL 300 MG/50 ML
VIAL
PACLITAXEL 6MG/ML 2015-01-01 2299-12-31 6 1 MG ML
J9267 44567050501 PACLITAXEL 100 MG/16.7 ML
VIAL
PACLITAXEL 6 MG/ML 2015-01-01 2299-12-31 6 1 MG ML
J9267 44567050601 PACLITAXEL PACLITAXEL 6 MG/ML 2015-10-01 2299-12-31 6 MG ML
J9267 45963061353 PACLITAXEL 100 MG/16.7 ML
VIAL
PACLITAXEL 6 MG/ML 2015-01-01 2299-12-31 6 1 MG ML
J9267 45963061356 PACLITAXEL PACLITAXEL 6 MG/ML 2015-10-01 2299-12-31 6 1 MG ML
J9267 45963061359 PACLITAXEL PACLITAXEL 6 MG/ML 2015-10-01 2299-12-31 6 1 MG ML
J9267 61703034209 PACLITAXEL 30 MG/5 ML
VIAL
PACLITAXEL 6MG/ML 2015-01-01 2299-12-31 6 1 MG ML
J9267 61703034222 PACLITAXEL 100 MG/16.7 ML
VIAL
PACLITAXEL 6MG/ML 2015-01-01 2299-12-31 6 1 MG ML
J9267 61703034250 PACLITAXEL 300 MG/50 ML
VIAL
PACLITAXEL 6MG/ML 2015-01-01 2299-12-31 6 1 MG ML
J9267 63323076305 PACLITAXEL 30 MG/5 ML
VIAL
PACLITAXEL 6MG/ML 2015-01-01 2299-12-31 6 1 MG ML
J9267 63323076306 PACLITAXEL 30 MG/5 ML
VIAL
PACLITAXEL 6 MG/ML 2015-01-01 2299-12-31 6 1 MG ML
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Jcode NDC Brand Name Generic Name Strength Effective Begin
Date
Effective End
Date
Conversion
Factor
Jcode Billing Units NDC
Billing
Units
J9267 63323076316 PACLITAXEL 100 MG/16.7 ML
VIAL
PACLITAXEL 6MG/ML 2015-01-01 2299-12-31 6 1 MG ML
J9267 63323076317 PACLITAXEL 100 MG/16.7 ML
VIAL
PACLITAXEL 6 MG/ML 2015-01-01 2299-12-31 6 1 MG ML
J9267 63323076350 PACLITAXEL 300 MG/50 ML
VIAL
PACLITAXEL 6MG/ML 2015-01-01 2299-12-31 6 1 MG ML
J9267 63323076352 PACLITAXEL 300 MG/50 ML
VIAL
PACLITAXEL 6 MG/ML 2015-01-01 2299-12-31 6 1 MG ML
J9267 66758004301 PACLITAXEL 30 MG/5 ML
VIAL
PACLITAXEL 6MG/ML 2015-01-01 2299-12-31 6 1 MG ML
J9267 66758004302 PACLITAXEL 100 MG/16.7 ML
VIAL
PACLITAXEL 6 MG/ML 2015-01-01 2299-12-31 6 1 MG ML
J9267 66758004303 PACLITAXEL 300 MG/50 ML
VIAL
PACLITAXEL 6MG/ML 2015-01-01 2299-12-31 6 1 MG ML
J9267 67457043451 PACLITAXEL 300 MG/50 ML
VIAL
PACLITAXEL 6 MG/ML 2015-01-01 2299-12-31 6 1 MG ML
J9267 67457044917 PACLITAXEL 100 MG/16.7 ML
VIAL
PACLITAXEL 6 MG/ML 2015-01-01 2299-12-31 6 1 MG ML
J9267 67457047152 PACLITAXEL 30 MG/5 ML
VIAL
PACLITAXEL 6 MG/ML 2015-01-01 2299-12-31 6 1 MG ML
J9271 00006302602 KEYTRUDA PEMBROLIZUMAB 25 MG/ML 2016-01-01 2299-12-31 25 1 MG ML
J9271 00006302902 KEYTRUDA PEMBROLIZUMAB 50 MG/ML 2016-01-01 2299-12-31 50 1 MG EA
J9280 16729010811 MYTOMYCIN MITOMYCIN 20 MG 2017-04-01 2299-12-31 4 5 MG EA
J9280 16729011505 MYTOMYCIN MITOMYCIN 5 MG 2017-04-01 2299-12-31 1 5 MG EA
J9280 16729011638 MYTOMYCIN MITOMYCIN 40 MG 2017-04-01 2299-12-31 8 5 MG EA
J9280 16729024605 MYTOMYCIN MITOMYCIN 5 MG 2017-04-01 2299-12-31 1 5 MG EA
J9280 16729024711 MYTOMYCIN MITOMYCIN 20 MG 2017-04-01 2299-12-31 4 5 MG EA
J9280 16729024838 MYTOMYCIN MITOMYCIN 40 MG 2017-04-01 2299-12-31 8 5 MG EA
J9299 00003377211 OPDIVO NIVOLUMAB 40MG/4ML 2016-01-01 2299-12-31 10 1 MG ML
J9299 00003377412 OPDIVO NIVOLUMAB 100 MG/10 ML 2016-01-01 2299-12-31 10 1 MG ML
J9301 50242007001 GAZYVA OBINUTUZUMAB 1000 MG/ML 2015-01-01 2299-12-31 100 10 MG ML
J9301 50242007001 GAZYVA OBINUTUZUMAB 1000MG/40ML 2015-01-01 2299-12-31 2.5 10 MG ML
J9302 00078066913 ARZERRA OFATUMUMAB 20 MG/ML VIAL 2016-02-11 2299-12-31 2 10 MG 1 ML
J9302 00078069061 ARZERRA OFATUMUMAB 20 MG/ML VIAL 2016-02-11 2299-12-31 2 10 MG 1 ML
J9302 00173082101 ARZERRA OFATUMUMAB 1000 MG/50 2011-06-20 2017-02-11 2 10 MG ML
J9302 00173082102 ARZERRA OFATUMUMAB 100 MG/5ML 2015-06-03 2299-12-31 2 10 MG ML
J9302 00173082133 ARZERRA OFATUMUMAB 100 MG/5ML 2011-06-20 2017-02-11 2 10 MG ML
J9303 55513095401 VECTIBIX PANITUMUMAB 100 MG/5ML 2009-01-01 2299-12-31 2 10 MG ML
J9303 55513095601 VECTIBIX PANITUMUMAB 400MG/20ML 2009-01-01 2299-12-31 2 10 MG ML
J9305 00002762301 ALIMTA 500 MG PEMETREXED SODIUM 500 MG 2017-04-01 2299-12-31 50 10 MG EA
J9305 00002764001 ALIMTA 100 MG PEMETREXED SODIUM 100 MG 2017-04-01 2299-12-31 10 10 MG EA
J9306 50242014501 PERJETA PERTUZUMAB 420 MG/14 ML 2014-01-01 2299-12-31 30 1 MG ML
J9307 48818000101 FOLOTYN PRALATREXATE 20MG/ML 2011-01-01 2299-12-31 20 1 MG ML
J9307 48818000102 FOLOTYN PRALATREXATE 40MG/2ML 2011-01-01 2299-12-31 20 1 MG ML
J9308 00002766901 CYRAMZA RAMUCIRUMAB 100 MG/10 ML 2016-01-01 2299-12-31 2 5 MG ML
J9308 00002767801 CYRAMZA RAMUCIRUMAB 500 MG/50 ML 2016-01-01 2299-12-31 2 5 MG ML
J9310 50242005121 RITUXAN RITUXIMAB 10 MG/ML 2009-01-01 2018-12-31 0.1 100 MG ML
J9310 50242005306 RITUXAN RITUXIMAB 10 MG/ML 2009-01-01 2018-12-31 0.1 100 MG ML
J9312 50242005121 RITUXAN RITUXIMAB 10 MG/ML 2019-01-01 2299-12-31 1 10 MG ML
J9312 50242005306 RITUXAN RITUXIMAB 10 MG/ML 2019-01-01 2299-12-31 1 10 MG ML
J9315 59572098301 ISTODAX ROMIDEPSIN 10 MG 2011-01-01 2299-12-31 10 1 MG EA
J9328 00085138101 TEMODAR TEMOZOLOMIDE 100 MG 2010-01-01 2299-12-31 100 1 MG EA
J9330 00008117901 TORISEL TEMSIROLIMUS FNL 30MG/3 2009-01-01 2299-12-31 25 1 MG ML
J9330 00008117905 TORISEL TEMSIROLIMUS FNL 30MG/3 2009-01-01 2299-12-31 25 1 MG ML
J9351 00007420101 HYCAMTIN TOPOTECAN HCL 4 MG 2011-01-01 2299-12-31 40 0.1 MG EA
J9351 00409030201 TOPOTECAN HCL TOPOTECAN HCL 4 MG/4 ML 2011-01-01 2299-12-31 40 0.1 MG ML
J9351 00409030225 TOPOTECAN HCL TOPOTECAN HCL 4 MG/4 ML 2013-09-24 2299-12-31 10 0.1 MG ML
J9351 00703471401 TOPOTECAN HCL TOPOTECAN HCL 4 MG/4 ML 2013-05-14 2299-12-31 10 0.1 MG ML
J9351 00703471471 TOPOTECAN HCL TOPOTECAN HCL 4 MG/4 ML 2013-05-14 2299-12-31 10 0.1 MG ML
J9351 16729015131 TOPOTECAN HCL TOPOTECAN HCL 4 MG 2013-07-23 2299-12-31 40 0.1 MG EA
J9351 25021020606 TOPOTECAN HCL TOPOTECAN HCL 4 MG 2011-01-01 2299-12-31 40 0.1 MG EA
J9351 25021020661 TOPOTECAN HCL TOPOTECAN HCL 4 MG 2011-03-22 2299-12-31 40 0.1 MG EA
J9351 25021023604 TOPOTECAN HCL TOPOTECAN HCL 4 MG/4 ML 2014-12-22 2299-12-31 10 0.1 MG ML
J9351 25021082406 TOPOTECAN HCL TOPOTECAN HCL 4 MG 2011-06-15 2299-12-31 40 0.1 MG EA
J9351 45963061556 TOPOTECAN HCL TOPOTECAN HCL 4 MG 2015-01-13 2299-12-31 40 0.1 MG EA
J9351 62756002340 TOPOTECAN HCL TOPOTECAN HCL 4 MG 2013-10-21 2299-12-31 40 0.1 MG EA
J9351 63323076210 TOPOTECAN HCL TOPOTECAN HCL 4 MG 2011-01-01 2299-12-31 40 0.1 MG EA
J9351 63323076217 TOPOTECAN HCL TOPOTECAN HCL 4 MG 2011-01-01 2299-12-31 40 0.1 MG EA
J9351 63323076294 TOPOTECAN HCL TOPOTECAN HCL 4 MG 2013-08-01 2299-12-31 40 0.1 MG EA
J9351 67457047404 TOPOTECAN HCL TOPOTECAN HCL 4 MG 2014-09-04 2299-12-31 40 0.1 MG EA
J9354 50242008701 KADCYLA ADO-TRASTUZUMAB
EMTANSINE
160 MG 2014-01-01 2299-12-31 160 1 MG EA
J9354 50242008801 KADCYLA ADO-TRASTUZUMAB
EMTANSINE
100 MG 2014-01-01 2299-12-31 100 1 MG EA
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Jcode NDC Brand Name Generic Name Strength Effective Begin
Date
Effective End
Date
Conversion
Factor
Jcode Billing Units NDC
Billing
Units
J9355 50242005656 HERCEPTIN 440 MG TRASTUZUMAB 440 MG 2017-01-01 2299-12-31 44 10 MG EA
J9355 50242013201 HERCEPTIN 150 MG TRASTUZUMAB 150 MG 2017-05-30 2299-12-31 15 10 MG EA
J9355 50242013468 HERCEPTIN 440 MG TRASTUZUMAB 440 MG 2017-01-01 2299-12-31 44 10 MG EA
J9370 00703440211 VINCASAR VINCRISTINE SULFATE 1 MG/ML 2017-04-01 2299-12-31 1 1 MG ML
J9370 00703441211 VINCASAR VINCRISTINE SULFATE 1 MG/ML 2017-04-01 2299-12-31 1 1 MG ML
J9370 61703030906 VINCRISTINE SULFATE VINCRISTINE SULFATE 1 MG/ML 2017-04-01 2299-12-31 1 1 MG ML
J9370 61703030916 VINCRISTINE SULFATE VINCRISTINE SULFATE 1 MG/ML 2017-04-01 2299-12-31 1 1 MG ML
J9370 61703030925 VINCRISTINE SULFATE VINCRISTINE SULFATE 1 MG/ML 2017-04-01 2299-12-31 1 1 MG ML
J9370 61703030926 VINCRISTINE SULFATE VINCRISTINE SULFATE 1 MG/ML 2017-04-01 2299-12-31 1 1 MG ML
J9371 20536032201 MARQIBO VINCRISTINE SULFATE
LIPOSOMAL
FNL 5MG/31 2014-01-01 2299-12-31 5 1 MG EA
Q0138 59338077501 FERAHEME FERUMOXYTOL 510 MG/17 ML 2014-11-25 2299-12-31 30 1 MG ML
Q0138 59338077510 FERAHEME FERUMOXYTOL 510 MG/17 ML 2014-11-25 2299-12-31 30 1 MG ML
Q2043 30237890006 PROVENGE SIPULEUCEL-T/LACTATED
RINGERS
50MM/250 2012-04-11 2299-12-31 1 1 UNIT EA
Q2049 47335008250 LIPODOX DOXORUBICIN HCL
LIPOSOMAL
2MG/ML 2012-07-01 2299-12-31 0.2 10 MG ML
Q2049 47335008350 LIPODOX 50 DOXORUBICIN HCL
LIPOSOMAL
2MG/ML 2012-07-01 2299-12-31 0.2 10 MG ML
Q2050 47335005040 DOXORUBICIN HCL
LIPOSOME
DOXORUBICIN HCL
LIPOSOME
2mg/ML 2015-09-09 2299-12-31 0.2 10 MG ML
Q5101 61314030401 ZARXIO FILGRASTIM 300 MCG/0.5 ML 2015-07-01 2299-12-31 600 1 MCG ML
Q5101 61314030410 ZARXIO FILGRASTIM 300 MCG/0.5 ML 2015-07-01 2299-12-31 600 1 MCG ML
Q5101 61314031201 ZARXIO FILGRASTIM 300 MCG/0.8 ML 2015-07-01 2299-12-31 600 1 MCG ML
Q5101 61314031210 ZARXIO FILGRASTIM 300 MCG/0.8 ML 2015-07-01 2299-12-31 600 1 MCG ML
Q5101 61314031801 ZARXIO 300 MCG SYRINGE FILGRASTIM-SNDZ 300 MCG/0.5 ML 2018-05-07 2299-12-31 600 1 MCG ML
Q5101 61314031810 ZARXIO 300 MCG SYRINGE FILGRASTIM-SNDZ 300 MCG/0.5 ML 2018-07-24 2299-12-31 600 1 MCG ML
Q5101 61314032601 ZARXIO 480 MCG SYRINGE FILGRASTIM-SNDZ 480 MCG/0.8 ML 2018-05-07 2299-12-31 600 1 MCG ML
Q5101 61314032610 ZARXIO 480 MCG SYRINGE FILGRASTIM-SNDZ 480 MCG/0.8 ML 2018-07-24 2299-12-31 600 1 MCG ML
Q9984 50419042401 KYLEENA 19.5 MG IUD LEVONORGESTREL 19.5 MG 2017-07-01 2017-12-31 1 19.5 MG EA
Q9993 70801000301 ZILRETTA TRIAMCINOLONE ACETONIDE 32 MG 2018-07-01 2299-12-31 1 32 MG EA
Page 26 of 26