physicians administered drug (pad) list - ky …...physicians administered drug (pad) list effective...
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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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Page 14 of 26
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
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
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
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
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
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
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
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
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
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
Page 24 of 26
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
Page 25 of 26
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