Medicare Part B Competitive Acquisition Program (CAP

)
2006 Drugs (June 30, 2006 Update) & Payment Amounts
Bioscrip, Inc.

Vendor Identification (VIN): Q103

Payment Amounts are based on the median of accepted bids and include PPI update
HCPCS

CAP NDCs

Long Description

J0150

00703-8771-03
00703-8773-01
55390-0067-10
55390-0068-01
63323-0651-02
63323-0651-04

INJECTION, ADENOSINE FOR THERAPEUTIC USE, 6
MG

J0152

00469-0871-20
00469-0871-30

INJECTION, ADENOSINE FOR DIAGNOSTIC USE, 30 MG

J0170

00409-4901-18
00409-4921-34
00409-7241-01
00548-1014-00
00548-1016-00
00548-2016-00
00548-3316-00
00548-9061-00

INJECTION, ADRENALIN, EPINEPHRINE, 1 ML AMPULE

J0207

58178-0017-03

INJECTION, AMIFOSTINE, 500 MG

J0215

59627-0021-03
59627-0021-04

INJECTION, ALEFACEPT, 0.5 MG

J0280

00409-5921-01
00409-5922-01
00409-7385-01
00409-7386-01
00517-3810-25
00517-3820-25

INJECTION, AMINOPHYLLIN, 250 MG

J0290

00781-3408-95
63323-0387-10
63323-0388-10
63323-0389-10
63323-0399-23

INJECTION, AMPICILLIN SODIUM, 500 MG

J0475

58281-0560-01
58281-0561-02
58281-0563-01

INJECTION, BACLOFEN, 10 MG

CAP June 2006 NDC Update

Page 1 of 21

HCPCS

CAP NDCs

Long Description

J0540

61570-0140-10
61570-0141-10

INJECTION, PENICILLIN G BENZATHINE AND
PENICILLIN G PROCAINE, 1,200,000 UNITS

J0550

61570-0142-10
61570-0144-10

INJECTION, PENICILLIN G BENZATHINE AND
PENICILLIN G PROCAINE, 2,400,000 UNITS

J0570

61570-0147-10

INJECTION, PENICILLIN G BENZATHINE, 1,200,000
UNITS

J0585

00023-1145-01

BOTULINUM TOXIN TYPE A, PER UNIT

J0587

10454-0710-10
10454-0711-10
59075-0712-10

BOTULINUM TOXIN TYPE B, PER 100 UNITS

J0600

00089-0510-06

INJECTION, EDETATE CALCIUM DISODIUM, 1000 MG

J0637

00006-3822-10
00006-3823-10

INJECTION, CASPOFUNGIN ACETATE, 5 MG

J0640

00703-5140-01
00703-5145-01
55390-0009-01
55390-0051-10
55390-0052-10
55390-0053-01
55390-0054-01

INJECTION, LEUCOVORIN CALCIUM, PER 50 MG

J0670

00074-1038-50
00074-1041-30
00074-1067-20
00074-2047-50
00186-0410-01
00186-0412-01
00186-0418-01
00186-0420-01
00186-0422-01

INJECTION, MEPIVACAINE HYDROCHLORIDE, PER 10
ML

CAP June 2006 NDC Update

Page 2 of 21

HCPCS

CAP NDCs

Long Description

J0690

00074-4732-03
00143-9923-90
00143-9924-90
00591-2365-69
00591-2366-68
00781-3157-96
00781-3346-95
10019-0610-01
10019-0611-03
63323-0236-10
63323-0237-10
63323-0238-61
63323-0446-61
66860-0001-03
66860-0002-03
66860-0003-02

INJECTION, CEFAZOLIN SODIUM, 500 MG

J0692

51479-0053-10
51479-0054-10
51479-0054-20
51479-0054-30
51479-0055-10
51479-0055-20
51479-0055-30

INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG

CAP June 2006 NDC Update

Page 3 of 21

HCPCS

CAP NDCs

Long Description

J0696

00409-7332-01
00409-7333-04
00409-7335-03
00409-7336-04
00409-7337-01
00409-7338-01
00781-3206-95
00781-3207-95
00781-3208-95
00781-3209-95
00781-3210-46
10019-0685-01
10019-0686-02
10019-0687-03
10019-0688-04
60505-0679-05
60505-0750-04
60505-0751-04
60505-0752-04
60505-0753-04
63323-0344-10
63323-0345-10
63323-0346-10
63323-0347-20
63323-0348-61

INJECTION, CEFTRIAXONE SODIUM, PER 250 MG

J0698

00039-0017-10
00039-0018-10
00039-0018-11
00039-0018-25
00039-0018-50
00039-0019-10
00039-0019-11
00039-0019-25
00039-0019-50
00039-0020-01
00039-0023-25
00039-0023-50
00039-0024-25
00039-0024-50
63323-0331-15
63323-0332-15
63323-0333-61
63323-0334-61
63323-0335-10

INJECTION, CEFOTAXIME SODIUM, PER GM

CAP June 2006 NDC Update

Page 4 of 21

HCPCS

CAP NDCs

Long Description

J0702

00085-0566-05

INJECTION, BETAMETHASONE ACETATE &
BETAMETHASONE SODIUM PHOSPHATE, PER 3 MG

J0704

Not currently
available. Please
contact vendor for
information about
availability.

INJECTION, BETAMETHASONE SODIUM PHOSPHATE,
PER 4 MG

J0735

66591-0965-41
66591-0975-41

INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG

J0800

63004-7731-01

INJECTION, CORTICOTROPIN, 40 UNITS

J0881

55513-0002-04
55513-0003-04
55513-0004-04
55513-0005-04
55513-0006-01
55513-0010-04
55513-0011-04
55513-0012-04
55513-0013-04
55513-0014-01
55513-0015-01
55513-0021-04
55513-0023-04
55513-0025-04
55513-0027-04
55513-0028-01
55513-0032-01
55513-0037-04
55513-0039-04
55513-0041-04
55513-0043-04
55513-0044-01
55513-0046-01
55513-0048-01
55513-0053-04
55513-0054-04
55513-0057-04
55513-0058-04
55513-0110-01
55513-0111-01

INJECTION, DARBEPOETIN ALFA, 1 MCG (NON-ESRD
USE)

CAP June 2006 NDC Update

Page 5 of 21

HCPCS

CAP NDCs

Long Description

J0885

59676-0302-01
59676-0302-02
59676-0303-01
59676-0303-02
59676-0304-01
59676-0304-02
59676-0310-01
59676-0310-02
59676-0312-01
59676-0320-01
59676-0340-01

INJECTION, EPOETIN ALPHA, (FOR NON ESRD USE),
PER 1000 UNITS

J0895

00409-2336-10
00409-2337-25

INJECTION, DEFEROXAMINE MESYLATE, 500 MG

J1000

00009-0271-01

INJECTION, DEPO-ESTRADIOL CYPIONATE, 5 MG

J1020

00009-0274-01

INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG

J1030

00009-0280-02
00009-0280-03
00009-0280-51
00009-0280-52
00009-3073-01
00009-3073-03
00703-0031-04

INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG

J1040

00009-0306-02
00009-0306-12
00703-0051-01
00703-0051-04

INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG

J1051

00009-0626-01

INJECTION, MEDROXYPROGESTERONE ACETATE, 50
MG

J1094

Not currently
available. Please
contact vendor for
information about
availability.

INJECTION, DEXAMETHASONE ACETATE, 1 MG

CAP June 2006 NDC Update

Page 6 of 21

HCPCS

CAP NDCs

Long Description

J1100

00517-4901-25
00517-4905-25
00641-0367-25
63323-0165-01
63323-0165-05
63323-0165-30
63323-0506-01
63323-0516-10

INJECTION, DEXAMETHASONE SODIUM PHOSPHATE,
1MG

J1190

55390-0014-02
55390-0060-02

INJECTION, DEXRAZOXANE HYDROCHLORIDE, PER
250 MG

J1200

00409-2290-31
00641-0376-25

INJECTION, DIPHENHYDRAMINE HCL, 50 MG

J1212

00433-0433-05
67457-0145-50

INJECTION, DMSO, DIMETHYL SULFOXIDE, 50%, 50 ML

J1245

55390-0555-90

INJECTION, DIPYRIDAMOLE, PER 10 MG

J1250

00409-2025-54
55390-0560-90

INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250
MG

J1260

00088-1206-32
00088-1209-26

INJECTION, DOLASETRON MESYLATE, 10 MG

J1335

00006-3843-71

INJECTION, ERTAPENEM SODIUM, 500 MG

J1440

55513-0530-10
55513-0924-10

INJECTION, FILGRASTIM (G-CSF), 300 MCG

J1441

55513-0209-10
55513-0546-10

INJECTION, FILGRASTIM (G-CSF), 480 MCG

J1450

00703-1019-09
55390-0012-01
55390-0046-01
59762-5035-02
59762-5036-02
59762-5037-02
61703-0414-63
61703-0414-64

INJECTION FLUCONAZOLE, 200 MG

CAP June 2006 NDC Update

Page 7 of 21

HCPCS

CAP NDCs

Long Description

J1580

00074-3402-01
00409-1207-03
63323-0010-02
63323-0010-20
63323-0513-02

INJECTION, GARAMYCIN, GENTAMICIN, 80 MG

J1600

11098-0533-01
11098-0533-10
66758-0011-02
66758-0011-03

INJECTION, GOLD SODIUM THIOMALATE, 50 MG

J1626

00004-0239-09
00004-0240-09
00004-0242-08

INJECTION, GRANISETRON HYDROCHLORIDE, 100
MCG

J1631

00703-7011-03
00703-7013-01
00703-7021-03
00703-7023-01
55390-0412-01
55390-0412-05
55390-0413-01
55390-0413-05
60505-0702-01
60505-0703-01
63323-0469-01
63323-0469-05
63323-0471-01
63323-0471-05

INJECTION, HALOPERIDOL DECANOATE, PER 50 MG

CAP June 2006 NDC Update

Page 8 of 21

HCPCS

J1642

CAP NDCs
00409-1280-31
00409-1281-32
00641-0387-25
00641-0389-25
00641-0392-25
00641-0393-25
00641-2436-45
00641-2438-45
00641-2442-45
00641-2443-45
17474-0123-01
17474-0123-02
17474-0123-03
17474-0123-05
17474-0125-01
17474-0125-02
17474-0125-03
17474-0125-05
63323-0017-10
63323-0544-01
63323-0544-11
63323-0545-01
63323-0545-05

Long Description

INJECTION, HEPARIN SODIUM, (HEPARIN LOCK
FLUSH), PER 10 UNITS

J1644

00409-1316-32
00409-1316-66
00641-0400-25
00641-0410-25
00641-2440-45
00641-2450-45
00641-2470-45
63323-0047-10
63323-0262-01
63323-0540-11
63323-0540-31
63323-0542-01
63323-0542-07
63323-0915-01

INJECTION, HEPARIN SODIUM, PER 1000 UNITS

J1645

00013-2406-91
00013-2426-01
00013-2426-91
00013-5190-01
00013-5191-01

INJECTION, DALTEPARIN SODIUM, PER 2500 IU

CAP June 2006 NDC Update

Page 9 of 21

HCPCS

J1650

CAP NDCs
00075-0620-40
00075-0621-60
00075-0622-80
00075-0623-00
00075-0624-30
00075-0626-03
00075-2912-01
00075-2915-01

Long Description

INJECTION, ENOXAPARIN SODIUM, 10 MG

J1655

67211-0342-08
67211-0342-53

INJECTION, TINZAPARIN SODIUM, 1000 IU

J1720

00009-0825-01
00009-0900-13
00009-0900-20
00009-0909-08
00009-0909-16
00009-0912-05
00009-0920-03

INJECTION, HYDROCORTISONE SODIUM SUCCINATE,
100 MG

J1745

57894-0030-01

INJECTION INFLIXIMAB, 10 MG

J1756

00517-2340-10

INJECTION, IRON SUCROSE, 1 MG

J1885

00409-3795-01
00409-3796-01
10019-0029-02
10019-0030-03
10019-0030-04
55390-0480-01
55390-0481-02
55390-0481-10
63323-0162-02

INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG

J1940

00409-6102-10
00517-5710-25
63323-0280-10

INJECTION, FUROSEMIDE, 20 MG

J1956

00045-0065-55
00045-0069-51

INJECTION, LEVOFLOXACIN, 250 MG

J2001

00264-9594-10
00264-9594-20
00338-0409-02
00338-0409-03
00409-7931-24

CAP June 2006 NDC Update

INJECTION, LIDOCAINE HCL FOR INTRAVENOUS
INFUSION, 10 MG

Page 10 of 21

HCPCS

CAP NDCs

Long Description

J2010

00009-0555-02

INJECTION, LINCOMYCIN HCL, 300 MG

J2150

00409-4031-01
00517-4050-25
63323-0024-25

INJECTION, MANNITOL, 25% IN 50 ML

J2260

00703-8005-03
00703-8006-03
10019-0070-01
10019-0070-02
61703-0242-50
67457-0160-20

INJECTION, MILRINONE LACTATE, 5 MG

J2300

00409-1463-01
00409-1464-01
00409-1465-01
00409-1467-01

INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10
MG

J2325

65847-0205-25

INJECTION, NESIRITIDE, 0.1 MG

J2353

00078-0340-61
00078-0341-61
00078-0342-61

INJECTION, OCTREOTIDE, DEPOT FORM FOR
INTRAMUSCULAR INJECTION, 1 MG

J2354

00078-0181-01
00078-0182-01
00078-0183-25
00078-0184-25
00703-3301-04
00703-3333-01
00703-3343-01
55390-0161-10
55390-0162-10
55390-0163-01
55390-0164-01

INJECTION, OCTREOTIDE, NON-DEPOT
SUBCUTANEOUS OR INTRAVENOUS INJECTION, 25
MCG

J2405

00173-0442-00
00173-0442-02
00173-0461-00

INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1
MG

J2430

00703-4075-59
00703-4085-51
00781-3147-84
55390-0129-01
61703-0324-39

INJECTION, PAMIDRONATE DISODIUM, PER 30 MG

J2505

55513-0190-01

INJECTION, PEGFILGRASTIM, 6 MG

CAP June 2006 NDC Update

Page 11 of 21

HCPCS

CAP NDCs

Long Description

J2550

00641-0928-25
00641-0929-25
00641-1495-35
00641-1496-35
00703-2201-04

INJECTION, PROMETHAZINE HCL, 50 MG

J2680

00703-5003-01
55390-0465-05

INJECTION, FLUPHENAZINE DECANOATE, 25 MG

J2765

60977-0451-02
60977-0451-03
61703-0210-11
61703-0210-21
61703-0210-35

INJECTION, METOCLOPRAMIDE HCL, 10 MG

J2780

55390-0616-01
55390-0616-10

INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG

J2820

50419-0002-33
50419-0595-05

INJECTION, SARGRAMOSTIM (GM-CSF), 50 MCG

J2912

00409-1966-04
00409-1966-05
00409-1966-07
00409-1966-12
00409-1966-14
00409-4888-10
00409-4888-12
00409-4888-20
00409-4888-50
00517-0648-25
00517-2810-25
17474-3002-01
63323-0186-00
63323-0186-10
63323-0186-20

INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML

J2916

52544-0922-26

INJECTION, SODIUM FERRIC GLUCONATE COMPLEX
IN SUCROSE INJECTION, 12.5 MG

J2920

00009-0113-19
00409-5684-01

INJECTION, METHYLPREDNISOLONE SODIUM
SUCCINATE, 40 MG

CAP June 2006 NDC Update

Page 12 of 21

HCPCS

CAP NDCs

Long Description

J2930

00009-0190-16
00009-0698-01
00009-0758-01
00009-0796-01
00009-3389-01

INJECTION, METHYLPREDNISOLONE SODIUM
SUCCINATE, 125 MG

J2997

50242-0041-64
50242-0044-13
50242-0085-27

INJECTION, ALTEPLASE RECOMBINANT, 1 MG

J3260

00409-3578-01
00409-3590-02
63323-0306-30
63323-0307-51

INJECTION, TOBRAMYCIN SULFATE, 80 MG

J3301

00003-0293-28
00003-0494-20

INJECTION, TRIAMCINOLONE ACETONIDE, PER 10MG

J3302

Not currently
available. Please
contact vendor for
information about
availability.

INJECTION, TRIAMCINOLONE DIACETATE, PER 5MG

J3303

54643-1054-00
54643-1056-00

INJECTION, TRIAMCINOLONE HEXACETONIDE, PER
5MG

J3315

52544-0153-76
52544-0154-76

INJECTION, TRIPTORELIN PAMOATE, 3.75 MG

J3370

00409-4332-01
00409-6509-01
00409-6533-01
63323-0221-10
63323-0284-20
63323-0314-61

INJECTION, VANCOMYCIN HCL, 500 MG

J3396

58768-0150-15

INJECTION, VERTEPORFIN, 0.1 MG

J3410

00517-4201-25
00517-5602-25
00517-5610-25
63323-0021-01

INJECTION, HYDROXYZINE HCL, 25 MG

J3420

00517-0032-25
00517-0130-05

INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO
1000 MCG

CAP June 2006 NDC Update

Page 13 of 21

HCPCS

CAP NDCs

Long Description

J3475

00409-2168-02
00409-2168-03
00409-6729-03
00409-6729-09
00517-2610-25
00517-2650-25
63323-0064-10
63323-0064-20
63323-0064-50

INJECTION, MAGNESIUM SULFATE, PER 500 MG

J3480

00074-3934-02
00409-1513-02
00409-6636-01
00409-6651-06
00409-6653-05
63323-0965-10
63323-0965-15
63323-0965-20
63323-0967-30

INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ

J3487

00078-0387-25

INJECTION, ZOLEDRONIC ACID, 1 MG

J7030

00264-1400-10
00264-4000-55
00264-7800-00
00264-7800-10
00264-7800-20
00338-0049-02
00338-0049-03
00338-0049-04
00409-7101-02
00409-7983-02
00409-7983-03
00409-7983-09
00409-7983-53
00409-7983-55

INFUSION, NORMAL SALINE SOLUTION , 1000 CC

J7040

00264-1400-10
00264-7800-00
00264-7800-10
00338-0049-04
00409-7983-09

INFUSION, NORMAL SALINE SOLUTION, STERILE (500
ML=1 UNIT)

J7042

00264-7610-00
00338-0089-04
00409-7941-09

5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT)

CAP June 2006 NDC Update

Page 14 of 21

HCPCS

CAP NDCs

Long Description

J7050

00264-1400-10
00338-0049-02
00338-0049-03
00338-0049-04
00409-1583-02
00409-7983-03
00409-7983-09
00409-7983-53

INFUSION, NORMAL SALINE SOLUTION , 250 CC

J7060

00338-0017-04
00409-1522-02
00409-1522-03
00409-7922-03
00409-7922-09

5% DEXTROSE/WATER (500 ML = 1 UNIT)

J7070

00264-7510-00
00264-7510-10
00338-0017-03
00338-0017-04
00409-7922-09

INFUSION, D5W, 1000 CC

J7120

00264-1350-10
00264-1750-00
00338-0117-03
00338-0117-04

RINGERS LACTATE INFUSION, 1000 CC

J7317

08024-0724-12
08024-0724-20
08363-7761-01
08363-7765-01

SODIUM HYALURONATE, PER 20 TO 25 MG DOSE FOR
INTRA-ARTICULAR INJECTION

J7320

58468-0090-01
66267-0921-03
68115-0535-03

HYLAN G-F 20, 16 MG, FOR INTRA ARTICULAR
INJECTION

J9000

10019-0920-01
10019-0921-02
55390-0232-10
55390-0238-01

DOXORUBICIN HCL, 10 MG

J9001

17314-9600-01
17314-9600-02

DOXORUBICIN HYDROCHLORIDE, ALL LIPID
FORMULATIONS, 10 MG

J9031

49281-0880-01

BCG (INTRAVESICAL) PER INSTILLATION

CAP June 2006 NDC Update

Page 15 of 21

HCPCS

CAP NDCs

Long Description

J9040

00703-3154-01
00703-3155-01
55390-0005-01
55390-0006-01
61703-0323-22
61703-0332-18

BLEOMYCIN SULFATE, 15 UNITS

J9045

00703-3244-11
00703-3246-11
00703-3249-11
00703-3264-01
00703-3266-01
00703-3268-71
10019-0915-01
55390-0153-01
55390-0154-01
55390-0155-01
61703-0339-18
61703-0339-22
61703-0339-50
61703-0339-56

CARBOPLATIN, 50 MG

J9050

00015-3012-38

CARMUSTINE, 100 MG

J9060

55390-0099-01
55390-0112-50
55390-0112-99

CISPLATIN, POWDER OR S0LUTION, PER 10 MG

J9062

00703-5747-11
00703-5748-11
55390-0099-01
55390-0112-50
55390-0112-99

CISPLATIN, 50 MG

J9065

55390-0124-01
63323-0140-10

INJECTION, CLADRIBINE, PER 1 MG

J9070

Not currently
available. Please
contact vendor for
information about
availability.

CYCLOPHOSPHAMIDE, 100 MG

J9080

Not currently
available. Please
contact vendor for
information about
availability.

CYCLOPHOSPHAMIDE, 200 MG

J9090

00015-0502-41
10019-0955-01

CYCLOPHOSPHAMIDE, 500 MG

CAP June 2006 NDC Update

Page 16 of 21

HCPCS

CAP NDCs

Long Description

J9091

10019-0956-01

CYCLOPHOSPHAMIDE, 1.0 GRAM

J9092

00015-0506-41
10019-0957-01

CYCLOPHOSPHAMIDE, 2.0 GRAM

J9093

Not currently
available. Please
contact vendor for
information about
availability.

CYCLOPHOSPHAMIDE, LYOPHILIZED, 100 MG

J9094

J9095

J9096

J9097

Not currently
available. Please
contact vendor for
information about
availability.
Not currently
available. Please
contact vendor for
information about
availability.
Not currently
available. Please
contact vendor for
information about
availability.
Not currently
available. Please
contact vendor for
information about
availability.

CYCLOPHOSPHAMIDE, LYOPHILIZED, 200 MG

CYCLOPHOSPHAMIDE, LYOPHILIZED, 500 MG

CYCLOPHOSPHAMIDE, LYOPHILIZED, 1.0 GRAM

CYCLOPHOSPHAMIDE, LYOPHILIZED, 2.0 GRAM

J9098

57665-0331-01

CYTARABINE LIPOSOME, 10 MG

J9100

55390-0131-10

CYTARABINE, 100 MG

J9110

55390-0133-01
55390-0134-01

CYTARABINE, 500 MG

J9130

63323-0127-10

DACARBAZINE, 100 MG

J9140

00703-5075-01
00703-5075-03
55390-0090-10
61703-0327-22

DACARBAZINE, 200 MG

J9150

00703-5233-13
55390-0108-01
55390-0108-10
55390-0281-10

DAUNORUBICIN, 10 MG

J9170

00075-8001-20
00075-8001-80

DOCETAXEL, 20 MG

CAP June 2006 NDC Update

Page 17 of 21

HCPCS

CAP NDCs

Long Description

J9178

00009-5091-01
00009-5093-01

INJECTION, EPIRUBICIN HCL, 2 MG

J9181

00703-5653-01
00703-5657-01
55390-0291-01
55390-0292-01
55390-0293-01

ETOPOSIDE, 10 MG

J9182

00703-5653-01
00703-5656-01
00703-5657-01
55390-0291-01
55390-0292-01
55390-0293-01

ETOPOSIDE, 100 MG

J9185

00703-4852-11
00703-5854-01

FLUDARABINE PHOSPHATE, 50 MG

J9190

00703-3015-13
00703-3018-12
00703-3019-12
63323-0117-20
63323-0117-51
63323-0117-61

FLUOROURACIL, 500 MG

J9200

61703-0331-09
63323-0145-07

FLOXURIDINE, 500 MG

J9201

00002-7501-01
00002-7502-01

GEMCITABINE HCL, 200 MG

J9202

00310-0950-36
00310-0951-30

GOSERELIN ACETATE IMPLANT, PER 3.6 MG

J9206

00009-7529-01
00009-7529-02

IRINOTECAN, 20 MG

J9208

10019-0925-01
63323-0142-10

IFOSFAMIDE, 1 GM

J9209

10019-0953-01
10019-0953-02

MESNA, 200 MG

J9211

00703-4156-11

IDARUBICIN HYDROCHLORIDE, 5 MG

CAP June 2006 NDC Update

Page 18 of 21

HCPCS

CAP NDCs

Long Description

J9213

00004-2015-07
00004-2015-09
00004-2016-09

INTERFERON, ALFA-2A, RECOMBINANT, 3 MILLION
UNITS

J9214

00085-0539-01
00085-0571-02
00085-1110-01
00085-1133-01
00085-1168-01
00085-1179-02
00085-1235-01
00085-1242-01
00085-1254-01

INTERFERON, ALFA-2B, RECOMBINANT, 1 MILLION
UNITS

J9219

00026-9711-01

LEUPROLIDE ACETATE IMPLANT, 65 MG

J9245

59572-0301-01

INJECTION, MELPHALAN HYDROCHLORIDE, 50 MG

J9250

55390-0033-10
55390-0034-10

METHOTREXATE SODIUM, 5 MG

J9260

55390-0032-10
55390-0033-10
55390-0034-10
61703-0408-41

METHOTREXATE SODIUM, 50 MG

J9263

00024-0590-10
00024-0591-20
00024-0596-02
00024-0597-04

INJECTION, OXALIPLATIN, 0.5 MG

J9265

55390-0114-05
55390-0114-20
55390-0114-50

PACLITAXEL, 30 MG

J9268

62701-0800-01

PENTOSTATIN, PER 10 MG

J9280

63323-0190-20

MITOMYCIN, 5 MG

J9290

55390-0252-01
63323-0191-40

MITOMYCIN, 20 MG

J9291

55390-0253-01

MITOMYCIN, 40 MG

J9293

44087-1520-01
44087-1525-01
44087-1530-01

INJECTION, MITOXANTRONE HYDROCHLORIDE, PER 5
MG

J9310

50242-0051-21
50242-0053-06

RITUXIMAB, 100 MG

CAP June 2006 NDC Update

Page 19 of 21

HCPCS
J9320
J9340

CAP NDCs
00703-4636-01
55390-0030-10

Long Description
STREPTOZOCIN, 1 GM
THIOTEPA, 15 MG

J9350

00007-4201-01
00007-4201-05

TOPOTECAN, 4 MG

J9355

50242-0134-68

TRASTUZUMAB, 10 MG

J9360

63323-0278-10

VINBLASTINE SULFATE, 1 MG

J9370

00703-4402-11
00703-4412-11
61703-0309-06
61703-0309-16

VINCRISTINE SULFATE, 1 MG

J9375

00703-4402-11
00703-4412-11
61703-0309-06
61703-0309-16

VINCRISTINE SULFATE, 2 MG

J9390

00703-4182-01
00703-4183-01
55390-0069-01
55390-0070-01
61703-0341-09

VINORELBINE TARTRATE, PER 10 MG

J9395

00310-0720-25
00310-0720-50

INJECTION, FULVESTRANT, 25 MG

J9600

58914-0155-75

PORFIMER SODIUM, 75 MG

Q3025

59627-0001-03
59627-0002-05

INJECTION, INTERFERON BETA-1A, 11 MCG FOR
INTRAMUSCULAR USE

J0128

68158-0149-51

ABARELIX INJECTION, 10 MG

J0180

58468-0040-01
58468-0041-01

AGALSIDASE BETA INJECTION, 1 MG

J0278

00409-1955-01
00409-1956-01
00703-9032-03
00703-9040-03
55390-0225-02
55390-0226-02
55390-0226-04

AMIKACIN, 100MG

J0878
J1751

67919-0011-01
52544-0931-02

DAPTOMYCIN INJECTION, 1 MG
IRON DEXTRAN 165, 50MG

J1752

00517-0134-10
00517-0234-10

IRON DEXTRAN 267, 50MG

CAP June 2006 NDC Update

Page 20 of 21

HCPCS
J1931
J2357
J2469
J2503

CAP NDCs
58468-0070-01
50242-0040-62
58063-0797-25
68782-0001-01

Long Description
LARONIDASE INJECTION, 0.1 MG
OMALIZUMAB INJECTION, 5 MG
PALONOSETRON HCL, 25MCG
PEGAPTANIB, 0.3MG

J2794

50458-0306-11
50458-0307-11
50458-0308-11

RISPERIDONE, LONG ACTING, 0.5MG

J9035

50242-0060-01
50242-0061-01

BEVACIZUMAB INJECTION, 10MG

J9041
J9055
J9225
J9264
J9305

63020-0049-01
66733-0948-23
55592-0500-01
68817-0134-50
00002-7623-01

BORTEZOMIB INJECTION, 0.1MG
CETUXIMAB INJECTION, 10MG
HISTRELIN IMPLANT, 50MG
PACLITAXEL PROTEIN BOUND PARTICLES, 1MG
PEMETREXED INJECTION, 10MG

CAP June 2006 NDC Update

Page 21 of 21

Sign up to vote on this title
UsefulNot useful