NDC codes

FDA NDC Directory
Product NDC (as listed)58264-0110Labeler and product segments. Claims need a package NDC.
Product NDC at billing width58264-0110Add the package segment from the table below.
Package NDCs as listed with the FDA, and the 11-digit 5-4-2 form used on claims. The highlighted digit is the added leading zero.
Package NDC11-digit (billing)PackageCopy
58264-0110-15826401100129.57 mL in 1 BOTTLE, GLASS (58264-0110-1)Marketed from Jan 1, 1990

How the 11-digit form is made: The package segment has 1 digit, so one leading zero is added to it (5-4-1 → 5-4-2). Formatting the NDC does not by itself make it billable — the product, package and quantity must match what was dispensed or administered, and payer rules apply. Conversion rules

Product information

Brand name (proprietary)
D-104
Generic name (nonproprietary)
apium graveolens whole, asclepias incarnata root, calcium arsenate, camphor (natural), echinacea angustifolia, eupatorium perfoliatum flowering top, euphrasia stricta, ferrous iodide, ichthammol, scabies lesion lysate (human), thuja occidentalis leafy twig, and trifolium repens flower
Active ingredients
Apium graveolens whole — 6 [hp_X]/mLAsclepias incarnata root — 4 [hp_X]/mLCalcium arsenate — 12 [hp_X]/mLCamphor (Natural) — 12 [hp_X]/mLEchinacea angustifolia — 4 [hp_X]/mLEupatorium perfoliatum flowering top — 6 [hp_X]/mLEuphrasia stricta — 6 [hp_X]/mLFerrous iodide — 6 [hp_X]/mLIchthammol — 12 [hp_X]/mLScabies lesion lysate (Human) — 30 [hp_X]/mLThuja occidentalis leafy twig — 6 [hp_X]/mLTrifolium repens flower — 4 [hp_X]/mL
Dosage form
Solution
Route
Sublingual
Product type
Over-the-counter drug
Marketing category
Unapproved homeopathic
Marketing start
Listing expires
Identifiers
Product ID 58264-0110_2b9ed194-def5-363e-e063-6294a90a8cdcSPL ID 2b9ed194-def5-363e-e063-6294a90a8cdcSPL set ID 09c3912a-71ba-4814-8b91-d0e787b542bfUNII 15V0BLB71G, 4N9UU1HQKG, 95OX15I8ZU, N20HL7Q941, VB06AV5US8, 1W0775VX6E, C9642I91WL, F5452U54PN, NQ14646378, 5UAU16Z1U4, 1NT28V9397, 49Y788T742

Billing references

What Med-Code can say about coding this product, and where each statement comes from. Nothing here is inferred from the name alone.

HCPCS codeNo match

No HCPCS code in Med-Code's directory. Sublingual products like this are usually dispensed by a pharmacy and billed by NDC.

NDC on a medical claim

N458264011001 followed by a unit qualifier and the quantity

Package 58264-0110-01. Unit qualifiers: F2 (international unit), GR (gram), ME (milligram), ML (milliliter), UN (unit (each)). The qualifier and quantity depend on what was given. About the N4 qualifier

Product label

Current FDA label (SPL), effective .

Indications (excerpt from the label)

INDICATIONS For viral infections.

Excerpt only. Read the full label for complete information.

Full label on DailyMed (opens in a new tab)

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