D-155 NDC 58264-0166

NDC codes

FDA NDC Directory

Product NDC (as listed)58264-0166Labeler and product segments. Claims need a package NDC.

Product NDC at billing width58264-0166Add 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 NDC	11-digit (billing)	Package	Copy
58264-0166-1	58264016601	29.57 mL in 1 BOTTLE, GLASS (58264-0166-1)Marketed from Feb 22, 2023

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-155
Generic name (nonproprietary): arsenicum album, carbo vegetabilis, ipecacuanha, nux vomica, sulfur
Active ingredients: Arsenic trioxide — 30 [hp_X]/mLStrychnos nux-vomica seed — 30 [hp_X]/mLActivated charcoal — 30 [hp_X]/mLIpecac — 30 [hp_X]/mL
Dosage form: Solution
Route: Sublingual
Labeler: DNA Labs
Product type: Over-the-counter drug
Marketing category: Unapproved homeopathic
Marketing start: Feb 22, 2023
Listing expires: Dec 31, 2026
Other FDA classes: Allergens (Chemical structure)Cell-mediated Immunity (Physiologic effect)Increased Histamine Release (Physiologic effect)Increased IgG Production (Physiologic effect)Plant Proteins (Chemical structure)Seed Storage Proteins (Chemical structure)
Identifiers: Product ID 58264-0166_2b9f0811-b771-31e7-e063-6294a90a2555SPL ID 2b9f0811-b771-31e7-e063-6294a90a2555SPL set ID f5512f34-08f0-b0f6-e053-2a95a90ab5bdUNII S7V92P67HO, 269XH13919, 2P3VWU3H10, 62I3C8233L
Pharmacologic class: Non-Standardized Plant Allergenic Extract

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

N458264016601 followed by a unit qualifier and the quantity

Package 58264-0166-01. 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

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