Dextromethorphan Polistirex NDC 58602-617

NDC codes

FDA NDC Directory

Product NDC (as listed)58602-617Labeler and product segments. Claims need a package NDC.

Product NDC at billing width58602-0617Add 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
58602-617-05	58602061705	1 BOTTLE in 1 CARTON (58602-617-05) / 89 mL in 1 BOTTLEMarketed from Apr 17, 2026
58602-617-06	58602061706	1 BOTTLE in 1 CARTON (58602-617-06) / 148 mL in 1 BOTTLEMarketed from Apr 17, 2026

How the 11-digit form is made: The product segment has 3 digits, so one leading zero is added to it (5-3-2 → 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): Dextromethorphan Polistirex
Generic name (nonproprietary): dextromethorphan polistirex
Active ingredients: Dextromethorphan — 30 mg/5mL
Dosage form: Suspension, Extended release
Route: Oral
Labeler: Aurohealth LLC
Product type: Over-the-counter drug
Marketing category: ANDA — Abbreviated New Drug Application (generic)Application ANDA 218417
Marketing start: Apr 17, 2026
Listing expires: Dec 31, 2027
Other FDA classes: Sigma-1 Receptor Agonists (Mechanism)Uncompetitive NMDA Receptor Antagonists (Mechanism)
Identifiers: Product ID 58602-617_272bae8c-f800-4cec-bc9a-014123bb81a6SPL ID 272bae8c-f800-4cec-bc9a-014123bb81a6SPL set ID 0fb8cdfc-3fa0-4773-813a-04c82b003bdfRxCUI 1373045UNII 7355X3ROTS
Pharmacologic class: Sigma-1 Agonist; Uncompetitive N-methyl-D-aspartate Receptor Antagonist

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. Oral products like this are usually dispensed by a pharmacy and billed by NDC.

NDC on a medical claim

N458602061705 followed by a unit qualifier and the quantity

Package 58602-0617-05. 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 May 13, 2026.

Indications (excerpt from the label)

Uses temporarily relieves cough due to minor throat and bronchial irritation as may occur with the common cold or inhaled irritants the impulse to cough to help you get to sleep

Excerpt only. Read the full label for complete information.

Full label on DailyMed (opens in a new tab)

Other NDCs under ANDA 218417

Products listed under the same FDA application: other strengths and forms, and repackagers who relabel the same product.

FDA NDC Directory listings under ANDA 218417
Product	Strength	Form · route	Labeler	Product NDC
Dextromethorphan Polistirex	Dextromethorphan 30 mg/5mL	Suspension, Extended releaseOral	Aurohealth LLC	58602-611
Dextromethorphan Polistirex	Dextromethorphan 30 mg/5mL	Suspension, Extended releaseOral	Aurohealth LLC	58602-610
Dextromethorphan Polistirex	Dextromethorphan 30 mg/5mL	Suspension, Extended releaseOral	Aurohealth LLC	58602-618