Vitrexate (folic acid) NDC 59088-167

NDC codes

FDA NDC Directory

Product NDC (as listed)59088-167Labeler and product segments. Claims need a package NDC.

Product NDC at billing width59088-0167Add 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
59088-167-54	59088016754	30 TABLET in 1 BOTTLE, PLASTIC (59088-167-54)Marketed from Nov 30, 2020

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): Vitrexate
Generic name (nonproprietary): folic acid
Active ingredients: .alpha.-tocopherol acetate, Dl- — 30 mg/1Magnesium oxide — 200 mg/1Chromium nicotinate — 35 ug/1Pyridoxine hydrochloride — 20 mg/1Molybdenum — 45 ug/1Selenium — 55 ug/1Cholecalciferol — 20 ug/1Riboflavin — 3.4 mg/1Niacinamide — 20 mg/1Ascorbic acid — 120 mg/1Folic acid — 1000 ug/1Cyanocobalamin — 8 ug/1Calcium carbonate — 200 mg/1Vitamin a acetate — 1500 ug/1Thiamine mononitrate — 3 mg/1Zinc oxide — 25 mg/1Manganese sulfate — 2.3 mg/1
Dosage form: Tablet
Route: Oral
Labeler: PureTek Corporation
Product type: Prescription drug
Marketing category: Unapproved drug (other)
Marketing start: Nov 30, 2020
Listing expires: Dec 31, 2026
Other FDA classes: Analogs/Derivatives (Chemical/Ingredient)Ascorbic Acid (Chemical structure)Calcium (Chemical structure)Divalent (Chemical structure)Decreased Copper Ion Absorption (Physiologic effect)Increased Coagulation Factor Activity (Physiologic effect)Increased Large Intestinal Motility (Physiologic effect)Inhibition Large Intestine Fluid/Electrolyte Absorption (Physiologic effect)Inhibition Small Intestine Fluid/Electrolyte Absorption (Physiologic effect)Magnesium Ion Exchange Activity (Mechanism)Magnetic Resonance Contrast Activity (Mechanism)Osmotic Activity (Mechanism)Stimulation Large Intestine Fluid/Electrolyte Secretion (Physiologic effect)Vitamin A (Chemical structure)Vitamin B 12 (Chemical structure)Vitamin B 6 (Chemical/Ingredient)Vitamin D (Chemical structure)
Identifiers: Product ID 59088-167_f204b4b3-176f-8839-e053-2a95a90a7115SPL ID f204b4b3-176f-8839-e053-2a95a90a7115SPL set ID b34fee43-bea9-45b7-e053-2a95a90aad4dUNII H0G9379FGK, 1C6V77QF41, PQ6CK8PD0R, 3LE3D9D6OY, WR1WPI7EW8, TLM2976OFR, 25X51I8RD4, 81AH48963U, 68Y4CF58BV, 8K0I04919X, P6YC3EG204, SOI2LOH54Z, W00LYS4T26, 3A3U0GI71G, H6241UJ22B, 935E97BOY8, A150AY412VUPC 0359088167540, 0359088171547
Pharmacologic class: Blood Coagulation Factor; Calculi Dissolution Agent; Copper Absorption Inhibitor; Osmotic Laxative; Paramagnetic Contrast Agent; Vitamin A; Vitamin B12; Vitamin B6 Analog; Vitamin C; Vitamin D

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

N459088016754 followed by a unit qualifier and the quantity

Package 59088-0167-54. 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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