NDC codes

FDA NDC Directory
Product NDC (as listed)67457-211Labeler and product segments. Claims need a package NDC.
Product NDC at billing width67457-0211Add 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
67457-211-02674570211021 VIAL, GLASS in 1 CARTON (67457-211-02) / 1.5 mL in 1 VIAL, GLASSMarketed from Oct 9, 2012

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)
Fomepizole
Generic name (nonproprietary)
fomepizole
Active ingredients
Fomepizole — 1 g/mL
Dosage form
Injection, Solution
Route
Intravenous
Product type
Prescription drug
Marketing category
ANDA — Abbreviated New Drug Application (generic)Application ANDA 078639
Marketing start
Listing expires
Identifiers
Product ID 67457-211_ac92fef1-664f-4cfd-aa72-b6507934b28fSPL ID ac92fef1-664f-4cfd-aa72-b6507934b28fSPL set ID 911312e2-3a7c-4c97-88a8-b8d92cd12923RxCUI 310414UNII 83LCM6L2BY
Pharmacologic class
Antidote

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 drug-specific HCPCS code in Med-Code's directory for this product. The directory is curated and not complete — check the current CMS HCPCS file before billing.

Administration

Drug administration (CPT 96360–96549)

When a clinician administers the drug, the administration is reported separately. Codes in this range cover hydration, therapeutic injections and infusions, and chemotherapy or other complex drug administration. The right code depends on route, duration and drug type, and self-administered drugs are not billed this way.

How CPT relates to drug billing

NDC on a medical claim

N467457021102 followed by a unit qualifier and the quantity

Package 67457-0211-02. 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 AND USAGE Fomepizole injection is indicated as an antidote for ethylene glycol (such as antifreeze) or methanol poisoning, or for use in suspected ethylene glycol or methanol ingestion, either alone or in combination with hemodialysis (see DOSAGE AND ADMINISTRATION ).

Excerpt only. Read the full label for complete information.

Full label on DailyMed (opens in a new tab)

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