Ravicti (glycerol phenylbutyrate) NDC 75987-050

NDC codes

FDA NDC Directory

Product NDC (as listed)75987-050Labeler and product segments. Claims need a package NDC.

Product NDC at billing width75987-0050Add 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
75987-050-06	75987005006	1 BOTTLE in 1 CARTON (75987-050-06) / 25 mL in 1 BOTTLEMarketed from Feb 28, 2013
75987-050-07	75987005007	4 BOTTLE in 1 CARTON (75987-050-07) / 25 mL in 1 BOTTLEMarketed from Feb 28, 2013

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): Ravicti
Generic name (nonproprietary): glycerol phenylbutyrate
Active ingredients: Glycerol phenylbutyrate — 1.1 g/mL
Dosage form: Liquid
Route: Oral
Labeler: Horizon Therapeutics USA, Inc.
Product type: Prescription drug
Marketing category: NDA — New Drug ApplicationApplication NDA 203284
Marketing start: Feb 28, 2013
Listing expires: Dec 31, 2026
Other FDA classes: Ammonium Ion Binding Activity (Mechanism)
Identifiers: Product ID 75987-050_a58b617c-635a-4a67-9f27-f9c93f8cba22SPL ID a58b617c-635a-4a67-9f27-f9c93f8cba22SPL set ID 900e7dc0-9afe-4f50-80de-90567bb78519RxCUI 1368453, 1368459UNII ZH6F1VCV7B
Pharmacologic class: Nitrogen Binding Agent

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

N475987005006 followed by a unit qualifier and the quantity

Package 75987-0050-06. 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

Label details couldn’t be retrieved right now. Open the label on DailyMed.

Other NDCs under NDA 203284

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

FDA NDC Directory listings under NDA 203284
Product	Strength	Form · route	Labeler	Product NDC
glycerol phenylbutyrate	Glycerol phenylbutyrate 1.1 g/mL	LiquidOral	Lupin Pharmaceuticals, Inc.	70748-425