NDC 79903-131OTC monographFDA OTC MONOGRAPH DRUG · M018

Equate Lubricant Eye Drops

Active substance: Polyethylene glycol 400, Propylene glycol

FDA labeler: Walmart, Inc.

8 formulations • 10 package configurations
All 18 registered NDCs — click to copy
In one line

Equate Lubricant Eye Drops (Polyethylene glycol 400, Propylene glycol) NDC 79903-131 converts to 79903-0131-30 for billing and bills under J3490 at Per Administration.

openFDA Live Registry SyncHIPAA 5-4-2 StandardCMS Level II Crosswalk
Listing: 79903-131
Billing & reimbursement crosswalk

NDC • HCPCS Level II • CPT administration

HCPCS Level II J-Code
J3490
Unclassified drugs (requires invoice & NDC on claim)
Billable unit: Per Administration
11-digit HIPAA NDC
79903-0131-30
Zero-padded 5-4-2 format
Standard conversion
CPT administration code
67028
Intravitreal injection of a pharmacologic agent
UB-04 revenue code
Rev 0636
0636 (Pharmacy - Extension of 0250 Drugs Requiring Detail)
Qualifier: ML

Interactive Unit Multiplier Calculator

J3490

Calculate the exact number of billable HCPCS units to report on CMS-1500 / 837P claims based on the patient dose and single-dose vial waste.

MG
Units to report on claim:
100 Units
Based on 1 mg = 1 billable unit (100.0 exact)
Box 24 / HCPCS Quantity Formatted Line:J3490 UN100 (N47990313130)
Complete drug registry

All registered strengths & packaging

Every registered strength and package for Equate Lubricant Eye Drops, with 10-digit and 11-digit NDC formats
Formulation / rolePackage NDCProduct NDC11-digit HIPAAPackaging detailCopy
.4 g/100mL, .3 g/100mL79903-131-3079903-13179903-0131-3030 VIAL, SINGLE-USE in 1 BOX (79903-131-30) / .4 mL in 1 VIAL, SINGLE-USE
.5 mg/100mL11716-0364-511716-036411716-0364-051 BOTTLE, DROPPER in 1 BOX (11716-0364-5) / 15 mL in 1 BOTTLE, DROPPER
.5 g/100mL, .9 g/100mL11716-0365-511716-036511716-0365-051 BOTTLE, DROPPER in 1 BOX (11716-0365-5) / 15 mL in 1 BOTTLE, DROPPER
.4 g/100mL, .3 g/100mL49035-528-0249035-52849035-0528-022 BOTTLE, DROPPER in 1 BOX (49035-528-02) / 15 mL in 1 BOTTLE, DROPPER
.4 g/100mL, .3 g/100mL49035-528-0349035-52849035-0528-032 BOTTLE, DROPPER in 1 BOX (49035-528-03) / 15 mL in 1 BOTTLE, DROPPER
.5 g/100mL49035-245-0149035-24549035-0245-0125 VIAL, SINGLE-USE in 1 BOX (49035-245-01) / .4 mL in 1 VIAL, SINGLE-USE
.5 g/100mL, .9 g/100mL79903-365-0579903-36579903-0365-051 BOTTLE, DROPPER in 1 BOX (79903-365-05) / 15 mL in 1 BOTTLE, DROPPER
.5 mg/100mL79903-364-0579903-36479903-0364-051 BOTTLE, DROPPER in 1 BOX (79903-364-05) / 15 mL in 1 BOTTLE, DROPPER
.3 g/100mL, .4 g/100mL49035-282-0149035-28249035-0282-012 BOTTLE, DROPPER in 1 BOX (49035-282-01) / 15 mL in 1 BOTTLE, DROPPER
.3 g/100mL, .4 g/100mL49035-282-0249035-28249035-0282-022 BOTTLE, DROPPER in 1 BOX (49035-282-02) / 15 mL in 1 BOTTLE, DROPPER
FDA drug label

Prescribing information

Taken from the manufacturer's FDA Structured Product Labeling submission. This is the label as filed, not a summary.

3 Label Sections
Uses ■ for use as a protectant against further irritation or to relieve dryness of the eye. ■ for temporary relief of burning, irritation, and discomfort due to dryness of the eye or exposure to wind or sun.
Directions: Instill 1 to 2 drops in the affected eye(s) as needed.
Warnings For external use only Do not use this product if ■ solution changes color or becomes cloudy When using this product ■ do not touch lip of container to any surface to avoid contamination ■ replace cap after using ■ remove contact lenses before using Stop use and ask a doctor if you experience ■ eye pain ■ changes in vision ■ continued redness or irritation ■ condition worsens or persists for more than72hours
Terms used here11-digit NDCBillable unitN4 qualifier
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