Active substance: Adeps suillus, Adrenalinium, Adrenocorticotrophin, Agrimonia eupatoria flos, Ammounium bromatum, Anacardium orientale, Antimonium crudum, Castanea sativa flos, Calcarea carbonica, Coenzyme A, Cortisone aceticum, Fucus vesiculosus, Hypothalamus, Kali bichromicum, Pituitarum posterium, RNA, Sabadilla, Staphysagria, Thyroidinum
Thinnr PROTOCOL (Adeps suillus, Adrenalinium, Adrenocorticotrophin, Agrimonia eupatoria flos, Ammounium bromatum, Anacardium orientale, Antimonium crudum, Castanea sativa flos, Calcarea carbonica, Coenzyme A, Cortisone aceticum, Fucus vesiculosus, Hypothalamus, Kali bichromicum, Pituitarum posterium, RNA, Sabadilla, Staphysagria, Thyroidinum) NDC 85095-100 converts to 85095-0100-04 for billing and bills under J0171 at 0.1 mg = 1 Unit.
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.
| Formulation / role | Package NDC | Product NDC | 11-digit HIPAA | Packaging detail | Copy |
|---|---|---|---|---|---|
| 8 [hp_X]/mL, 8 [hp_X]/mL, 8 [hp_X]/mL, 8 [hp_X]/mL, 8 [hp_X]/mL, 8 [hp_X]/mL, 8 [hp_X]/mL, 8 [hp_X]/mL, 8 [hp_X]/mL, 8 [hp_X]/mL, 8 [hp_X]/mL, 8 [hp_X]/mL, 8 [hp_X]/mL, 8 [hp_X]/mL, 8 [hp_X]/mL, 8 [hp_X]/mL, 8 [hp_X]/mL, 8 [hp_X]/mL, 8 [hp_X]/mL | 85095-100-04 | 85095-100 | 85095-0100-04 | 118 mL in 1 BOTTLE (85095-100-04) |
Taken from the manufacturer's FDA Structured Product Labeling submission. This is the label as filed, not a summary.