| Source HCPCS Code |
|
Target NDC Code |
J0578
INJECTION, BUPRENORPHINE EXTENDED-RELEASE (BRIXADI), GREATER THAN 7 DAYS AND UP TO 28 DAYS OF THERAPY
|
⇄
|
58284-0228-01
BRIXADI MONTHLY 128MG 32 MG/0.09 ML
|
| Detail Information |
| Relationship Start Date |
04/01/2024 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
0.36 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
J0578
Injection, buprenorphine extended release (brixadi), greater than 7 days, up to 28 days of therapy
|
⇄
|
58284-0228-91
BRIXADI MONTHLY 128 MG/0.36 ML SYRINGE
|
| Detail Information |
| Relationship Start Date |
04/01/2024 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
0.36 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
SYRINGE |
| Route Of Administration |
SQ |
| Billing Units |
ML |
|
|
|
J0578
INJECTION, BUPRENORPHINE EXTENDED-RELEASE (BRIXADI), GREATER THAN 7 DAYS AND UP TO 28 DAYS OF THERAPY
|
⇄
|
58284-0264-01
BRIXADI MONTHLY 64MG 32 MG/0.09 ML
|
| Detail Information |
| Relationship Start Date |
04/01/2024 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
0.18 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
J0578
Injection, buprenorphine extended release (brixadi), greater than 7 days, up to 28 days of therapy
|
⇄
|
58284-0264-91
BRIXADI MONTHLY 64 MG/0.18 ML SYRINGE
|
| Detail Information |
| Relationship Start Date |
04/01/2024 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
0.18 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
SYRINGE |
| Route Of Administration |
SQ |
| Billing Units |
ML |
|
|
|
J0578
INJECTION, BUPRENORPHINE EXTENDED-RELEASE (BRIXADI), GREATER THAN 7 DAYS AND UP TO 28 DAYS OF THERAPY
|
⇄
|
58284-0296-01
BRIXADI MONTHLY 96MG 32 MG/0.09 ML
|
| Detail Information |
| Relationship Start Date |
04/01/2024 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
0.27 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
SC |
| Billing Units |
EA |
|
|
|
J0578
Injection, buprenorphine extended release (brixadi), greater than 7 days, up to 28 days of therapy
|
⇄
|
58284-0296-91
BRIXADI MONTHLY 96 MG/0.27 ML SYRINGE
|
| Detail Information |
| Relationship Start Date |
04/01/2024 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
0.27 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
SYRINGE |
| Route Of Administration |
SQ |
| Billing Units |
ML |
|
|
|
J0578
Inj brixadi, more than 7 day
|
⇄
|
58284-0228-01
Brixadi (monthly dosing)
|
| Detail Information |
| Relationship Start Date |
|
| Relationship End Date |
|
| Number Of Items In Ndc Package |
|
| Ndc Package Measure |
|
| Ndc Package Type |
|
| Route Of Administration |
|
| Billing Units |
|
|
|
|
J0578
Inj brixadi, more than 7 day
|
⇄
|
58284-0264-01
Brixadi (monthly dosing)
|
| Detail Information |
| Relationship Start Date |
|
| Relationship End Date |
|
| Number Of Items In Ndc Package |
|
| Ndc Package Measure |
|
| Ndc Package Type |
|
| Route Of Administration |
|
| Billing Units |
|
|
|
|
J0578
Inj brixadi, more than 7 day
|
⇄
|
58284-0296-01
Brixadi (monthly dosing)
|
| Detail Information |
| Relationship Start Date |
|
| Relationship End Date |
|
| Number Of Items In Ndc Package |
|
| Ndc Package Measure |
|
| Ndc Package Type |
|
| Route Of Administration |
|
| Billing Units |
|
|
|
|