| Source HCPCS Code |
|
Target NDC Code |
J0650
INJECTION, LEVOTHYROXINE SODIUM, NOT OTHERWISE SPECIFIED, 10 MCG
|
⇄
|
25021-0468-10
LEVOTHYROXINE SODIUM (PF,LATEX-FREE) 100 MCG
|
| Detail Information |
| Relationship Start Date |
04/01/2024 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0650
INJECTION, LEVOTHYROXINE SODIUM, NOT OTHERWISE SPECIFIED, 10 MCG
|
⇄
|
25021-0469-10
LEVOTHYROXINE SODIUM (PF,LATEX-FREE) 200 MCG
|
| Detail Information |
| Relationship Start Date |
04/01/2024 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0650
INJECTION, LEVOTHYROXINE SODIUM, NOT OTHERWISE SPECIFIED, 10 MCG
|
⇄
|
25021-0470-10
LEVOTHYROXINE SODIUM (PF,LATEX-FREE) 500 MCG
|
| Detail Information |
| Relationship Start Date |
04/01/2024 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0650
INJECTION, LEVOTHYROXINE SODIUM, NOT OTHERWISE SPECIFIED, 10 MCG
|
⇄
|
42023-0201-01
LEVOTHYROXINE SODIUM (SINGLE USE,PF) 100 MCG
|
| Detail Information |
| Relationship Start Date |
04/01/2024 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0650
INJECTION, LEVOTHYROXINE SODIUM, NOT OTHERWISE SPECIFIED, 10 MCG
|
⇄
|
42023-0202-01
LEVOTHYROXINE SODIUM (SINGLE USE,PF) 200 MCG
|
| Detail Information |
| Relationship Start Date |
04/01/2024 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0650
INJECTION, LEVOTHYROXINE SODIUM, NOT OTHERWISE SPECIFIED, 10 MCG
|
⇄
|
42023-0203-01
LEVOTHYROXINE SODIUM (SINGLE USE,PF) 500 MCG
|
| Detail Information |
| Relationship Start Date |
04/01/2024 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0650
Injection, levothyroxine sodium, not otherwise specified, 10 mcg
|
⇄
|
63323-0647-10
LEVOTHYROXINE 200 MCG VIAL
|
| Detail Information |
| Relationship Start Date |
04/01/2024 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0650
Injection, levothyroxine sodium, not otherwise specified, 10 mcg
|
⇄
|
63323-0648-10
LEVOTHYROXINE 500 MCG VIAL
|
| Detail Information |
| Relationship Start Date |
04/01/2024 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0650
Injection, levothyroxine sodium, not otherwise specified, 10 mcg
|
⇄
|
63323-0649-07
LEVOTHYROXINE 100 MCG VIAL
|
| Detail Information |
| Relationship Start Date |
04/01/2024 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0650
INJECTION, LEVOTHYROXINE SODIUM, NOT OTHERWISE SPECIFIED, 10 MCG
|
⇄
|
63323-0649-16
LEVOTHYROXINE SODIUM NOVAPLUS (PF,LATEX-FREE) 100 MCG
|
| Detail Information |
| Relationship Start Date |
04/01/2024 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0650
Injection, levothyroxine sodium, not otherwise specified, 10 mcg
|
⇄
|
63323-0649-94
LEVOTHYROXINE 100 MCG VIAL
|
| Detail Information |
| Relationship Start Date |
04/01/2024 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0650
Injection, levothyroxine sodium, not otherwise specified, 10 mcg
|
⇄
|
66794-0647-02
LEVOTHYROXINE 200 MCG VIAL
|
| Detail Information |
| Relationship Start Date |
04/01/2024 |
| Relationship End Date |
04/02/2024 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0650
Injection, levothyroxine sodium, not otherwise specified, 10 mcg
|
⇄
|
66794-0648-02
LEVOTHYROXINE 500 MCG VIAL
|
| Detail Information |
| Relationship Start Date |
04/01/2024 |
| Relationship End Date |
04/02/2024 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0650
Injection, levothyroxine sodium, not otherwise specified, 10 mcg
|
⇄
|
66794-0649-02
LEVOTHYROXINE 100 MCG VIAL
|
| Detail Information |
| Relationship Start Date |
04/01/2024 |
| Relationship End Date |
04/02/2024 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
UN |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0650
INJECTION, LEVOTHYROXINE SODIUM, NOT OTHERWISE SPECIFIED, 10 MCG
|
⇄
|
70710-1833-01
LEVOTHYROXINE SODIUM LYOPHILIZED 100 MCG
|
| Detail Information |
| Relationship Start Date |
02/06/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0650
INJECTION, LEVOTHYROXINE SODIUM, NOT OTHERWISE SPECIFIED, 10 MCG
|
⇄
|
70710-1834-01
LEVOTHYROXINE SODIUM LYOPHILIZED 200 MCG
|
| Detail Information |
| Relationship Start Date |
02/06/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0650
INJECTION, LEVOTHYROXINE SODIUM, NOT OTHERWISE SPECIFIED, 10 MCG
|
⇄
|
70710-1835-01
LEVOTHYROXINE SODIUM LYOPHILIZED 500 MCG
|
| Detail Information |
| Relationship Start Date |
02/06/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0650
INJECTION, LEVOTHYROXINE SODIUM, NOT OTHERWISE SPECIFIED, 10 MCG
|
⇄
|
70860-0451-10
LEVOTHYROXINE SODIUM (PF,LATEX-FREE) 100 MCG
|
| Detail Information |
| Relationship Start Date |
04/01/2024 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0650
INJECTION, LEVOTHYROXINE SODIUM, NOT OTHERWISE SPECIFIED, 10 MCG
|
⇄
|
70860-0452-10
LEVOTHYROXINE SODIUM (PF,LATEX-FREE) 200 MCG
|
| Detail Information |
| Relationship Start Date |
04/01/2024 |
| Relationship End Date |
04/30/2024 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0650
INJECTION, LEVOTHYROXINE SODIUM, NOT OTHERWISE SPECIFIED, 10 MCG
|
⇄
|
70860-0453-10
LEVOTHYROXINE SODIUM (PF,LATEX-FREE) 500 MCG
|
| Detail Information |
| Relationship Start Date |
04/01/2024 |
| Relationship End Date |
08/31/2024 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0650
INJECTION, LEVOTHYROXINE SODIUM, NOT OTHERWISE SPECIFIED, 10 MCG
|
⇄
|
72266-0261-01
LEVOTHYROXINE SODIUM LYOPHILIZED 100 MCG
|
| Detail Information |
| Relationship Start Date |
09/04/2025 |
| Relationship End Date |
99/99/9999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
EA |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
EA |
|
|
|
J0650
Inj, levothyroxine nos 10mcg
|
⇄
|
70860-0451-10
Levothyroxine Sodium
|
| 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 |
|
|
|
|
J0650
Inj, levothyroxine nos 10mcg
|
⇄
|
70860-0452-10
Levothyroxine Sodium
|
| 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 |
|
|
|
|
J0650
Inj, levothyroxine nos 10mcg
|
⇄
|
70860-0453-10
Levothyroxine Sodium
|
| 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 |
|
|
|
|
J0650
Inj, levothyroxine nos 10mcg
|
⇄
|
42023-0201-01
Levothyroxine Sodium
|
| 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 |
|
|
|
|
J0650
Inj, levothyroxine nos 10mcg
|
⇄
|
42023-0202-01
Levothyroxine Sodium
|
| 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 |
|
|
|
|
J0650
Inj, levothyroxine nos 10mcg
|
⇄
|
42023-0203-01
Levothyroxine Sodium
|
| 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 |
|
|
|
|
J0650
Inj, levothyroxine nos 10mcg
|
⇄
|
72266-0261-01
Levothyroxine Sodium
|
| 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 |
|
|
|
|
J0650
Inj, levothyroxine nos 10mcg
|
⇄
|
63323-0647-10
Levothyroxine Sodium
|
| 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 |
|
|
|
|
J0650
Inj, levothyroxine nos 10mcg
|
⇄
|
63323-0648-10
Levothyroxine Sodium
|
| 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 |
|
|
|
|
J0650
Inj, levothyroxine nos 10mcg
|
⇄
|
63323-0649-07
Levothyroxine Sodium
|
| 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 |
|
|
|
|
J0650
Inj, levothyroxine nos 10mcg
|
⇄
|
63323-0649-16
Levothyroxine Sodium
|
| 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 |
|
|
|
|
J0650
Inj, levothyroxine nos 10mcg
|
⇄
|
63323-0649-94
Levothyroxine Sodium
|
| 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 |
|
|
|
|
J0650
Inj, levothyroxine nos 10mcg
|
⇄
|
25021-0468-10
Levothyroxine Sodium
|
| 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 |
|
|
|
|
J0650
Inj, levothyroxine nos 10mcg
|
⇄
|
25021-0469-10
Levothyroxine Sodium
|
| 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 |
|
|
|
|
J0650
Inj, levothyroxine nos 10mcg
|
⇄
|
25021-0470-10
Levothyroxine Sodium
|
| 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 |
|
|
|
|
J0650
Inj, levothyroxine nos 10mcg
|
⇄
|
70710-1833-01
Levothyroxine Sodium
|
| 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 |
|
|
|
|
J0650
Inj, levothyroxine nos 10mcg
|
⇄
|
70710-1834-01
Levothyroxine Sodium
|
| 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 |
|
|
|
|
J0650
Inj, levothyroxine nos 10mcg
|
⇄
|
70710-1835-01
Levothyroxine Sodium
|
| 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 |
|
|
|
|