| Source HCPCS Code |
|
Target NDC Code |
J0801
Inj, corticotropin (acthar gel), up to 40 units
|
⇄
|
63004-8710-01
HP ACTHAR GEL 80 UNIT/ML VIAL
|
| Detail Information |
| Relationship Start Date |
10/01/2023 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
5 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IJ |
| Billing Units |
ML |
|
|
|
J0801
Injection, corticotropin (acthar gel), up to 40 units
|
⇄
|
63004-8711-01
ACTHAR 80 UNIT/ML SELFJECT
|
| Detail Information |
| Relationship Start Date |
10/01/2023 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
SYRINGE |
| Route Of Administration |
SQ |
| Billing Units |
ML |
|
|
|
J0801
Injection, corticotropin (acthar gel), up to 40 units
|
⇄
|
63004-8711-04
ACTHAR 80 UNIT/ML SELFJECT
|
| Detail Information |
| Relationship Start Date |
10/01/2023 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
4 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
SYRINGE |
| Route Of Administration |
SQ |
| Billing Units |
ML |
|
|
|
J0801
Injection, corticotropin (acthar gel), up to 40 units
|
⇄
|
63004-8712-01
ACTHAR 40 UNIT/0.5 ML SELFJECT
|
| Detail Information |
| Relationship Start Date |
10/01/2023 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
0.5 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
SYRINGE |
| Route Of Administration |
SQ |
| Billing Units |
ML |
|
|
|
J0801
Injection, corticotropin (acthar gel), up to 40 units
|
⇄
|
63004-8712-04
ACTHAR 40 UNIT/0.5 ML SELFJECT
|
| Detail Information |
| Relationship Start Date |
10/01/2023 |
| Relationship End Date |
12/31/3999 |
| Number Of Items In Ndc Package |
2 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
SYRINGE |
| Route Of Administration |
SQ |
| Billing Units |
ML |
|
|
|
J0801
Inj. acthar gel to 40 units
|
⇄
|
63004-8710-01
H.P. Acthar
|
| 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 |
|
|
|
|
J0801
Inj. acthar gel to 40 units
|
⇄
|
63004-8711-04
Acthar Gel
|
| 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 |
|
|
|
|
J0801
Inj. acthar gel to 40 units
|
⇄
|
63004-8712-04
Acthar Gel
|
| 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 |
|
|
|
|