| Source HCPCS Code |
|
Target NDC Code |
J1599
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), NOT OTHERWISE SPECIFIED, 500 MG
|
⇄
|
00069-1011-02
PANZYGA (PF,LATEX-FREE) 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
08/07/2019 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
10 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BO |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
IVIG NON-LYOPHILIZED, NOS
|
⇄
|
00069-1109-01
PANZYGA 10% (2.5 G/25 ML) V
|
| Detail Information |
| Relationship Start Date |
01/01/2023 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
25 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), NOT OTHERWISE SPECIFIED, 500 MG
|
⇄
|
00069-1109-02
PANZYGA (PF,LATEX-FREE) 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
08/07/2019 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
25 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BO |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
IVIG NON-LYOPHILIZED, NOS
|
⇄
|
00069-1224-01
PANZYGA 10% (5 G/50 ML) VIA
|
| Detail Information |
| Relationship Start Date |
01/01/2023 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
50 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), NOT OTHERWISE SPECIFIED, 500 MG
|
⇄
|
00069-1224-02
PANZYGA (PF,LATEX-FREE) 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
08/07/2019 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
50 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BO |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
IVIG NON-LYOPHILIZED, NOS
|
⇄
|
00069-1312-01
PANZYGA 10% (10 G/100 ML) V
|
| Detail Information |
| Relationship Start Date |
01/01/2023 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
100 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), NOT OTHERWISE SPECIFIED, 500 MG
|
⇄
|
00069-1312-02
PANZYGA (PF,LATEX-FREE) 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
08/07/2019 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
100 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BO |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
IVIG NON-LYOPHILIZED, NOS
|
⇄
|
00069-1415-01
PANZYGA 10% (20 G/200 ML) V
|
| Detail Information |
| Relationship Start Date |
01/01/2023 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
200 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), NOT OTHERWISE SPECIFIED, 500 MG
|
⇄
|
00069-1415-02
PANZYGA (PF,LATEX-FREE) 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
08/07/2019 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
200 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BO |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
IVIG NON-LYOPHILIZED, NOS
|
⇄
|
00069-1558-01
PANZYGA 10% (30 G/300 ML) V
|
| Detail Information |
| Relationship Start Date |
01/01/2023 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
300 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), NOT OTHERWISE SPECIFIED, 500 MG
|
⇄
|
00069-1558-02
PANZYGA (PF,LATEX-FREE) 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
08/07/2019 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
300 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BO |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), NOT OTHERWISE SPECIFIED, 500 MG
|
⇄
|
64208-8234-01
GAMMAPLEX (1X50ML,SINGLE USE) 2.5 GM/50 ML
|
| Detail Information |
| Relationship Start Date |
1/1/2011 |
| Relationship End Date |
12/31/2011 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), NOT OTHERWISE SPECIFIED, 500 MG
|
⇄
|
64208-8234-02
GAMMAPLEX (1X100ML,SINGLE USE) 5 GM/ 100 ML
|
| Detail Information |
| Relationship Start Date |
1/1/2011 |
| Relationship End Date |
12/31/2011 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), NOT OTHERWISE SPECIFIED, 500 MG
|
⇄
|
64208-8234-03
GAMMAPLEX (1X200ML,SINGLE USE) 10 GM/ 200 ML
|
| Detail Information |
| Relationship Start Date |
1/1/2011 |
| Relationship End Date |
12/31/2011 |
| Number Of Items In Ndc Package |
1 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), NOT OTHERWISE SPECIFIED, 500 MG
|
⇄
|
68982-0820-01
PANZYGA (PF,LATEX-FREE) 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
11/12/2018 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
10 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BO |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), NOT OTHERWISE SPECIFIED, 500 MG
|
⇄
|
68982-0820-02
PANZYGA (PF,LATEX-FREE) 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
11/12/2018 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
25 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BO |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), NOT OTHERWISE SPECIFIED, 500 MG
|
⇄
|
68982-0820-03
PANZYGA (PF,LATEX-FREE) 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
11/12/2018 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
50 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BO |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), NOT OTHERWISE SPECIFIED, 500 MG
|
⇄
|
68982-0820-04
PANZYGA (PF,LATEX-FREE) 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
11/12/2018 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
100 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BO |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), NOT OTHERWISE SPECIFIED, 500 MG
|
⇄
|
68982-0820-05
PANZYGA (PF,LATEX-FREE) 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
11/12/2018 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
200 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BO |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), NOT OTHERWISE SPECIFIED, 500 MG
|
⇄
|
68982-0820-06
PANZYGA (PF,LATEX-FREE) 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
11/12/2018 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
300 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
BO |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), NOT OTHERWISE SPECIFIED, 500 MG
|
⇄
|
68982-0822-01
PANZYGA (CARTON,PF,LATEX-FREE) 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
07/01/2021 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
10 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), NOT OTHERWISE SPECIFIED, 500 MG
|
⇄
|
68982-0822-02
PANZYGA (CARTON,PF,LATEX-FREE) 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
07/01/2021 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
25 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), NOT OTHERWISE SPECIFIED, 500 MG
|
⇄
|
68982-0822-03
PANZYGA (CARTON,PF,LATEX-FREE) 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
07/01/2021 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
50 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), NOT OTHERWISE SPECIFIED, 500 MG
|
⇄
|
68982-0822-04
PANZYGA (CARTON,PF,LATEX-FREE) 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
07/01/2021 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
100 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), NOT OTHERWISE SPECIFIED, 500 MG
|
⇄
|
68982-0822-05
PANZYGA (CARTON,PF,LATEX-FREE) 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
07/01/2021 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
200 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), NOT OTHERWISE SPECIFIED, 500 MG
|
⇄
|
68982-0822-06
PANZYGA (CARTON,PF,LATEX-FREE) 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
07/01/2021 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
300 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
IVIG NON-LYOPHILIZED, NOS
|
⇄
|
68982-0822-82
PANZYGA 10% (2.5 G/25 ML) V
|
| Detail Information |
| Relationship Start Date |
11/26/2018 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
25 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
IVIG NON-LYOPHILIZED, NOS
|
⇄
|
68982-0822-83
PANZYGA 10% (5 G/50 ML) VIA
|
| Detail Information |
| Relationship Start Date |
11/26/2018 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
50 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
IVIG NON-LYOPHILIZED, NOS
|
⇄
|
68982-0822-84
PANZYGA 10% (10 G/100 ML) V
|
| Detail Information |
| Relationship Start Date |
11/26/2018 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
100 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
IVIG NON-LYOPHILIZED, NOS
|
⇄
|
68982-0822-85
PANZYGA 10% (20 G/200 ML) V
|
| Detail Information |
| Relationship Start Date |
11/26/2018 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
200 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
IVIG NON-LYOPHILIZED, NOS
|
⇄
|
68982-0822-86
PANZYGA 10% (30 G/300 ML) V
|
| Detail Information |
| Relationship Start Date |
11/26/2018 |
| Relationship End Date |
06/30/2023 |
| Number Of Items In Ndc Package |
300 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
VIAL |
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), NOT OTHERWISE SPECIFIED, 500 MG
|
⇄
|
83372-0605-01
Yimmugo SDV, 5GM IN 50ML 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
03/01/2025 |
| Relationship End Date |
03/31/2026 |
| Number Of Items In Ndc Package |
50 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), NOT OTHERWISE SPECIFIED, 500 MG
|
⇄
|
83372-0605-11
Yimmugo SDV, 10GM IN 100ML 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
03/01/2025 |
| Relationship End Date |
03/31/2026 |
| Number Of Items In Ndc Package |
100 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|
J1599
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), NOT OTHERWISE SPECIFIED, 500 MG
|
⇄
|
83372-0605-21
Yimmugo SDV, 20GM IN 200ML 100 MG/1 ML
|
| Detail Information |
| Relationship Start Date |
03/01/2025 |
| Relationship End Date |
03/31/2026 |
| Number Of Items In Ndc Package |
200 |
| Ndc Package Measure |
ML |
| Ndc Package Type |
|
| Route Of Administration |
IV |
| Billing Units |
ML |
|
|
|