Product attributes as listed by the labeler in the FDA NDC Directory.
FDA pharmacologic class: Nucleic Acid Synthesis Inhibitors [MoA]; Nucleoside Metabolic Inhibitor [EPC]
Also searchable as: Decitabine
Drug codes appear here only when a CMS NDC–HCPCS crosswalk lists at least one of this drug’s NDC packages. CodeRx never assigns a code from the name or ingredient.
Injection, decitabine, 1 mg
Derived: 28 of 34 NDC package(s) for this drug appear in the CMS NDC–HCPCS crosswalk for J0894. CMS quarters Q1 2021 – Q4 2026
J-codes are permanent national codes for drugs and biologicals — most often clinician-administered (buy-and-bill) products paid under Medicare Part B — plus certain immunosuppressive, inhalation (via DME), and oral anticancer/antiemetic drugs. Units are reported in multiples of the dosage in the code descriptor.
Package NDCs from the FDA directory, normalized to the 11-digit 5-4-2 format used on claims.
| 11-digit NDC | FDA NDC | Package description | Strength · form | Labeler | HCPCS · units / NDC | Status |
|---|---|---|---|---|---|---|
| 00143-9385-01 | 0143-9385-01 | 1 VIAL, SINGLE-DOSE in 1 CARTON (0143-9385-01) / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL, SINGLE-DOSE | 50 mg/1Injection, Powder, Lyophilized, For Solution | Hikma Pharmaceuticals USA Inc. | J0894 · 50 units |
One HCPCS billing unit of J0894
1 MG
Medicare payment limit per unit (Q4 2026): $1.098
Billable units per package for each NDC are listed in the NDC packages table above (CMS “BILLUNITSPKG”).
Medicare Part B payment limits for the codes above, then how the home infusion per diem S-codes are paid. Commercial payer rates, AWP, and WAC are not included.
| Quarter | Effective | Payment limit | Per (billing unit) | Coinsurance | Change | CMS notes |
|---|---|---|---|---|---|---|
| Q4 2026 | Oct 1, 2026 – Dec 31, 2026 | $1.098 | 1 MG | 20% | +3.2% |
Medicare coverage is set nationally (NCDs) and by each Medicare Administrative Contractor (LCDs and Billing & Coding articles). These links open the official documents.
Which Medicare benefit pays for this drug?
ICD-10-CM codes that Medicare contractors' Billing and Coding articles list as supporting medical necessity for this drug's HCPCS codes — covered diagnoses, not how often each is used. Washington (Noridian JF) articles come first; other contractors' articles are linked below.
No current Medicare Billing and Coding article lists J0894, J0893.
Quarterly changes to the HCPCS codes linked to this drug.
| Quarterly file | Change | CMS action code | Details |
|---|---|---|---|
| Q1 2023 | In earliest ingested file | P — Payment change | Added date Jan 1, 2007 |
| Quarterly file | Change | CMS action code | Details |
|---|
Disclaimer. This application provides informational coding and reimbursement reference data. It does not constitute legal, clinical, coding, or billing advice. Codes, payment amounts, payer rules, and coverage policies can change. Verify all information with current CMS publications, the applicable payer, and your organization’s compliance policies before submitting a claim. CodeRx is not affiliated with or endorsed by CMS, FDA, Medicare, or any payer.
Injection, decitabine (sun pharma), not therapeutically equivalent to j0894, 1 mg
Derived: 1 of 34 NDC package(s) for this drug appear in the CMS NDC–HCPCS crosswalk for J0893. CMS quarters Q1 2023 – Q1 2026Not in the latest CMS crosswalk.
J-codes are permanent national codes for drugs and biologicals — most often clinician-administered (buy-and-bill) products paid under Medicare Part B — plus certain immunosuppressive, inhalation (via DME), and oral anticancer/antiemetic drugs. Units are reported in multiples of the dosage in the code descriptor.
When a home infusion pharmacy dispenses this drug, the drug is billed with the code above and each day of pharmacy services, supplies, and equipment with a per diem S-code. CMS publishes no drug-to-per-diem crosswalk, so CodeRx picks the therapy category from the FDA pharmacologic class and route. S-codes are not payable by Medicare; confirm the code against the payer contract.
Matched on: Nucleoside Metabolic Inhibitor
Payers use either the general per diem or the detailed codes, not both — follow the contract.
| Listed |
| 00781-3296-80 | 0781-3296-80 | 1 VIAL, SINGLE-DOSE in 1 CARTON (0781-3296-80) / 10 mL in 1 VIAL, SINGLE-DOSE | — | Sandoz Inc | J0894 · 50 units (Q2 2023) | Discontinued by the firm (D) |
|---|
| 16714-0749-01 | 16714-749-01 | 1 VIAL in 1 CARTON (16714-749-01) / 20 mL in 1 VIAL | — | NorthStar RxLLC | J0894 · 50 units (Q3 2022) | Discontinued by the firm (D) |
|---|
| 16714-0928-01 | 16714-928-01 | 1 VIAL, SINGLE-DOSE in 1 CARTON (16714-928-01) / 10 mL in 1 VIAL, SINGLE-DOSE | — | Northstar Rx LLC | J0894 · 50 units (Q4 2024) | Discontinued by the firm (D) |
|---|
| 16729-0224-05 | 16729-224-05 | 1 VIAL in 1 CARTON (16729-224-05) / 20 mL in 1 VIAL | 50 mg/20mLInjection, Powder, Lyophilized, For Solution | Accord Healthcare Inc. | J0894 · 50 units | Listed |
|---|
| 25021-0219-20 | 25021-219-20 | 1 VIAL in 1 CARTON (25021-219-20) / 20 mL in 1 VIAL | 50 mg/20mLInjection, Powder, Lyophilized, For Solution | Sagent Pharmaceuticals | J0894 · 50 units | Listed |
|---|
| 25021-0231-20 | 25021-231-20 | 1 VIAL in 1 CARTON (25021-231-20) / 10 mL in 1 VIAL | — | Sagent Pharmaceuticals | J0894 · 50 units | Discontinued by the firm (D) |
|---|
| 31722-0304-31 | 31722-304-31 | 1 VIAL, SINGLE-DOSE in 1 CARTON (31722-304-31) / 10 mL in 1 VIAL, SINGLE-DOSE | 50 mg/10mLInjection, Powder, Lyophilized, For Solution | Camber Pharmaceuticals, Inc. | Not in CMS crosswalk | Listed |
|---|
| 43598-0348-37 | 43598-348-37 | 1 VIAL, SINGLE-USE in 1 CARTON (43598-348-37) / 10 mL in 1 VIAL, SINGLE-USE | — | Dr. Reddy's Laboratories Inc. | J0894 · 50 units (Q4 2023) | Discontinued by the firm (D) |
|---|
| 43598-0427-37 | 43598-427-37 | 1 VIAL, SINGLE-USE in 1 CARTON (43598-427-37) / 10 mL in 1 VIAL, SINGLE-USE | 50 mg/10mLInjection, Powder, Lyophilized, For Solution | Dr. Reddy's Laboratories Inc. | J0894 · 50 units | Listed |
|---|
| 47335-0361-41 | 47335-361-41 | 1 KIT in 1 CARTON (47335-361-41) * 10 mL in 1 VIAL, SINGLE-DOSE * 10 mL in 1 VIAL (47335-362-40) | —Kit | Sun Pharmaceutical Industries, Inc. | J0893 · 50 units (Q1 2026)J0894 · 50 units (Q4 2022) | Listed |
|---|
| 50742-0430-01 | 50742-430-01 | 1 VIAL in 1 CARTON (50742-430-01) / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL | — | Ingenus Pharmaceuticals, LLC | J0894 · 50 units (Q3 2026) | Discontinued by the firm (D) |
|---|
| 55111-0556-10 | 55111-556-10 | 1 VIAL, SINGLE-USE in 1 CARTON (55111-556-10) / 10 mL in 1 VIAL, SINGLE-USE | 50 mg/10mLInjection, Powder, Lyophilized, For Solution | Dr.Reddy's Laboratories Limited | J0894 · 50 units | Listed |
|---|
| 55150-0376-01 | 55150-376-01 | 1 VIAL, SINGLE-DOSE in 1 CARTON (55150-376-01) / 26 mL in 1 VIAL, SINGLE-DOSE | 50 mg/26mLInjection, Powder, Lyophilized, For Solution | Eugia US LLC | J0894 · 50 units | Listed |
|---|
| 63323-0825-20 | 63323-825-20 | 1 VIAL, SINGLE-DOSE in 1 CARTON (63323-825-20) / 20 mL in 1 VIAL, SINGLE-DOSE | — | Fresenius Kabi USA, LLC | J0894 · 50 units (Q4 2023) | Discontinued by the firm (D) |
|---|
| 67184-0535-01 | 67184-0535-1 | 1 VIAL in 1 CARTON (67184-0535-1) / 20 mL in 1 VIAL | 50 mg/20mLInjection, Powder, Lyophilized, For Solution | Qilu Pharmaceutical Co., Ltd. | Not in CMS crosswalk | Listed |
|---|
| 67457-0316-25 | 67457-316-25 | 1 VIAL in 1 CARTON (67457-316-25) / 20 mL in 1 VIAL | 50 mg/20mLInjection, Powder, Lyophilized, For Solution | Mylan Institutional LLC | J0894 · 50 units | Listed |
|---|
| 68001-0422-37 | 68001-422-37 | 1 VIAL, SINGLE-USE in 1 CARTON (68001-422-37) / 20 mL in 1 VIAL, SINGLE-USE | — | BluePoint Laboratories | J0894 · 50 units (Q1 2026) | Discontinued by the firm (D) |
|---|
| 68001-0573-41 | 68001-573-41 | 1 VIAL in 1 CARTON (68001-573-41) / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL | — | BluePoint Laboratories | J0894 · 50 units | Discontinued by the firm (D) |
|---|
| 68001-0618-37 | 68001-618-37 | 1 VIAL in 1 CARTON (68001-618-37) / 20 mL in 1 VIAL | 50 mg/20mLInjection, Powder, Lyophilized, For Solution | BluePoint Laboratories | J0894 · 50 units | Listed |
|---|
| 68001-0642-41 | 68001-642-41 | 1 VIAL, SINGLE-DOSE in 1 CARTON (68001-642-41) / 10 mL in 1 VIAL, SINGLE-DOSE | 50 mg/10mLInjection, Powder, Lyophilized, For Solution | BluePoint Laboratories | J0894 · 50 units | Listed |
|---|
| 68001-0713-37 | 68001-713-37 | 1 VIAL, SINGLE-DOSE in 1 CARTON (68001-713-37) / 10 mL in 1 VIAL, SINGLE-DOSE | 50 mg/10mLInjection, Powder, Lyophilized, For Solution | BluePoint Laboratories | Not in CMS crosswalk | Listed |
|---|
| 68083-0528-01 | 68083-528-01 | 1 VIAL, SINGLE-DOSE in 1 CARTON (68083-528-01) / 10 mL in 1 VIAL, SINGLE-DOSE | 50 mg/10mLInjection, Powder, Lyophilized, For Solution | Gland Pharma Limited | Not in CMS crosswalk | Listed |
|---|
| 69097-0285-37 | 69097-285-37 | 1 VIAL, SINGLE-USE in 1 CARTON (69097-285-37) / 10 mL in 1 VIAL, SINGLE-USE | — | Cipla USA Inc. | J0894 · 50 units (Q4 2024) | Discontinued by the firm (D) |
|---|
| 69097-0905-67 | 69097-905-67 | 1 VIAL, SINGLE-USE in 1 CARTON (69097-905-67) / 10 mL in 1 VIAL, SINGLE-USE | — | Cipla USA Inc. | J0894 · 50 units | Discontinued by the firm (D) |
|---|
| 70121-1644-01 | 70121-1644-1 | 1 VIAL, SINGLE-USE in 1 CARTON (70121-1644-1) / 20 mL in 1 VIAL, SINGLE-USE | 50 mg/20mLInjection, Powder, Lyophilized, For Solution | Amneal Pharmaceuticals LLC | J0894 · 50 units (Q1 2025) | Listed |
|---|
| 70860-0219-20 | 70860-219-20 | 1 VIAL, SINGLE-DOSE in 1 CARTON (70860-219-20) / 20 mL in 1 VIAL, SINGLE-DOSE | — | Athenex Pharmaceutical Division, LLC. | J0894 · 50 units | Discontinued by the firm (D) |
|---|
| 71288-0119-20 | 71288-119-20 | 1 VIAL, SINGLE-DOSE in 1 CARTON (71288-119-20) / 20 mL in 1 VIAL, SINGLE-DOSE | 50 mg/20mLInjection, Powder, Lyophilized, For Solution | Meitheal Pharmaceuticals Inc. | J0894 · 50 units | Listed |
|---|
| 71288-0119-91 | 71288-119-91 | 1 VIAL, SINGLE-DOSE in 1 CARTON (71288-119-91) / 20 mL in 1 VIAL, SINGLE-DOSE | 50 mg/20mLInjection, Powder, Lyophilized, For Solution | Meitheal Pharmaceuticals Inc. | Not in CMS crosswalk | Listed |
|---|
| 72162-2634-02 | 72162-2634-2 | 1 VIAL, SINGLE-USE in 1 CARTON (72162-2634-2) / 20 mL in 1 VIAL, SINGLE-USE | 50 mg/10mLInjection, Powder, Lyophilized, For Solution | Bryant Ranch Prepack | Not in CMS crosswalk | Listed |
|---|
| 72205-0031-01 | 72205-031-01 | 1 VIAL, SINGLE-USE in 1 CARTON (72205-031-01) / 20 mL in 1 VIAL, SINGLE-USE | 50 mg/10mLInjection, Powder, Lyophilized, For Solution | Novadoz Pharmaceuticals LLC | J0894 · 50 units | Listed |
|---|
| 72205-0036-01 | 72205-036-01 | 1 VIAL, SINGLE-DOSE in 1 CARTON (72205-036-01) / 10 mL in 1 VIAL, SINGLE-DOSE | 50 mg/10mLInjection, Powder, Lyophilized, For Solution | Novadoz Pharmaceuticals LLC | J0894 · 50 units | Listed |
|---|
| 72603-0107-01 | 72603-107-01 | 1 VIAL, SINGLE-DOSE in 1 CARTON (72603-107-01) / 10 mL in 1 VIAL, SINGLE-DOSE | 50 mg/10mLInjection, Powder, Lyophilized, For Solution | Northstar Rx LLC | J0894 · 50 units | Listed |
|---|
| 75834-0190-01 | 75834-190-01 | 1 VIAL in 1 CARTON (75834-190-01) / 20 mL in 1 VIAL | 50 mg/20mLInjection, Powder, Lyophilized, For Solution | Nivagen Pharmaceuticals, Inc. | J0894 · 50 units | Listed |
|---|
| — |
| Q3 2026 | Jul 1, 2026 – Sep 30, 2026 | $1.064 | 1 MG | 20% | +6.3% | — |
|---|
| Q2 2026 | Apr 1, 2026 – Jun 30, 2026 | $1.001 | 1 MG | 20% | +54.5% | — |
|---|
| Q1 2026 | Jan 1, 2026 – Mar 31, 2026 | $0.648 | 1 MG | 20% | −46.8% | — |
|---|
| Q4 2025 | Oct 1, 2025 – Dec 31, 2025 | $1.218 | 1 MG | 20% | −23.5% | — |
|---|
| Q3 2025 | Jul 1, 2025 – Sep 30, 2025 | $1.592 | 1 MG | 20% | −9.8% | — |
|---|
| Q2 2025 | Apr 1, 2025 – Jun 30, 2025 | $1.765 | 1 MG | 20% | −24.4% | — |
|---|
| Q1 2025 | Jan 1, 2025 – Mar 31, 2025 | $2.334 | 1 MG | 20% | +43.2% | — |
|---|
| Q4 2024 | Oct 1, 2024 – Dec 31, 2024 | $1.630 | 1 MG | 20% | +13.9% | — |
|---|
| Q3 2024 | Jul 1, 2024 – Sep 30, 2024 | $1.431 | 1 MG | 20% | −12.8% | — |
|---|
| Q2 2024 | Apr 1, 2024 – Jun 30, 2024 | $1.641 | 1 MG | 20% | −3.1% | — |
|---|
| Q1 2024 | Jan 1, 2024 – Mar 31, 2024 | $1.694 | 1 MG | 20% | +47.7% | — |
|---|
| Q4 2023 | Oct 1, 2023 – Dec 31, 2023 | $1.147 | 1 MG | 20% | −42.6% | — |
|---|
| Q3 2023 | Jul 1, 2023 – Sep 30, 2023 | $2.000 | 1 MG | 20% | −17.5% | — |
|---|
| Q2 2023 | Apr 1, 2023 – Jun 30, 2023 | $2.425 | 1 MG | 20% | +90.0% | — |
|---|
| Q1 2023 | Jan 1, 2023 – Mar 31, 2023 | $1.276 | 1 MG | — | −9.8% | — |
|---|
| Q4 2022 | Oct 1, 2022 – Dec 31, 2022 | $1.415 | 1 MG | — | −10.7% | — |
|---|
| Q3 2022 | Jul 1, 2022 – Sep 30, 2022 | $1.585 | 1 MG | — | −41.6% | — |
|---|
| Q2 2022 | Apr 1, 2022 – Jun 30, 2022 | $2.713 | 1 MG | — | −5.9% | — |
|---|
| Q1 2022 | Jan 1, 2022 – Mar 31, 2022 | $2.883 | 1 MG | — | −15.8% | — |
|---|
| Q4 2021 | Oct 1, 2021 – Dec 31, 2021 | $3.426 | 1 MG | — | −17.8% | — |
|---|
| Q3 2021 | Jul 1, 2021 – Sep 30, 2021 | $4.166 | 1 MG | — | +20.3% | — |
|---|
| Q2 2021 | Apr 1, 2021 – Jun 30, 2021 | $3.463 | 1 MG | — | +1.1% | — |
|---|
| Q1 2021 | Jan 1, 2021 – Mar 31, 2021 | $3.426 | 1 MG | — | — | — |
|---|
| Quarter | Effective | Payment limit | Per (billing unit) | Coinsurance | Change | CMS notes |
|---|---|---|---|---|---|---|
| Q1 2026 | Jan 1, 2026 – Mar 31, 2026 | $0.777 | 1 MG | 20% | +0.0% | — |
| Q4 2025 | Oct 1, 2025 – Dec 31, 2025 | $0.777 | 1 MG | 20% | +0.0% | — |
| Q3 2025 | Jul 1, 2025 – Sep 30, 2025 | $0.777 | 1 MG | 20% | +0.0% | — |
| Q2 2025 | Apr 1, 2025 – Jun 30, 2025 | $0.777 | 1 MG | 20% | +0.0% | Added April 2025 |
| Q1 2024 | Jan 1, 2024 – Mar 31, 2024 | $0.777 | 1 MG | 20% | −63.3% | — |
| Q4 2023 | Oct 1, 2023 – Dec 31, 2023 | $2.120 | 1 MG | 20% | −5.4% | — |
| Q3 2023 | Jul 1, 2023 – Sep 30, 2023 | $2.240 | 1 MG | 20% | +19.1% | — |
| Q2 2023 | Apr 1, 2023 – Jun 30, 2023 | $1.881 | 1 MG | 20% | +19.4% | — |
| Q1 2023 | Jan 1, 2023 – Mar 31, 2023 | $1.576 | 1 MG | — | — | Added January 2023 |
| Code | Description (CMS) | Max fee · Non-rural | Max fee · Rural | PA / EPA | HCA comments |
|---|---|---|---|---|---|
| A4220 | Infusion pump refill kit | $24.61 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
| A4221 | Supp non-insulin inf cath/wk | $24.96 | N/A | — | — |
| A4222 | Infusion supplies with pump | $47.35 | N/A | — | — |
| A4223 | Infusion supplies w/o pump | BR* | N/A | — | *Please see 2nd Tab for Requirements |
Maximum allowable fees as published by HCA, per billing unit of each code. BR = by report (invoice required); DP = covered under another program (see comments); N/A = no separate rate for that area. HCA pays the lesser of the provider’s usual charge and the maximum allowable fee (WAC 182-553).
How Medicare pays for home infusion instead
Medicare pays no per diem. Under its home infusion therapy services benefit, a qualified home infusion supplier is paid per infusion day, and only for drugs given through a Medicare-covered external infusion pump:
Verification neededCodeRx links to coverage documents instead of copying them: CMS distributes their code lists under AMA, ADA, and AHA license terms that limit reuse. Medicare Advantage, Medicaid, and commercial plans set their own coverage and prior-authorization rules.
| Q3 2024 | Descriptor changed | C — Long description changed | Now: Injection, decitabine (sun pharma), not therapeutically equivalent to j0894, 1 mgBefore: Injection, decitabine (sun pharma) not therapeutically equivalent to j0894, 1 mg |
|---|---|---|---|
| Q3 2024 | Dates changed | C — Long description changed | Added Jan 1, 2023 · action effective Jul 1, 2024 · termination — |
| Q1 2024 | Dates changed | P — Payment change | Added Jan 1, 2023 · action effective Jan 1, 2024 · termination — |
| Q1 2023 | In earliest ingested file | A — Added | Added date Jan 1, 2023 |
Every import with its checksum is listed on the data sources page.
| A4224 | Supply insulin inf cath/wk | $24.96 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| A4225 | Sup/ext insulin inf pump syr | $3.35 | N/A | — | — |
|---|
| A4230 | Infus insulin pump non needl | $201.45 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| A4231 | Infusion insulin pump needle | $134.29 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| A4232 | Syringe w/needle insulin 3cc | $79.14 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| A4238 | Adju cgm supply allowance | $270.89 | N/A | EPA | Invoice Required/See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| A4239 | Non-adju cgm supply allow | $263.72 | N/A | EPA | Limit: 1 unit/month - See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| A4246 | Betadine/phisohex solution | $2.87 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| A4247 | Betadine/iodine swabs/wipes | $4.55 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| A4602 | Replace lithium battery 1.5v | $5.31 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| A4927 | Non-sterile gloves | DP | N/A | PA - Exceptions to Max | Please see Medical Equipment Fee Schedule for rates |
|---|
| A4930 | Sterile, gloves per pair | DP | N/A | — | Please see Medical Equipment Fee Schedule for rates |
|---|
| A9276 | Disposable sensor, cgm sys | BR | N/A | PA/EPA | Invoice Required/See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| A9277 | External transmitter, cgm | BR | N/A | PA/EPA | invoice required |
|---|
| A9278 | External receiver, cgm sys | BR | N/A | PA/EPA | Invoice Required/See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| B4164 | Parenteral 50% dextrose solu | $18.8947 | N/A | — | — |
|---|
| B4168 | Parenteral sol amino acid 3. | $27.5508 | N/A | — | — |
|---|
| B4172 | Parenteral sol amino acid 5. | $31.74 | N/A | — | — |
|---|
| B4176 | Parenteral sol amino acid 7- | $53.3162 | N/A | — | — |
|---|
| B4178 | Parenteral sol amino acid > | $63.9988 | N/A | — | — |
|---|
| B4180 | Parenteral sol carb > 50% | $27.1261 | N/A | — | — |
|---|
| B4185 | Pn soln nos 10 grams lipids | $12.4967 | N/A | — | — |
|---|
| B4189 | Parenteral sol amino acid & | $197.7092 | N/A | — | — |
|---|
| B4193 | Parenteral sol 52-73 gm prot | $255.4644 | N/A | — | — |
|---|
| B4197 | Parenteral sol 74-100 gm pro | $311.0195 | N/A | — | — |
|---|
| B4199 | Parenteral sol > 100gm prote | $355.3902 | N/A | — | — |
|---|
| B4216 | Parenteral nutrition additiv | $8.5885 | N/A | — | — |
|---|
| B4220 | Parenteral supply kit premix | $8.907 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| B4222 | Parenteral supply kit homemi | $10.9817 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| B4224 | Parenteral administration ki | $27.8113 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| B5000 | Parenteral sol renal-amirosy | $13.2205 | N/A | — | — |
|---|
| B5100 | Parenteral solution hepatic | $5.1627 | N/A | — | — |
|---|
| B9004-NU | Parenteral infus pump portab | $2,806.3937 | N/A | — | — |
|---|
| B9004-RR | Parenteral infus pump portab | $444.257 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| B9006-NU | Parenteral infus pump statio | $2,806.3937 | N/A | — | — |
|---|
| B9006-RR | Parenteral infus pump statio | $444.257 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| B9999 | Parenteral supp not othrws c | BR | N/A | PA | invoice required |
|---|
| E0776-NU | Iv pole | $177.29 | N/A | — | — |
|---|
| E0776-RR | Iv pole | $17.73 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| E0779-RR | Amb infusion pump mechanical | $23.00 | $23.00 | — | — |
|---|
| E0780-NU | Mech amb infusion pump <8hrs | $14.26 | N/A | — | — |
|---|
| E0781-RR | External ambulatory infus pu | $298.50 | $331.38 | — | — |
|---|
| E0784-RR | Ext amb infusn pump insulin | $538.23 | $556.19 | PA | For Omnipod See Pharmacy Benefit/See Home Infusion & Parenteral Nutrion Billing Guide fo rDetails |
|---|
| E0791-RR | Parenteral infusion pump sta | $354.62 | $394.73 | — | — |
|---|
| E1399 | Durable medical equipment mi | BR | N/A | PA | Invoice Required |
|---|
| E2102-NU | Adju cgm receiver/monitor | $226.32 | N/A | EPA | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| E2102-RR | Adju cgm receiver/monitor | $22.63 | N/A | EPA | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| E2102-UE | Adju cgm receiver/monitor | $169.75 | N/A | EPA | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| E2103 | Non-adju cgm receiver/mon | $290.73 | N/A | EPA | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| K0601 | Repl batt silver oxide 1.5 v | $1.52 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| K0602 | Repl batt silver oxide 3 v | $8.57 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| K0603 | Repl batt alkaline 1.5 v | $0.77 | N/A | — | See Home Infusion & Parenteral Nutrition Billing Guide for Details |
|---|
| K0604 | Repl batt lithium 3.6 v | $8.26 | N/A | — | — |
|---|
| K0605 | Repl batt lithium 4.5 v | $19.73 | N/A | — | — |
|---|
| K0739 | Repair/svc dme non-oxygen eq | $30.90 | N/A | PA | — |
|---|