Medicare Part B Competitive Acquisition Program (CAP) 2008 Drug List Bioscrip, Inc. Vendor Identification (VIN): Q103 January 1, 2008 Update – additions and changes are indicated by light blue highlight and a double asterisk (**). When used as a part of Medicare claims, NDCs must be submitted in a HIPAA compliant format.
HCPCS CAP NDCs Long Description **Not currently available. Please
J0128 contact vendor for ABARELIX INJECTION, 10 MG information about availability.
00703-8771-03 00703-8773-01
J0150 55390-0067-10 55390-0068-01
INJECTION, ADENOSINE FOR THERAPEUTIC USE, 6 MG
63323-0651-02 63323-0651-04
J0152 00469-0871-20 00469-0871-30 INJECTION, ADENOSINE FOR DIAGNOSTIC USE, 30 MG
00409-4901-18 00409-4921-34 00409-7241-01
J0170 00548-1014-00 00548-1016-00 INJECTION, ADRENALIN, EPINEPHRINE, 1 ML AMPULE
00548-2016-00 00548-3316-00 00548-9061-00
J0180 58468-0040-01 58468-0041-01 AGALSIDASE BETA INJECTION, 1 MG
J0207 58178-0017-03 INJECTION, AMIFOSTINE, 500 MG
J0215 59627-0021-03 59627-0021-04 INJECTION, ALEFACEPT, 0.5 MG
CAP Jan 2007 NDC Update Page 1 of 24
HCPCS CAP NDCs Long Description
J0278
00409-1955-01 00409-1956-01 00703-9032-03 00703-9040-03 55390-0225-02 55390-0226-02 55390-0226-04
AMIKACIN, 100MG
J0280
00409-5921-01 00409-5922-01 00409-7385-01 00409-7386-01 00517-3810-25 00517-3820-25
INJECTION, AMINOPHYLLIN, 250 MG
J0290
00781-3408-95 63323-0387-10 63323-0388-10 63323-0389-10 63323-0399-23
INJECTION, AMPICILLIN SODIUM, 500 MG
J0475 58281-0560-01 58281-0561-02 58281-0563-01
INJECTION, BACLOFEN, 10 MG
J0540 61570-0140-10 61570-0141-10
INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, 1,200,000 UNITS
J0550 61570-0142-10 61570-0144-10
INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, 2,400,000 UNITS
J0570 61570-0147-10 **60793-0701-10
INJECTION, PENICILLIN G BENZATHINE, 1,200,000 UNITS
J0585 00023-1145-01 BOTULINUM TOXIN TYPE A, PER UNIT
J0587 10454-0710-10 10454-0711-10 59075-0712-10
BOTULINUM TOXIN TYPE B, PER 100 UNITS
J0600 00089-0510-06 INJECTION, EDETATE CALCIUM DISODIUM, 1000 MG
J0637 00006-3822-10 00006-3823-10 INJECTION, CASPOFUNGIN ACETATE, 5 MG
CAP Jan 2007 NDC Update Page 2 of 24
HCPCS CAP NDCs Long Description
J0640
00703-5140-01 00703-5145-01 55390-0009-01 55390-0051-10 55390-0052-10 55390-0053-01 55390-0054-01
INJECTION, LEUCOVORIN CALCIUM, PER 50 MG
J0670
00074-1038-50 00074-1041-30 00074-1067-20 00074-2047-50 00186-0410-01 00186-0412-01 00186-0418-01 00186-0420-01 00186-0422-01
INJECTION, MEPIVACAINE HYDROCHLORIDE, PER 10 ML
J0690
00074-4732-03 00143-9923-90 00143-9924-90 00591-2365-69 00591-2366-68 00781-3157-96 00781-3346-95 10019-0610-01 10019-0611-03 63323-0236-10 63323-0237-10 63323-0238-61 63323-0446-61 66860-0001-03 66860-0002-03 66860-0003-02
INJECTION, CEFAZOLIN SODIUM, 500 MG
J0692
51479-0053-10 51479-0054-10 51479-0054-20 51479-0054-30 51479-0055-10 51479-0055-20 51479-0055-30
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
CAP Jan 2007 NDC Update Page 3 of 24
HCPCS CAP NDCs Long Description
00409-7332-01 00409-7333-04 00409-7335-03 00409-7336-04 00409-7337-01 00409-7338-01 00781-3206-95 00781-3207-95 00781-3208-95 00781-3209-95 00781-3210-46 10019-0685-01
J0696 10019-0686-02 INJECTION, CEFTRIAXONE SODIUM, PER 250 MG 10019-0687-03 10019-0688-04 60505-0679-05 60505-0750-04 60505-0751-04 60505-0752-04 60505-0753-04 63323-0344-10 63323-0345-10 63323-0346-10 63323-0347-20 63323-0348-61
00039-0017-10 00039-0018-10 00039-0018-11 00039-0018-25 00039-0018-50 00039-0019-10 00039-0019-11 00039-0019-25 00039-0019-50
J0698 00039-0020-01 INJECTION, CEFOTAXIME SODIUM, PER GM 00039-0023-25 00039-0023-50 00039-0024-25 00039-0024-50 63323-0331-15 63323-0332-15 63323-0333-61 63323-0334-61 63323-0335-10
CAP Jan 2007 NDC Update Page 4 of 24
HCPCS CAP NDCs Long Description
J0702 00085-0566-05 INJECTION, BETAMETHASONE ACETATE & BETAMETHASONE SODIUM PHOSPHATE, PER 3 MG
J0704
Not currently available. Please contact vendor for information about availability.
INJECTION, BETAMETHASONE SODIUM PHOSPHATE, PER 4 MG
J0735 66591-0965-41 66591-0975-41 INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG
J0800 63004-7731-01 INJECTION, CORTICOTROPIN, 40 UNITS
J0878 67919-0011-01 DAPTOMYCIN INJECTION, 1 MG
CAP Jan 2007 NDC Update Page 5 of 24
HCPCS CAP NDCs Long Description
J0881
55513-0002-04 55513-0003-04 55513-0004-04 55513-0005-04 55513-0006-01 55513-0010-04 55513-0011-04 55513-0012-04 55513-0013-04 55513-0014-01 55513-0015-01 55513-0021-04 55513-0023-04 55513-0025-04 55513-0027-04 55513-0028-01 55513-0032-01 55513-0037-04 55513-0039-04 55513-0041-04 55513-0043-04 55513-0044-01 55513-0046-01 55513-0048-01 55513-0053-04 55513-0054-04 55513-0057-04 55513-0058-04 55513-0110-01 55513-0111-01 55513-037-04 55513-039-04 55513-041-04 55513-043-04 55513-044-01 55513-046-01 55513-048-01
INJECTION, DARBEPOETIN ALFA, 1 MCG (NON-ESRD USE)
59676-0302-01 59676-0302-02 59676-0303-01 59676-0303-02
J0885 59676-0304-01 59676-0304-02 59676-0310-01
INJECTION, EPOETIN ALPHA, (FOR NON ESRD USE), PER 1000 UNITS
59676-0310-02 59676-0312-01 59676-0320-01 59676-0340-01
J0894 58063-0600-50 INJECTION, DECITABINE, 1MG
CAP Jan 2007 NDC Update Page 6 of 24
HCPCS CAP NDCs Long Description
J0895 00409-2336-10 00409-2337-25 INJECTION, DEFEROXAMINE MESYLATE, 500 MG
J1000 00009-0271-01 INJECTION, DEPO-ESTRADIOL CYPIONATE, 5 MG
J1020 00009-0274-01 INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG
00009-0280-02 00009-0280-03 00009-0280-51
J1030 00009-0280-52 00009-3073-01 INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
00009-3073-03 00703-0031-04
00009-0306-02
J1040 00009-0306-12 00703-0051-01 INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
00703-0051-04
J1051 00009-0626-01 INJECTION, MEDROXYPROGESTERONE ACETATE, 50 MG
Not currently available. Please
J1094 contact vendor for INJECTION, DEXAMETHASONE ACETATE, 1 MG information about availability.
00517-4901-25 00517-4905-25 00641-0367-25
J1100 63323-0165-01 63323-0165-05
INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG
63323-0165-30 63323-0506-01 63323-0516-10
J1190 55390-0014-02 55390-0060-02
INJECTION, DEXRAZOXANE HYDROCHLORIDE, PER 250 MG
J1200 00409-2290-31 00641-0376-25 INJECTION, DIPHENHYDRAMINE HCL, 50 MG
00433-0433-05 J1212 67457-0145-50 INJECTION, DMSO, DIMETHYL SULFOXIDE, 50%, 50 ML
**67457-0177-50
CAP Jan 2007 NDC Update Page 7 of 24
HCPCS CAP NDCs Long Description
J1245 55390-0555-90 INJECTION, DIPYRIDAMOLE, PER 10 MG
J1250 00409-2025-54 55390-0560-90
INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG
J1260 00088-1206-32 00088-1209-26 INJECTION, DOLASETRON MESYLATE, 10 MG
J1335 00006-3843-71 INJECTION, ERTAPENEM SODIUM, 500 MG
J1440 55513-0530-10 55513-0924-10 INJECTION, FILGRASTIM (G-CSF), 300 MCG
J1441 55513-0209-10 55513-0546-10 INJECTION, FILGRASTIM (G-CSF), 480 MCG
J1450
00703-1019-09 55390-0012-01 55390-0046-01 59762-5035-02 59762-5036-02 59762-5037-02 61703-0414-63 61703-0414-64
INJECTION FLUCONAZOLE, 200 MG
J1580
00074-3402-01 00409-1207-03 63323-0010-02 63323-0010-20 63323-0513-02
INJECTION, GARAMYCIN, GENTAMICIN, 80 MG
J1600
11098-0533-01 11098-0533-10 66758-0011-02 66758-0011-03
INJECTION, GOLD SODIUM THIOMALATE, 50 MG
J1626 00004-0239-09 00004-0240-09 00004-0242-08
INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG
CAP Jan 2007 NDC Update Page 8 of 24
HCPCS CAP NDCs Long Description
J1631
00703-7011-03 00703-7013-01 00703-7021-03 00703-7023-01 55390-0412-01 55390-0412-05 55390-0413-01 55390-0413-05 60505-0702-01 60505-0703-01 63323-0469-01 63323-0469-05 63323-0471-01 63323-0471-05
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
J1644
00409-1316-32 00409-1316-66 00641-0400-25 00641-0410-25 00641-2440-45 00641-2450-45 00641-2470-45 63323-0047-10 63323-0262-01 63323-0540-11 63323-0540-31 63323-0542-01 63323-0542-07 63323-0915-01
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
J1645
00013-2406-91 00013-2426-01 00013-2426-91 00013-5190-01 00013-5191-01
INJECTION, DALTEPARIN SODIUM, PER 2500 IU
CAP Jan 2007 NDC Update Page 9 of 24
HCPCS CAP NDCs Long Description
J1650
00075-0620-40 00075-0621-60 00075-0622-80 00075-0623-00 00075-0624-30 00075-0626-03 00075-2912-01 00075-2915-01
INJECTION, ENOXAPARIN SODIUM, 10 MG
J1655 67211-0342-08 67211-0342-53 INJECTION, TINZAPARIN SODIUM, 1000 IU
J1720
00009-0825-01 00009-0900-13 00009-0900-20 00009-0909-08 00009-0909-16 00009-0912-05 00009-0920-03
INJECTION, HYDROCORTISONE SODIUM SUCCINATE, 100 MG
J1745 57894-0030-01 INJECTION INFLIXIMAB, 10 MG
J1751 52544-0931-02 IRON DEXTRAN 165, 50MG
J1752 00517-0134-10 00517-0234-10 IRON DEXTRAN 267, 50MG
J1756 00517-2340-10 INJECTION, IRON SUCROSE, 1 MG
J1885
00409-3795-01 00409-3796-01 10019-0029-02 10019-0030-03 10019-0030-04 55390-0480-01 55390-0481-02 55390-0481-10 63323-0162-02
INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG
CAP Jan 2007 NDC Update Page 10 of 24
HCPCS CAP NDCs Long Description
J1931 58468-0070-01 LARONIDASE INJECTION, 0.1 MG
J1940 00409-6102-10 00517-5710-25 63323-0280-10
INJECTION, FUROSEMIDE, 20 MG
J1956 00045-0065-55 00045-0069-51 INJECTION, LEVOFLOXACIN, 250 MG
J2001
00264-9594-10 00264-9594-20 00338-0409-02 00338-0409-03 00409-7931-24
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS INFUSION, 10 MG
J2010 00009-0555-02 INJECTION, LINCOMYCIN HCL, 300 MG
J2150 00409-4031-01 00517-4050-25 63323-0024-25
INJECTION, MANNITOL, 25% IN 50 ML
J2260
00703-8005-03 00703-8006-03 10019-0070-01 10019-0070-02 61703-0242-50 67457-0160-20
INJECTION, MILRINONE LACTATE, 5 MG
J2300
00409-1463-01 00409-1464-01 00409-1465-01 00409-1467-01
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
**J2323 **59075-730-15 **INJECTION, NATALIZUMAB, 1 MG
CAP Jan 2007 NDC Update Page 11 of 24
HCPCS CAP NDCs Long Description
J2325 65847-0205-25 INJECTION, NESIRITIDE, 0.1 MG
J2353 00078-0340-61 00078-0341-61 00078-0342-61
INJECTION, OCTREOTIDE, DEPOT FORM FOR INTRAMUSCULAR INJECTION, 1 MG
00078-0181-01 00078-0182-01 00078-0183-25 00078-0184-25
J2354 00703-3301-04 00703-3333-01 00703-3343-01
INJECTION, OCTREOTIDE, NON-DEPOT SUBCUTANEOUS OR INTRAVENOUS INJECTION, 25 MCG
55390-0161-10 55390-0162-10 55390-0163-01 55390-0164-01
J2357 50242-0040-62 OMALIZUMAB INJECTION, 5 MG
J2405 00173-0442-00 00173-0442-02 00173-0461-00
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
00703-4075-59 00703-4085-51
J2430 00781-3147-84 55390-0129-01
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
61703-0324-39
J2469 58063-0797-25 PALONOSETRON HCL, 25MCG
J2503 68782-0001-01 PEGAPTANIB, 0.3MG J2505 55513-0190-01 INJECTION, PEGFILGRASTIM, 6 MG
00641-0928-25 00641-0929-25
J2550 00641-1495-35 00641-1496-35
INJECTION, PROMETHAZINE HCL, 50 MG
00703-2201-04
CAP Jan 2007 NDC Update Page 12 of 24
HCPCS CAP NDCs Long Description
J2680 00703-5003-01 55390-0465-05 INJECTION, FLUPHENAZINE DECANOATE, 25 MG
60977-0451-02 60977-0451-03
J2765 61703-0210-11 61703-0210-21
INJECTION, METOCLOPRAMIDE HCL, 10 MG
61703-0210-35
**INJECTION, RANIBIZUMAB, 0.1 MG **J2778 **50242-080-01
**[Formerly Q4082 – Drug/bio NOC part B drug CAP, billed in 0.5mg increments]
J2780 55390-0616-01 55390-0616-10 INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
50458-0306-11 J2794 50458-0307-11 RISPERIDONE, LONG ACTING, 0.5MG
50458-0308-11
J2820 50419-0002-33 50419-0595-05 INJECTION, SARGRAMOSTIM (GM-CSF), 50 MCG
J2916 52544-0922-26 INJECTION, SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE INJECTION, 12.5 MG
J2920 00009-0113-19 00409-5684-01
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, 40 MG
J2930
00009-0190-16 00009-0698-01 00009-0758-01 00009-0796-01 00009-3389-01
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, 125 MG
50242-0041-64 J2997 50242-0044-13 INJECTION, ALTEPLASE RECOMBINANT, 1 MG
50242-0085-27
CAP Jan 2007 NDC Update Page 13 of 24
HCPCS CAP NDCs Long Description
J3240 58468-1849-04 INJECTION, THYROTROPIN ALPHA, 0.9 MG, PROVIDED IN 1.1 MG VIAL
J3260
00409-3578-01 00409-3590-02 63323-0306-30 63323-0307-51
INJECTION, TOBRAMYCIN SULFATE, 80 MG
J3301 00003-0293-28 00003-0494-20 INJECTION, TRIAMCINOLONE ACETONIDE, PER 10MG
J3302
Not currently available. Please contact vendor for information about availability.
INJECTION, TRIAMCINOLONE DIACETATE, PER 5MG
J3303 54643-1054-00 54643-1056-00
INJECTION, TRIAMCINOLONE HEXACETONIDE, PER 5MG
J3315 52544-0153-76 52544-0154-76 INJECTION, TRIPTORELIN PAMOATE, 3.75 MG
J3370
00409-4332-01 00409-6509-01 00409-6533-01 63323-0221-10 63323-0284-20 63323-0314-61
INJECTION, VANCOMYCIN HCL, 500 MG
J3396 58768-0150-15 00078-0437-61 INJECTION, VERTEPORFIN, 0.1 MG
J3410
00517-4201-25 00517-5602-25 00517-5610-25 63323-0021-01
INJECTION, HYDROXYZINE HCL, 25 MG
J3420 00517-0032-25 00517-0130-05
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
CAP Jan 2007 NDC Update Page 14 of 24
HCPCS CAP NDCs Long Description
J3475
00409-2168-02 00409-2168-03 00409-6729-03 00409-6729-09 00517-2610-25 00517-2650-25 63323-0064-10 63323-0064-20 63323-0064-50
INJECTION, MAGNESIUM SULFATE, PER 500 MG
J3480
00074-3934-02 00409-1513-02 00409-6636-01 00409-6651-06 00409-6653-05 63323-0965-10 63323-0965-15 63323-0965-20 63323-0967-30
INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ
ACID **(ZOMETA), 1 MG J3487 00078-0387-25 INJECTION, ZOLEDRONIC
**J3488 **00078-0435-61 **INJECTION, ZOLEDRONIC ACID (RECLAST), 1 MG
CAP Jan 2007 NDC Update Page 15 of 24
HCPCS CAP NDCs Long Description
J7030
00264-4000-55 00264-4001-55 00264-7800-00 00264-7800-10 00264-7800-20 00338-0049-02 00338-0049-03 00338-0049-04 00409-7101-02 00409-7983-02 00409-7983-03 00409-7983-09 00409-7983-53 00409-7983-55
INFUSION, NORMAL SALINE SOLUTION , 1000 CC
J7040
00264-1400-10 00264-7800-00 00264-7800-10 00338-0049-04 00409-7983-09
INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML=1 UNIT)
J7042 00264-7610-00 00338-0089-04 00409-7941-09
5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT)
J7050
00264-1400-10 00338-0049-02 00338-0049-03 00338-0049-04 00409-1583-02 00409-7983-03 00409-7983-09 00409-7983-53
INFUSION, NORMAL SALINE SOLUTION , 250 CC
J7060
00338-0017-04 00409-1522-02 00409-1522-03 00409-7922-03 00409-7922-09
5% DEXTROSE/WATER (500 ML = 1 UNIT)
CAP Jan 2007 NDC Update Page 16 of 24
HCPCS CAP NDCs Long Description
00264-7510-00 00264-7510-10
J7070 00338-0017-03 INFUSION, D5W, 1000 CC 00338-0017-04 00409-7922-09
00264-1350-10
J7120 00264-1750-00 00338-0117-03 RINGERS LACTATE INFUSION, 1000 CC
00338-0117-04
08024-0724-12 **HYALURONAN OR DERIVATIVE, HYALGAN OR
**J7321 08024-0724-20 08363-7761-01
SUPARTZ, FOR INTRA-ARTICULAR INJECTION, Per Dose
08363-7765-01
**J7322 58468-0090-01 66267-0921-03 68115-0535-03
**HYALURONAN OR DERIVATIVE, SYNVISC, FOR INTRA-ARTICULAR INJECTION, PER DOSE
**J7323 55566-4100-01 **HYALURONAN OR DERIVATIVE, EUFLEXXA, FOR INTRA-ARTICULAR INJECTION, PER DOSE
**J7324 **59676-0360-01 **HYALURONAN OR DERIVATIVE, ORTHOVISC, FOR INTRA-ARTICULAR INJECTION, PER DOS
10019-0920-01
J9000 10019-0921-02 55390-0232-10 DOXORUBICIN HCL, 10 MG
55390-0238-01
J9001 17314-9600-01 17314-9600-02
DOXORUBICIN HYDROCHLORIDE, ALL LIPID FORMULATIONS, 10 MG
CAP Jan 2007 NDC Update Page 17 of 24
HCPCS CAP NDCs Long Description
J9010 50419-0357-03 ALEMTUZUMAB, 10 MG
J9031 49281-0880-01 BCG (INTRAVESICAL) PER INSTILLATION
J9035 50242-0060-01 50242-0061-01 BEVACIZUMAB INJECTION, 10MG
J9040
00703-3154-01 00703-3155-01 55390-0005-01 55390-0006-01 61703-0323-22 61703-0332-18
BLEOMYCIN SULFATE, 15 UNITS
J9041 63020-0049-01 BORTEZOMIB INJECTION, 0.1MG
J9045
00703-3244-11 00703-3246-11 00703-3249-11 00703-3264-01 00703-3266-01 00703-3278-01 10019-0915-01 55390-0153-01 55390-0154-01 55390-0155-01 61703-0339-18 61703-0339-22 61703-0339-50 61703-0339-56
CARBOPLATIN, 50 MG
J9050 00015-3012-38 CARMUSTINE, 100 MG
J9055 66733-0948-23 CETUXIMAB INJECTION, 10MG
CAP Jan 2007 NDC Update Page 18 of 24
HCPCS CAP NDCs Long Description
J9060 55390-0099-01 55390-0112-50 55390-0112-99
CISPLATIN, POWDER OR S0LUTION, PER 10 MG
J9062
00703-5747-11 00703-5748-11 55390-0099-01 55390-0112-50 55390-0112-99
CISPLATIN, 50 MG
J9065 55390-0124-01 63323-0140-10 INJECTION, CLADRIBINE, PER 1 MG
J9070
Not currently available. Please contact vendor for information about availability.
CYCLOPHOSPHAMIDE, 100 MG
J9080
Not currently available. Please contact vendor for information about availability.
CYCLOPHOSPHAMIDE, 200 MG
J9090 00015-0502-41 10019-0955-01 CYCLOPHOSPHAMIDE, 500 MG
J9091 10019-0956-01 CYCLOPHOSPHAMIDE, 1.0 GRAM
J9092 00015-0506-41 10019-0957-01 CYCLOPHOSPHAMIDE, 2.0 GRAM
J9093
Not currently available. Please contact vendor for information about availability.
CYCLOPHOSPHAMIDE, LYOPHILIZED, 100 MG
J9094
Not currently available. Please contact vendor for information about availability.
CYCLOPHOSPHAMIDE, LYOPHILIZED, 200 MG
J9095
Not currently available. Please contact vendor for information about availability.
CYCLOPHOSPHAMIDE, LYOPHILIZED, 500 MG
CAP Jan 2007 NDC Update Page 19 of 24
HCPCS CAP NDCs Long Description Not currently available. Please
J9096 contact vendor for information about
CYCLOPHOSPHAMIDE, LYOPHILIZED, 1.0 GRAM
availability. Not currently available. Please
J9097 contact vendor for information about
CYCLOPHOSPHAMIDE, LYOPHILIZED, 2.0 GRAM
availability.
J9098 57665-0331-01 CYTARABINE LIPOSOME, 10 MG
J9100 55390-0131-10 CYTARABINE, 100 MG
J9110 55390-0133-01 55390-0134-01 CYTARABINE, 500 MG
J9130 63323-0127-10 DACARBAZINE, 100 MG 00703-5075-01
J9140 00703-5075-03 55390-0090-10 DACARBAZINE, 200 MG
61703-0327-22 00703-5233-13
J9150 55390-0108-01 55390-0108-10 DAUNORUBICIN, 10 MG
55390-0281-10
J9160 64365-0503-01 DENILEUKIN DIFTITOX, 300 MCG
J9170 00075-8001-20 00075-8001-80 DOCETAXEL, 20 MG
J9178 00009-5091-01 00009-5093-01 INJECTION, EPIRUBICIN HCL, 2 MG
00703-5653-01 00703-5657-01
J9181 55390-0291-01 55390-0292-01
ETOPOSIDE, 10 MG
55390-0293-01 00703-5653-01 00703-5656-01
J9182 00703-5657-01 55390-0291-01 ETOPOSIDE, 100 MG
55390-0292-01 55390-0293-01
CAP Jan 2007 NDC Update Page 20 of 24
HCPCS CAP NDCs Long Description
J9185 00703-4852-11 00703-5854-01 50419-0511-06
FLUDARABINE PHOSPHATE, 50 MG
J9190
00703-3015-13 00703-3018-12 00703-3019-12 63323-0117-20 63323-0117-51 63323-0117-61
FLUOROURACIL, 500 MG
J9200 61703-0331-09 63323-0145-07 FLOXURIDINE, 500 MG
J9201 00002-7501-01 00002-7502-01 GEMCITABINE HCL, 200 MG
J9202 00310-0950-36 00310-0951-30 GOSERELIN ACETATE IMPLANT, PER 3.6 MG
J9206 00009-7529-01 00009-7529-02 IRINOTECAN, 20 MG
J9208 10019-0925-01 63323-0142-10 IFOSFAMIDE, 1 GM
J9209 10019-0953-01 10019-0953-02 MESNA, 200 MG
J9211 00703-4156-11 IDARUBICIN HYDROCHLORIDE, 5 MG
J9213 00004-2015-07 00004-2015-09 00004-2016-09
INTERFERON, ALFA-2A, RECOMBINANT, 3 MILLION UNITS
J9214
00085-0539-01 00085-0571-02 00085-1110-01 00085-1133-01 00085-1168-01 00085-1179-02 00085-1235-01 00085-1242-01 00085-1254-01
INTERFERON, ALFA-2B, RECOMBINANT, 1 MILLION UNITS
CAP Jan 2007 NDC Update Page 21 of 24
HCPCS CAP NDCs Long Description
J9219 00026-9711-01 LEUPROLIDE ACETATE IMPLANT, 65 MG
J9225 55592-0500-01 HISTRELIN IMPLANT, 50MG
J9245 59572-0301-01 INJECTION, MELPHALAN HYDROCHLORIDE, 50 MG
J9250 55390-0033-10 55390-0034-10 METHOTREXATE SODIUM, 5 MG
J9260
55390-0032-10 55390-0033-10 55390-0034-10 61703-0408-41
METHOTREXATE SODIUM, 50 MG
J9263 00024-0590-10 00024-0591-20 INJECTION, OXALIPLATIN, 0.5 MG
J9264 68817-0134-50 PACLITAXEL PROTEIN BOUND PARTICLES, 1MG
J9265 55390-0114-05 55390-0114-20 55390-0114-50
PACLITAXEL, 30 MG
J9268 62701-0800-01 PENTOSTATIN, PER 10 MG
J9280 63323-0190-20 MITOMYCIN, 5 MG
J9290 55390-0252-01 63323-0191-40 MITOMYCIN, 20 MG
J9291 55390-0253-01 MITOMYCIN, 40 MG
J9293 44087-1520-01 44087-1525-01 44087-1530-01
INJECTION, MITOXANTRONE HYDROCHLORIDE, PER 5 MG
J9305 00002-7623-01 PEMETREXED INJECTION, 10MG
CAP Jan 2007 NDC Update Page 22 of 24
HCPCS CAP NDCs Long Description
J9310 50242-0051-21 50242-0053-06 RITUXIMAB, 100 MG
J9320 00703-4636-01 STREPTOZOCIN, 1 GM
J9340 55390-0030-10 THIOTEPA, 15 MG
J9350 00007-4201-01 00007-4201-05 TOPOTECAN, 4 MG
J9355 50242-0134-68 TRASTUZUMAB, 10 MG
J9360 63323-0278-10
00703-4402-11
VINBLASTINE SULFATE, 1 MG
J9370 00703-4412-11 61703-0309-06 61703-0309-16 00703-4402-11
VINCRISTINE SULFATE, 1 MG
J9375 00703-4412-11 61703-0309-06 61703-0309-16 00703-4182-01 00703-4183-01
VINCRISTINE SULFATE, 2 MG
J9390 55390-0069-01 55390-0070-01 61703-0341-09
VINORELBINE TARTRATE, PER 10 MG
J9395 00310-0720-25 00310-0720-50 INJECTION, FULVESTRANT, 25 MG
J9600 58914-0155-75 PORFIMER SODIUM, 75 MG
Q3025 59627-0001-03 59627-0002-05
INJECTION, INTERFERON BETA-1A, 11 MCG FOR INTRAMUSCULAR USE
CAP Jan 2007 NDC Update Page 23 of 24
CAP NOC DRUGS - Supplied under Q4082- Drug/bio NOC part B drug CAP Please note that ranibizumab (Lucentis®) is now billed under J2778
CAP NDCs Drug Name and billing amount
none
CAP Jan 2007 NDC Update Page 24 of 24