Ingenix HCPCS Brand Name Directory
00 HEB Prelim 05 Page 1 Wednesday, December 15, 2004 2:08 PM
Ingenix HCPCS Brand
Name Directory
Crosswalk of Level II codes to
brand names and NDCs
2005
3rd edition
02 HEB J Brand 05 Page 100 Wednesday, December 15, 2004 2:33 PM
MORPHINE SULFATE
Drug List by Brand Name
HCPCS
Brand Name
Generic Name
Unit
Manufacturer
Rte
Form
NDC
J2270
4 MORPHINE SUL-
morphine sulfate
up to 10 mg
Faulding
INJ
SOL
6170321985
FATE
Pharmaceutical Co
J2270
4 MORPHINE SUL-
morphine sulfate
up to 10 mg
Faulding
INJ
SOL
6170322175
FATE
Pharmaceutical Co
Drug List by
Brand Name
J2270
4 MORPHINE SUL-
morphine sulfate
up to 10 mg
Faulding
INJ
SOL
6170322185
FATE
Pharmaceutical Co
J2270
4 MORPHINE SUL-
morphine sulfate
up to 10 mg
Faulding
INJ
SOL
6170322321
FATE
Pharmaceutical Co
J2270
4 MORPHINE SUL-
morphine sulfate
up to 10 mg
Faulding
INJ
SOL
6170322343
FATE
Pharmaceutical Co
J2270
4 MORPHINE SUL-
morphine sulfate
up to 10 mg
Faulding
INJ
SOL
6170322471
FATE
Pharmaceutical Co
J2270
4 MORPHINE SUL-
morphine sulfate
up to 10 mg
Faulding
INJ
SOL
6170322472
FATE
Pharmaceutical Co
J2270
4 MORPHINE SUL-
morphine sulfate
up to 10 mg
Faulding
INJ
SOL
6170322476
FATE
Pharmaceutical Co
J2270
4 MORPHINE SUL-
morphine sulfate
up to 10 mg
Faulding
INJ
SOL
6170322486
FATE
Pharmaceutical Co
J2270
4 MORPHINE SUL-
morphine sulfate
up to 10 mg
Faulding
INJ
SOL
6170322521
FATE
Pharmaceutical Co
J2270
4 MORPHINE SUL-
morphine sulfate
up to 10 mg
Faulding
INJ
SOL
6170322543
FATE
Pharmaceutical Co
J2270
4 MORPHINE SUL-
morphine sulfate
up to 10 mg
Faulding
INJ
SOL
6170322672
FATE
Pharmaceutical Co
J2270
4 MORPHINE SUL-
morphine sulfate
up to 10 mg
Faulding
INJ
SOL
6170322676
FATE
Pharmaceutical Co
J2270
4 MORPHINE SUL-
morphine sulfate
up to 10 mg
Faulding
INJ
SOL
6170322686
FATE
Pharmaceutical Co
J2270
4 MORPHINE SUL-
morphine sulfate
up to 10 mg
Faulding
INJ
SOL
6170323132
FATE
Pharmaceutical Co
J2270
4 MORPHINE SUL-
morphine sulfate
up to 10 mg
Faulding
INJ
SOL
6170323286
FATE
Pharmaceutical Co
J2275
4 MORPHINE SUL-
morphine sulfate
per 10 mg
Abbott Laboratories
INJ
SOL
0074113501
FATE
J2275
4 MORPHINE SUL-
morphine sulfate
per 10 mg
Abbott Laboratories
INJ
SOL
0074113502
FATE
J2275
4 MORPHINE SUL-
morphine sulfate
per 10 mg
Abbott Laboratories
INJ
SOL
0074113503
FATE
J2275
4 MORPHINE SUL-
morphine sulfate
per 10 mg
Abbott Laboratories
INJ
SOL
0074113504
FATE
J2275
4 MORPHINE SUL-
morphine sulfate
per 10 mg
Abbott Laboratories
INJ
SOL
0074125801
FATE
J2275
4 MORPHINE SUL-
morphine sulfate
per 10 mg
Abbott Laboratories
INJ
SOL
0074125802
FATE
J2275
4 MORPHINE SUL-
morphine sulfate
per 10 mg
Abbott Laboratories
INJ
SOL
0074125811
FATE
J2275
4 MORPHINE SUL-
morphine sulfate
per 10 mg
Abbott Laboratories
INJ
SOL
0074125821
FATE
J2275
4 MORPHINE SUL-
morphine sulfate
per 10 mg
Abbott Laboratories
INJ
SOL
0074125830
FATE
J2275
4 MORPHINE SUL-
morphine sulfate
per 10 mg
Abbott Laboratories
INJ
SOL
0074125831
FATE
J2275
4 MORPHINE SUL-
morphine sulfate
per 10 mg
Abbott Laboratories
INJ
SOL
0074125901
FATE
100 — 2005 HCPCS Brand Name Directory
4 Quantity alert
03 HEB J NDC 05 Page 336 Wednesday, December 15, 2004 2:47 PM
6258444142
Drug List by NDC
Generic
HCPCS
NDC
Brand Name
Unit
Manufacturer
Rte
Form
Name
S0028
4
6258444142
PEPCID
famotidine
20 mg/2 ml
Amerisource Health
IV
SOL
Services Corp
J2930
4
6258445445
SOLU-MEDROL
methylprednisolone
125 mg
Amerisource Health
INJ
Vial
sod succ
Services Corp
J2920
4
6258445545
SOLU-MEDROL
methylprednisolone
40 mg
Amerisource Health
INJ
Vial
sod succ
Services Corp
J1720
4
6258445645
SOLU CORTEF
hydrocortisone sodium 100 mg
Amerisource Health
INJ
PWD
succinate
Services Corp
S0104
6258446450
RETROVIR
zidovudine
100 mg
Amerisource Health
ORAL
CAP
Services Corp
S0187
4
6258460008
NOLVADEX
tamoxifen
10 mg
Amerisource Health
ORAL
TAB
Services Corp
S0179
4
6258477901
MEGESTROL ACETATE megestrol acetate
40 mg
Amerisource Health
ORAL
TAB
Services Corp
NDC
S0179
4
6258477933
MEGESTROL ACETATE megestrol acetate
40 mg
Amerisource Health
ORAL
TAB
Drug List by
Services Corp
S0179
4
6258477950
MEGESTROL ACETATE megestrol acetate
40 mg
Amerisource Health
ORAL
TAB
Services Corp
Q0175
6258481701
PERPHENAZINE
perphenazine
4 mg
Amerisource Health
ORAL
TAB
Services Corp
S0106
4
6258481800
BUSPAR
buprioion HCl
5 mg
Amerisource Health
ORAL
TAB
Services Corp
S0106
4
6258481850
BUSPAR
buprioion HCl
5 mg
Amerisource Health
ORAL
TAB
Services Corp
S0106
4
6258481900
BUSPAR
buprioion HCl
10 mg
Amerisource Health
ORAL
TAB
Services Corp
S0106
4
6266003730
WELLBUTRIN XL
bupropion HCl
150 mg
Biovail Corp
ORAL
TAB
S0106
4
6266003830
WELLBUTRIN
buprioion HCl
300 mg
Biovail Corp
ORAL
TAB
J9280
4
6270101001
MITOMYCIN
mitomycin
5 mg
Supergen Inc
INJ
PWD
J9280
4
6270101101
MITOMYCIN
mitomycin
20 mg
Supergen Inc
INJ
PWD
J9290
4
6270101101
MITOMYCIN
mitomycin
20 mg
Supergen Inc
IV
VIAL
J9268
4
6270180001
NIPENT
pentostatin
10 mg
Supergen Inc
IV
VIAL
J9268
4
6270180010
NIPENT
pentostatin
10 mg
Supergen Inc
IV
VIAL
J0690
4
6277800903
CEFAZOLIN
cefazolin sodium
500 mg
Hikma Farmaceutica
INJ
Vial
J0595
4
6279431131
BUTORPHANOL TAR-
butorphanol tartrate
1 mg
Bertek Pharmaceuti-
INJ
SOL
TRATE
cals Inc
J0595
4
6279431197
BUTORPHANOL TAR-
butorphanol tartrate
1 mg
Bertek Pharmaceuti-
INJ
SOL
TRATE
cals Inc
Q0177
6292762104
HYDROXYZINE PAMO- hydroxyzine pamoate
25 mg
Monument Pharma-
ORAL
SOL
ATE
ceutical Co Inc
Q0177
6292762116
HYDROXYZINE PAMO- hydroxyzine pamoate
25 mg
Monument Pharma-
ORAL
SOL
ATE
ceutical Co Inc
C9103
4
6300477292
GLOFIL 125
iothalamate sodium I-
1 mg/ml
Questcor Pharmaceuti-
IV
SOL
125
cals Inc
C9103
4
6300477292
GLOFIL 125
iothalamate sodium I-
1 mg/ml
Questcor Pharmaceuti-
SC
SOL
125
cals Inc
J9041
6302004901
VELCADE
bortezomib
3.5 mg
Millenium Pharmaceu-
IV
PWD
ticals Inc
J9031
4
6308811021
PACIS BCG LIVE
BCG, live
120 mg
Shire Biologics Div
IVL
PELLET
Shire Biochem Inc
S0012
4
6328559401
BUTORPHANOL TAR-
butorphanol tartrate
10 mg
Patheon Inc Toronto
NASAL
SOL
TRATE
Region Operations
336 — 2005 HCPCS Brand Name Directory
4 Quantity alert
04 HEB DME Prod 05 Page 441 Wednesday, December 15, 2004 2:56 PM
Supply List by Brand Name
Tempur-Med Overlay
HCPCS
Product
Manufacturer
A6259
4
Tegaderm I.V. Transparent Dressing — transparent film, greater than 48 sq in
3M Health Care
A6257
4
Tegaderm I.V. Transparent Dressings — (#1610 and #1655) — transparent film, 16 sq in 3M Health Care
or less
A6257
4
Tegaderm Plus #9524 — transparent film, 16 sq in or less
3M Health Care
A6258
4
Tegaderm Plus #9524 — transparent film, greater than 6 sq in
3M Health Care
A6259
4
Tegaderm Plus #9524 — transparent film, greater than 48 sq in
3M Health Care
A6203
4
Tegaderm Transparent Dressing with absorbent pad — composite, 16 sq in. or less,
3M Health Care
adhesive
A6204
4
Tegaderm Transparent Dressing with absorbent pad — composite, greater than 16 sq in, 3M Health Care
adhesive
A6205
4
Tegaderm Transparent Dressing with absorbent pad
3M Health Care
A6248
4
Tegagel Hydrogel Wound Filler — hydrogel dressing, wound filler per oz.
3M Health Care
A6231
4
Tegagel Hydrogel Wound Filler with Gauze — gauze (hydrogel), 16 sq in or less
3M Health Care
A6196
4
Tegagen HG Wound Cover — 16 sq in. or less
3M Health Care
A6197
4
Tegagen HG Wound Cover — greater than 16 sq in.
3M Health Care
A6198
4
Tegagen HG Wound Cover — greater than 48 sq in.
3M Health Care
A6199
4
Tegagen HG Wound Filler — per 6 in.
3M Health Care
A6196
4
Tegagen HI Wound Cover — 16 sq in. or less
3M Health Care
A6197
4
Tegagen HI Wound Cover — greater than 16 sq in.
3M Health Care
A6198
4
Tegagen HI Wound Cover — greater than 48 sq in.
3M Health Care
A6199
4
Tegagen HI Wound Filler — per 6 in.
3M Health Care
A6206
4
Tegapore — contact layer, 16 sq in or greater than
3M Health Care
Supply List by
Brand Name
A6207
4
Tegapore — contact layer greater than 16 sq in
3M Health Care
A6208
4
Tegapore — contact layer greater than 48 sq in.
3M Health Care
A6234
4
Tegasorb — hydrocolloid, 16 sq in or less
3M Health Care
A6235
4
Tegasorb — hydrocolloid greater than 16 sq in
3M Health Care
A6236
4
Tegasorb — hydrocolloid, greater than 48 sq in
3M Health Care
A6237
4
Tegasorb — hydrocolloid, 16 sq in. or less, adhesive
3M Health Care
A6238
4
Tegasorb — hydrocolloid, greater than 16 sq in, adhesive
3M Health Care
A6239
4
Tegasorb — hydrocolloid, greater than 48 sq in., adhesive
3M Health Care
A6238
4
Tegasorb Hydrocolloid Dressing — Sacral Design — hydrocolloid, greater than 16 sq in, 3M Health Care
adhesive
K0014
Teknique XHD Power Wheelchair
Hoveround Corporation
A6216
4
Telfa — gauze, 16 sq in.orgreater than
The Kendall Company (Tyco Healthcare)
A6217
4
Telfa — gauze, greater than 16 sq in
The Kendall Company (Tyco Healthcare)
A6218
4
Telfa — gauze, greater than 48 sq in
The Kendall Company (Tyco Healthcare)
A6219
4
Telfa Island Dressing — gauze, 16 sq in. or less, adhesive
The Kendall Company (Tyco Healthcare)
A6220
4
Telfa Island Dressing — gauze, greater than 16 sq in, adhesive
The Kendall Company (Tyco Healthcare)
A6221
4
Telfa Island Dressing — gauze, greater than 48 sq in, adhesive
The Kendall Company (Tyco Healthcare)
A6252
4
Telfa Max — absorptive dressing, greater than 16 sq in
The Kendall Company (Tyco Healthcare)
A6253
4
Telfa Max — absorptive dressing., greater than 48 sq in
The Kendall Company (Tyco Healthcare)
A6203
4
Telfa Plus Island Dressing — composite, 16 sq in. or less, adhesive
The Kendall Company (Tyco Healthcare)
A6204
4
Telfa Plus Island Dressing — composite, greater than 16 sq in, adhesive
The Kendall Company (Tyco Healthcare)
A6205
4
Telfa Plus Island Dressing — composite greater than 48 sq in, adhesive
The Kendall Company (Tyco Healthcare)
A6203
4
Telfa Xtra — composite, 16 sq in. or less, adhesive
The Kendall Company (Tyco Healthcare)
A6204
4
Telfa Xtra — composite, greater than 16 sq in, adhesive
The Kendall Company (Tyco Healthcare)
A6205
4
Telfa Xtra — composite greater than 48 sq in, adhesive
The Kendall Company (Tyco Healthcare)
E1031
Temco Transport Chair — rollabout chair
Temco
K0012
Tempest
Everest & Jennings
K0108
TempPro Back Buddy without Board Insert — other wheelchair accessories
Profex Medical Products
E0184
Tempur-Med Mattress
Tempur-Medical, Inc.
E0199
Tempur-Med Overlay — dry pressure pad/standard. Mattress
Tempur-Pedic
4 Quantity alert
+ Requires more than one code to report
2005 HCPCS Brand Name Directory — 441
