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NDC Look-up Sample from Medicare



April 2017 NDC - HCPCS Crosswalk for Medicare Part B Drugs

Effective April 1, 2017 through June 30, 2017

The ASP crosswalks are maintained by the Division of Ambulatory Services to support ASP-based Medicare Part B payments only. The crosswalks are intended to help the public (including

HCPCS Code

Short Descriptor

LABELER NAME

90630 90630 90653 90655 90656 90656 90656 90656 90656 90657 90661 90662 90662 90670 90670 90670 90672 90672 90673 90673 90674 90685 90685 90686 90686 90686 90686 90686 90686 90686 90686 90687 90687 90688 90688 90688 90688 90732 90732 90732 90732 90732 90740 90740 90740 90740 90740 90743 90743 90743 90743 90743 90743 90743 90743 90744 90744 90744 90744 90744 90744 90744 90746 90746 90746 90746 90746 90746 90746 90746 90746 90746 90747 90747 90747 90747 90747 Q2035 Q2035 Q2037 Q2037 Q2038

Flu vacc iiv4 no preserv id

Sanofi Pasteur

Flu vacc iiv4 no preserv id

Sanofi Pasteur

Iiv adjuvant vaccine im

Seqirus

IIV3 VACC NO PRSV 0.25 ML IM Sanofi Pasteur

IIV3 VACC NO PRSV 0.5 ML IM

bioCSL

IIV3 VACC NO PRSV 0.5 ML IM

Seqirus

IIV3 VACC NO PRSV 0.5 ML IM

GlaxoSmithKline

IIV3 VACC NO PRSV 0.5 ML IM

Novartis

IIV3 VACC NO PRSV 0.5 ML IM

Seqirus

IIV3 VACCINE SPLT 0.25 ML IM Sanofi Pasteur

CCIIV3 VAC NO PRSV 0.5 ML IM Novartis

Iiv no prsv increased ag im

Sanofi Pasteur

Iiv no prsv increased ag im

Sanofi Pasteur

PCV13 VACCINE IM

Wyeth/PFIZER U.S.

PCV13 VACCINE IM

Wyeth/PFIZER U.S.

PCV13 VACCINE IM

Wyeth/PFIZER U.S.

Laiv4 vaccine intranasal

MedImmune, LLC

Laiv4 vaccine intranasal

MedImmune, LLC

Riv3 vaccine no preserv im

Protein Sciences

Riv3 vaccine no preserv im

Protein Sciences

CCIIV4 VAC NO PRSV 0.5 ML IM Seqirus

IIV4 VACC NO PRSV 0.25 ML IM Sanofi Pasteur

IIV4 VACC NO PRSV 0.25 ML IM Sanofi Pasteur

IIV4 VACC NO PRSV 0.5 ML IM

GlaxoSmithKline

IIV4 VACC NO PRSV 0.5 ML IM

ID Biomedical

IIV4 VACC NO PRSV 0.5 ML IM

Sanofi Pasteur

IIV4 VACC NO PRSV 0.5 ML IM

Sanofi Pasteur

IIV4 VACC NO PRSV 0.5 ML IM

Sanofi Pasteur

IIV4 VACC NO PRSV 0.5 ML IM

Sanofi Pasteur

IIV4 VACC NO PRSV 0.5 ML IM

GlaxoSmithKline

IIV4 VACC NO PRSV 0.5 ML IM

GlaxoSmithKline

IIV4 VACCINE SPLT 0.25 ML IM Sanofi Pasteur

IIV4 VACCINE SPLT 0.25 ML IM Sanofi Pasteur

IIV4 VACCINE SPLT 0.5 ML IM

GlaxoSmithKline

IIV4 VACCINE SPLT 0.5 ML IM

ID Biomedical

IIV4 VACCINE SPLT 0.5 ML IM

Sanofi Pasteur

IIV4 VACCINE SPLT 0.5 ML IM

Sanofi Pasteur

PPSV23 VACC 2 YRS+ SUBQ/IM Merck

PPSV23 VACC 2 YRS+ SUBQ/IM Merck

PPSV23 VACC 2 YRS+ SUBQ/IM Merck

PPSV23 VACC 2 YRS+ SUBQ/IM Merck

PPSV23 VACC 2 YRS+ SUBQ/IM Merck

HEPB VACC 3 DOSE IMMUNSUP IM Merck

HEPB VACC 3 DOSE IMMUNSUP IM GlaxoSmithKline

HEPB VACC 3 DOSE IMMUNSUP IM GlaxoSmithKline

HEPB VACC 3 DOSE IMMUNSUP IM GlaxoSmithKline

HEPB VACC 3 DOSE IMMUNSUP IM GlaxoSmithKline

HEPB VACC 2 DOSE ADOLESC IM Merck

HEPB VACC 2 DOSE ADOLESC IM Merck

HEPB VACC 2 DOSE ADOLESC IM Merck

HEPB VACC 2 DOSE ADOLESC IM Merck

HEPB VACC 2 DOSE ADOLESC IM Merck

HEPB VACC 2 DOSE ADOLESC IM Merck

HEPB VACC 2 DOSE ADOLESC IM GlaxoSmithKline

HEPB VACC 2 DOSE ADOLESC IM GlaxoSmithKline

HEPB VACC 3 DOSE PED/ADOL IM Merck

HEPB VACC 3 DOSE PED/ADOL IM Merck

HEPB VACC 3 DOSE PED/ADOL IM Merck

HEPB VACC 3 DOSE PED/ADOL IM Merck

HEPB VACC 3 DOSE PED/ADOL IM GlaxoSmithKline

HEPB VACC 3 DOSE PED/ADOL IM GlaxoSmithKline

HEPB VACC 3 DOSE PED/ADOL IM GlaxoSmithKline

HEPB VACCINE 3 DOSE ADULT IM Merck

HEPB VACCINE 3 DOSE ADULT IM Merck

HEPB VACCINE 3 DOSE ADULT IM Merck

HEPB VACCINE 3 DOSE ADULT IM Merck

HEPB VACCINE 3 DOSE ADULT IM Merck

HEPB VACCINE 3 DOSE ADULT IM Merck

HEPB VACCINE 3 DOSE ADULT IM GlaxoSmithKline

HEPB VACCINE 3 DOSE ADULT IM GlaxoSmithKline

HEPB VACCINE 3 DOSE ADULT IM GlaxoSmithKline

HEPB VACCINE 3 DOSE ADULT IM GlaxoSmithKline

HEPB VACC 4 DOSE IMMUNSUP IM Merck

HEPB VACC 4 DOSE IMMUNSUP IM GlaxoSmithKline

HEPB VACC 4 DOSE IMMUNSUP IM GlaxoSmithKline

HEPB VACC 4 DOSE IMMUNSUP IM GlaxoSmithKline

HEPB VACC 4 DOSE IMMUNSUP IM GlaxoSmithKline

Afluria vacc, 3 yrs & >, im

bioCSL

Afluria vacc, 3 yrs & >, im

Seqirus

Fluvirin vacc, 3 yrs & >, im

Novartis

Fluvirin vacc, 3 yrs & >, im

Seqirus

Fluzone vacc, 3 yrs & >, im

Sanofi Pasteur

NDC

DRUG NAME

49281-0708-40 Fluzone Quadrivalent Intradermal 2015/2016 49281-0710-40 Fluzone Intradermal Quadrivalent 2016/2017 70461-0001-01 Fluad 2016/2017 49281-0113-25 Fluzone (Preservative Free) 33332-0015-01 Afluria (Preservative Free) 2015/2016 33332-0016-01 Afluria (Preservative Free) 2016/2017 58160-0883-52 Fluarix (Preservative Free) 2015/2016 66521-0118-02 Fluvirin (Preservative Free) 2015/2016 70461-0119-02 Fluvirin (Preservative Free) 2016/2017 49281-0396-15 Fluzone 2015/2016 62577-0614-01 Flucelvax 2015/2016 49281-0397-65 Fluzone High-Dose 2015/2016 49281-0399-65 Fluzone High-Dose 2016/2017 00005-1971-02 Prevnar - 13 00005-1971-04 Prevnar - 13 00005-1971-05 Prevnar - 13 66019-0302-10 FluMist Quadrivalent 2015/2016 66019-0303-10 Flumist Quadrivalent 2016/2017 42874-0015-10 Flublok 2015/2016 42874-0016-10 Flublok 2016/2017 70461-0200-01 Flucelvax Quadrivalent 2016/2017 49281-0515-25 Fluzone Quadrivalent (Preservative free) 2015/2016 49281-0516-25 Fluzone Quadrivalent (Preservative Free) 2016/2017 19515-0901-52 Flulaval Quadrivalent 2015/2016 19515-0908-52 Flulaval Quadrivalent (Preservative Free) 2016/2017 49281-0415-10 Fluzone Quadrivalent (Preservative free) 2015/2016 49281-0415-50 Fluzone Quadrivalent (Preservative free) 2015/2016 49281-0416-10 Fluzone Quadrivalent (Preservative Free) 2016/2017 49281-0416-50 Fluzone Quadrivalent (Preservative Free) 2016/2017 58160-0903-52 Fluarix Quadrivalent (Preservative free) 2015/2016 58160-0905-52 Fluarix Quadrivalent (Preservative Free) 2016/2017 49281-0623-15 Fluzone Quadrivalent 2015/2016 49281-0625-15 Fluzone Quadrivalent 2016/2017 19515-0898-11 Flulaval Quadrivalent 2015/2016 19515-0903-11 Flulaval Quadrivalent 2016/2017 49281-0623-15 Fluzone Quadrivalent 2015/2016 49281-0625-15 Fluzone Quadrivalent 2016/2017 00006-4739-00 Pneumovax 23 00006-4739-01 Pneumovax 23 00006-4837-02 Pneumovax 23 00006-4837-03 Pneumovax 23 00006-4943-00 Pneumovax 23 00006-4992-00 Recombivax Hb 58160-0821-11 Engerix-B 58160-0821-43 Engerix-B 58160-0821-46 Engerix-B 58160-0821-52 Engerix-B 00006-4094-02 Recombivax Hb 00006-4094-06 Recombivax Hb 00006-4094-09 Recombivax Hb 00006-4094-31 Recombivax Hb 00006-4995-00 Recombivax Hb 00006-4995-41 Recombivax Hb 58160-0820-11 Engerix-B Pediatric 58160-0820-46 Engerix-B Pediatric 00006-4094-06 Recombivax Hb 00006-4094-09 Recombivax Hb 00006-4981-00 Recombivax Hb 00006-4995-41 Recombivax Hb 58160-0820-11 Engerix-B Pediatric 58160-0820-46 Engerix-B Pediatric 58160-0820-52 Engerix-B Pediatric 00006-4094-02 Recombivax Hb 00006-4094-06 Recombivax Hb 00006-4094-09 Recombivax Hb 00006-4094-31 Recombivax Hb 00006-4995-00 Recombivax Hb 00006-4995-41 Recombivax Hb 58160-0821-11 Engerix-B 58160-0821-43 Engerix-B 58160-0821-46 Engerix-B 58160-0821-52 Engerix-B 00006-4992-00 Recombivax Hb 58160-0821-11 Engerix-B 58160-0821-43 Engerix-B 58160-0821-46 Engerix-B 58160-0821-52 Engerix-B 33332-0115-10 Afluria 2015/2016 33332-0116-10 Afluria 2016/2017 66521-0118-10 Fluvirin 2015/2016 70461-0119-10 Fluvirin 2016/2017 49281-0396-15 Fluzone 2015/2016

HCPCS PKG SIZE PKG QTY

BILL

BILL UNITS

DOSAGE

UNITS PKG

0.1 ML

0.1

10

1 10

0.1 ML

0.1

10

1 10

0.5 ML

0.5

10

1 10

0.25 ML

0.25

10

1 10

0.5 ML

0.5

10

1 10

0.5 ML

0.5

10

1 10

0.5 ML

0.5

10

1 10

0.5 ML

0.5

10

1 10

0.5 ML

0.5

10

1 10

0.25 ML

5

1 20 20

0.5 ML

0.5

10

1 10

0.5 ML

0.5

10

1 10

0.5 ML

0.5

10

1 10

0.5 ML

0.5

10

1 10

0.5 ML

0.5

1

1

1

0.5 ML

0.5

1

1

1

0.2 ML

0.2

10

1 10

0.2 ML

0.2

10

1 10

0.2 ML

0.5

10

1 10

0.5 ML

0.5

10

1 10

0.5 ML

0.5

10

1 10

0.25 ML

0.25

10

1 10

0.25 ML

0.25

10

1 10

0.5 ML

0.5

1

1

1

0.5 ML

0.5

10

1 10

0.5 ML

0.5

10

1 10

0.5 ML

0.5

10

1 10

0.5 ML

0.5

10

1 10

0.5 ML

0.5

10

1 10

0.5 ML

0.5

10

1 10

0.5 ML

0.5

10

1 10

0.25 ML

5

1 20 20

0.25 ML

5

1 20 20

0.5 ML

5

1 10 10

0.5 ML

5

1 10 10

0.5 ML

5

1 10 10

0.5 ML

5

1 10 10

0.5 ML

2.5

1

5

5

0.5 ML

0.5

1

1

1

0.5 ML

0.5

1

1

1

0.5 ML

0.5

10

1 10

0.5 ML

0.5

10

1 10

40 MCG

1

1

1

1

40 MCG

1

10 0.5

5

40 MCG

1

1 0.5 0.5

40 MCG

1

5 0.5 2.5

40 MCG

1

10 0.5

5

1 DOSE

1

10

1 10

1 DOSE

1

6

6

6

1 DOSE

1

6

6

6

1 DOSE

1

1

1

1

1 DOSE

1

1

1

1

1 DOSE

1

10

1 10

1 DOSE

0.5

10

1 10

1 DOSE

0.5

5

1

5

1 DOSE

1

6

1

6

1 DOSE

1

6

6

6

1 DOSE

0.5

10

1 10

1 DOSE

1

10

1 10

1 DOSE

0.5

10

1 10

1 DOSE

0.5

5

1

5

1 DOSE

0.5

10

1 10

1 EACH

1

10

1 10

1 DOSE

1

6

1

6

1 DOSE

1

6

1

6

1 DOSE

1

1

1

1

1 EACH

1

1

1

1

1 EACH

1

10

1 10

1 EACH

1

10

1 10

1 EACH

1

1

1

1

1 EACH

1

5

1

5

1 EACH

1

10

1 10

40 MCG

1

1

1

1

40 MCG

1

10 0.5

5

40 MCG

1

1 0.5 0.5

40 MCG

1

5 0.5 2.5

40 MCG

1

10 0.5

5

0.5 ML

5

1 10 10

0.5 ML

5

1 10 10

0.5 ML

5

1 10 10

0.5 ML

5

1 10 10

0.5 ML

5

1 10 10

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