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    HCPCS Details

    HCPC J9017
    Short Description Arsenic trioxide injection
    Long Description Injection, arsenic trioxide, 1 mg
    Pricing indicator 51
    Coverage code C
    ASC payment group code YY
    BETOS2 code O1D
    Action code N
    Type of service 1
    Effective date 2009-01-01
    Date Added 2002-01-01

    HCPCS/NDC Cross-Walk

    NDC HCPC Description Drug Name Labeler Name HCPCS Dosage PKG Size PKG QTY Bill Units Bill Units PKG
    00781349894 J9017 Arsenic trioxide injection Arsenic Trioxide Sandoz Inc 1 mg 6 1 12 12
    00781349895 J9017 Arsenic trioxide injection Arsenic Trioxide Sandoz Inc 1 mg 6 10 12 120
    14789060010 J9017 Arsenic trioxide injection ARSENIC TRIOXIDE NEXUS PHARMACEUTICAL INC 1 MG 10 10 10 100
    23155086941 J9017 Arsenic trioxide injection Arsenic Trioxide AVET PHARMACEUTICALS, INC. 1 MG 10 10 10 100
    23155087041 J9017 Arsenic trioxide injection Arsenic Trioxide AVET PHARMACEUTICALS, INC. 1 MG 6 10 12 120
    25021022610 J9017 Arsenic trioxide injection Arsenic Trioxide SAGENT PHARMACEUTICALS, INC. 1 MG 10 10 10 100
    25021022706 J9017 Arsenic trioxide injection Arsenic Trioxide SAGENT PHARMACEUTICALS, INC. 1 MG 6 10 12 120
    50742043810 J9017 Arsenic trioxide injection ARSENIC TRIOXIDE INGENUS PHARMACEUTICALS, LLC 1 MG 10 1 10 10
    54879002710 J9017 Arsenic trioxide injection Arsenic Trioxide STI PHARMA, LLC 1 MG 10 10 10 100
    55150036610 J9017 Arsenic trioxide injection Arsenic Trioxide AUROMEDICS PHARMA, LLC 1 MG 6 10 12 120
    63323063710 J9017 Arsenic trioxide injection Arsenic Trioxide FRESENIUS KABI 1 MG 10 10 10 100
    63459060106 J9017 Arsenic trioxide injection Trisenox CEPHALON INC. 1 MG 6 10 12 120
    68382099710 J9017 Arsenic trioxide injection Arsenic Trioxide ZYDUS PHARMACEUTICALS 1 MG 10 10 10 100
    69918072002 J9017 Arsenic trioxide injection ARSENIC TRIOXIDE AMRING PHARMACEUTICALS 1 MG 10 2 10 20
    69918072010 J9017 Arsenic trioxide injection ARSENIC TRIOXIDE AMRING PHARMACEUTICALS 1 MG 10 10 10 100
    70121148307 J9017 Arsenic trioxide injection Arsenic Trioxide AMNEAL BIOSCIENCES 1 MG 10 10 10 100
    70121165801 J9017 Arsenic trioxide injection Arsenic Trioxide AMNEAL BIOSCIENCES 1 MG 6 10 12 120
    70710161006 J9017 Arsenic trioxide injection Arsenic Trioxide ZYDUS PHARMACEUTICALS 1 MG 6 10 12 120
    70710189506 J9017 Arsenic trioxide injection Arsenic Trioxide ZYDUS PHARMACEUTICALS 1 MG 10 10 10 100
    70710189606 J9017 Arsenic trioxide injection Arsenic Trioxide ZYDUS PHARMACEUTICALS 1 MG 6 10 12 120
    70860021710 J9017 Arsenic trioxide injection ARSENIC TRIOXIDE ATHENEX 1 MG 10 1 10 10
    The ASP crosswalks are maintained by the Division of Data Analysis and Market Based Pricing to support ASP-based Medicare Part B payments only. The crosswalks are intended to help the public (including entities that submit manufacturer ASP data and providers who bill for drugs) understand which drug products (identified by NDCs) are assigned to which HCPCS billing codes. The crosswalks are not intended to be a comprehensive list of all drugs/NDCs available in the United States. The NDC to HCPCS Crosswalk also includes information on the NDC package size and the number of billable units (as defined by the HCPCS code descriptor). Comments on the file may be sent to [email protected].

    HCPCS Billing Calculator

    Dosage given to patient (per dose)
    HCPCS Dosage 1 MG
    HCPCS/CPT Billing Units 1
    Total doses ordered
    Billing Units 1

    Drug Details

    • Arsenic trioxide is used in combination with tretinoin to treat acute promyelocytic leukemia (APL; a type of cancer in which there are too many immature blood cells in the blood and bone marrow) in certain people as a first treatment. It is also used to treat APL in certain people who have not been helped by other types of chemotherapy or whose condition has improved but then worsened following treatment with a retinoid and other types of chemotherapy treatment(s). Arsenic trioxide is in a class of medications called anti-neoplastics. It works by slowing or stopping the growth of cancer cells.