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    HCPCS Details

    HCPC Q9963
    Short Description Hocm 350-399mg/ml iodine,1ml
    Long Description High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml
    Pricing indicator 51
    Coverage code D
    ASC payment group code
    BETOS2 code I1E
    Action code N
    Type of service 4
    Effective date 2005-07-01
    Date Added 2005-07-01

    HCPCS/NDC Cross-Walk

    NDC HCPC Description Drug Name Labeler Name HCPCS Dosage PKG Size PKG QTY Bill Units Bill Units PKG
    00019481604 Q9963 Hocm 350-399mg/ml iodine,1ml Md GastrovieW LIEBEL FLARSHEIM 1 ML 30 25 30 750
    00270044535 Q9963 Hocm 350-399mg/ml iodine,1ml Gastrografin BRACCO DIAGNOSTICS 1 ML 30 24 30 720
    00270044540 Q9963 Hocm 350-399mg/ml iodine,1ml Gastrografin BRACCO DIAGNOSTICS 1 ML 120 12 120 1440
    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 ML
    HCPCS/CPT Billing Units 1
    Total doses ordered
    Billing Units 1