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    HCPCS Details

    HCPC Q9967
    Short Description Locm 300-399mg/ml iodine,1ml
    Long Description Low osmolar contrast material, 300-399 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 2008-01-01
    Date Added 2008-01-01

    HCPCS/NDC Cross-Walk

    NDC HCPC Description Drug Name Labeler Name HCPCS Dosage PKG Size PKG QTY Bill Units Bill Units PKG
    00019132300 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 320 LIEBEL FLARSHEIM 1 ML 100 20 100 2000
    00019132302 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 320 LIEBEL FLARSHEIM 1 ML 20 25 20 500
    00019132306 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 320 LIEBEL FLARSHEIM 1 ML 50 25 50 1250
    00019132311 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 320 LIEBEL FLARSHEIM 1 ML 100 12 100 1200
    00019132316 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 320 LIEBEL FLARSHEIM 1 ML 150 12 150 1800
    00019132321 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 320 LIEBEL FLARSHEIM 1 ML 200 12 200 2400
    00019132327 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 320 LIEBEL FLARSHEIM 1 ML 125 20 125 2500
    00019132352 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 320 LIEBEL FLARSHEIM 1 ML 50 20 50 1000
    00019132361 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 320 LIEBEL FLARSHEIM 1 ML 500 6 500 3000
    00019132365 Q9967 Locm 300-399mg/ml iodine,1ml IOVERSOL INJECTION 678 MG/ML LIEBEL FLARSHEIM 1 ML 500 6 500 3000
    00019132378 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 320 LIEBEL FLARSHEIM 1 ML 50 20 50 1000
    00019132385 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 320 LIEBEL FLARSHEIM 1 ML 75 20 75 1500
    00019132387 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 320 LIEBEL FLARSHEIM 1 ML 125 20 125 2500
    00019132390 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 320 LIEBEL FLARSHEIM 1 ML 100 20 100 2000
    00019132395 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 320 LIEBEL FLARSHEIM 1 ML 75 20 75 1500
    00019133200 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 300 LIEBEL FLARSHEIM 1 ML 100 20 100 2000
    00019133206 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 300 LIEBEL FLARSHEIM 1 ML 50 25 50 1250
    00019133211 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 300 LIEBEL FLARSHEIM 1 ML 100 12 100 1200
    00019133216 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 300 LIEBEL FLARSHEIM 1 ML 150 12 150 1800
    00019133221 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 300 LIEBEL FLARSHEIM 1 ML 200 12 200 2400
    00019133261 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 300 LIEBEL FLARSHEIM 1 ML 500 6 500 3000
    00019133265 Q9967 Locm 300-399mg/ml iodine,1ml IOVERSOL INJECTION 636 MG/ML LIEBEL FLARSHEIM 1 ML 500 6 500 3000
    00019133290 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 300 LIEBEL FLARSHEIM 1 ML 100 20 100 2000
    00019133300 Q9967 Locm 300-399mg/ml iodine,1ml Oxilan 350 LIEBEL FLARSHEIM 1 ML 100 20 100 2000
    00019133306 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 350 LIEBEL FLARSHEIM 1 ML 50 25 50 1250
    00019133311 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 350 LIEBEL FLARSHEIM 1 ML 100 12 100 1200
    00019133316 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 350 LIEBEL FLARSHEIM 1 ML 150 12 150 1800
    00019133321 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 350 LIEBEL FLARSHEIM 1 ML 200 12 200 2400
    00019133327 Q9967 Locm 300-399mg/ml iodine,1ml Oxilan 350 LIEBEL FLARSHEIM 1 ML 125 20 125 2500
    00019133361 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 350 LIEBEL FLARSHEIM 1 ML 500 6 500 3000
    00019133365 Q9967 Locm 300-399mg/ml iodine,1ml IOVERSOL INJECTION 741 MG/ML LIEBEL FLARSHEIM 1 ML 500 6 500 3000
    00019133378 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 350 LIEBEL FLARSHEIM 1 ML 50 20 50 1000
    00019133387 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 350 LIEBEL FLARSHEIM 1 ML 125 20 125 2500
    00019133390 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 350 LIEBEL FLARSHEIM 1 ML 100 20 100 2000
    00019133395 Q9967 Locm 300-399mg/ml iodine,1ml Optiray 350 LIEBEL FLARSHEIM 1 ML 75 20 75 1500
    00270131525 Q9967 Locm 300-399mg/ml iodine,1ml Isovue-300 BRACCO DIAGNOSTICS 1 ML 30 10 30 300
    00270131530 Q9967 Locm 300-399mg/ml iodine,1ml Isovue-300 BRACCO DIAGNOSTICS 1 ML 50 10 50 500
    00270131535 Q9967 Locm 300-399mg/ml iodine,1ml Isovue-300 BRACCO DIAGNOSTICS 1 ML 100 10 100 1000
    00270131545 Q9967 Locm 300-399mg/ml iodine,1ml Isovue-300 BRACCO DIAGNOSTICS 1 ML 200 10 200 2000
    00270131595 Q9967 Locm 300-399mg/ml iodine,1ml Isovue-300 BRACCO DIAGNOSTICS 1 ML 500 6 500 3000
    00270131604 Q9967 Locm 300-399mg/ml iodine,1ml Isovue-370 BRACCO DIAGNOSTICS 1 ML 125 10 125 1250
    00270131630 Q9967 Locm 300-399mg/ml iodine,1ml Isovue-370 BRACCO DIAGNOSTICS 1 ML 50 10 50 500
    00270131635 Q9967 Locm 300-399mg/ml iodine,1ml Isovue-370 BRACCO DIAGNOSTICS 1 ML 100 10 100 1000
    00270131637 Q9967 Locm 300-399mg/ml iodine,1ml Isovue-370 BRACCO DIAGNOSTICS 1 ML 150 10 150 1500
    00270131645 Q9967 Locm 300-399mg/ml iodine,1ml Isovue-370 BRACCO DIAGNOSTICS 1 ML 200 10 200 2000
    00270131652 Q9967 Locm 300-399mg/ml iodine,1ml Isovue-370 BRACCO DIAGNOSTICS 1 ML 75 10 75 750
    00270131695 Q9967 Locm 300-399mg/ml iodine,1ml Isovue-370 BRACCO DIAGNOSTICS 1 ML 500 6 500 3000
    00270141215 Q9967 Locm 300-399mg/ml iodine,1ml Isovue-M-300 BRACCO DIAGNOSTICS 1 ML 15 10 15 150
    00270730010 Q9967 Locm 300-399mg/ml iodine,1ml IOMERON Astrazeneca Pharmaceuticals, Lp 1 ML 100 56 100 5600
    00270730020 Q9967 Locm 300-399mg/ml iodine,1ml IOMERON Astrazeneca Pharmaceuticals, Lp 1 ML 200 10 200 2000
    00407141310 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 300 GE HEALTHCARE 1 ML 10 10 10 100
    00407141348 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 300 (Novaplus) GE HEALTHCARE 1 ML 500 10 500 5000
    00407141353 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 300 GE HEALTHCARE 1 ML 125 10 125 1250
    00407141359 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 300 GE HEALTHCARE 1 ML 30 10 30 300
    00407141361 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 300 GE HEALTHCARE 1 ML 50 10 50 500
    00407141362 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 300 GE HEALTHCARE 1 ML 75 10 75 750
    00407141363 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 300 GE HEALTHCARE 1 ML 100 10 100 1000
    00407141365 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 300 GE HEALTHCARE 1 ML 150 10 150 1500
    00407141366 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 300 GE HEALTHCARE 1 ML 200 10 200 2000
    00407141368 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 300 GE HEALTHCARE 1 ML 500 10 500 5000
    00407141369 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 300 GE HEALTHCARE 1 ML 125 10 125 1250
    00407141372 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 300 GE HEALTHCARE 1 ML 500 10 500 5000
    00407141386 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 300 GE HEALTHCARE 1 ML 50 10 50 500
    00407141387 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 300 GE HEALTHCARE 1 ML 100 10 100 1000
    00407141388 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 300 GE HEALTHCARE 1 ML 150 10 150 1500
    00407141389 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 300 GE HEALTHCARE 1 ML 500 10 500 5000
    00407141448 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 350 (Novaplus) GE HEALTHCARE 1 ML 500 10 500 5000
    00407141472 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 350 GE HEALTHCARE 1 ML 500 10 500 5000
    00407141476 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 350 GE HEALTHCARE 1 ML 125 10 125 1250
    00407141482 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 350 GE HEALTHCARE 1 ML 50 10 50 500
    00407141484 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 350 GE HEALTHCARE 1 ML 100 10 100 1000
    00407141485 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 350 GE HEALTHCARE 1 ML 125 10 125 1250
    00407141486 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 350 GE HEALTHCARE 1 ML 150 10 150 1500
    00407141487 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 350 GE HEALTHCARE 1 ML 200 10 200 2000
    00407141488 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 350 GE HEALTHCARE 1 ML 500 10 500 5000
    00407141489 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 350 GE HEALTHCARE 1 ML 50 10 50 500
    00407141490 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 350 GE HEALTHCARE 1 ML 75 10 75 750
    00407141491 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 350 GE HEALTHCARE 1 ML 100 10 100 1000
    00407141493 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 350 GE HEALTHCARE 1 ML 150 10 150 1500
    00407141494 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 350 GE HEALTHCARE 1 ML 200 10 200 2000
    00407141495 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 350 GE HEALTHCARE 1 ML 125 10 125 1250
    00407141498 Q9967 Locm 300-399mg/ml iodine,1ml Omnipaque 350 GE HEALTHCARE 1 ML 500 10 500 5000
    00407222316 Q9967 Locm 300-399mg/ml iodine,1ml Visipaque 320 GE HEALTHCARE 1 ML 50 10 50 500
    00407222317 Q9967 Locm 300-399mg/ml iodine,1ml Visipaque 320 GE HEALTHCARE 1 ML 100 10 100 1000
    00407222319 Q9967 Locm 300-399mg/ml iodine,1ml Visipaque 320 GE HEALTHCARE 1 ML 150 10 150 1500
    00407222321 Q9967 Locm 300-399mg/ml iodine,1ml Visipaque 320 GE HEALTHCARE 1 ML 200 10 200 2000
    00407222323 Q9967 Locm 300-399mg/ml iodine,1ml Visipaque 320 GE HEALTHCARE 1 ML 500 10 500 5000
    00407222362 Q9967 Locm 300-399mg/ml iodine,1ml Visipaque 320 GE HEALTHCARE 1 ML 50 10 50 500
    00407222364 Q9967 Locm 300-399mg/ml iodine,1ml Visipaque 320 GE HEALTHCARE 1 ML 100 10 100 1000
    00407222366 Q9967 Locm 300-399mg/ml iodine,1ml Visipaque 320 GE HEALTHCARE 1 ML 150 10 150 1500
    00407222367 Q9967 Locm 300-399mg/ml iodine,1ml Visipaque 320 GE HEALTHCARE 1 ML 200 10 200 2000
    50419034405 Q9967 Locm 300-399mg/ml iodine,1ml Ultravist 300 BAYER HEALTHCARE PHARMACEUTICALS INC. 1 ML 50 10 50 500
    50419034410 Q9967 Locm 300-399mg/ml iodine,1ml Ultravist 300 BAYER HEALTHCARE PHARMACEUTICALS INC. 1 ML 100 10 100 1000
    50419034412 Q9967 Locm 300-399mg/ml iodine,1ml Ultravist 300 BAYER HEALTHCARE PHARMACEUTICALS INC. 1 ML 125 10 125 1250
    50419034415 Q9967 Locm 300-399mg/ml iodine,1ml Ultravist 300 BAYER HEALTHCARE PHARMACEUTICALS INC. 1 ML 150 10 150 1500
    50419034421 Q9967 Locm 300-399mg/ml iodine,1ml Ultravist 300 BAYER HEALTHCARE PHARMACEUTICALS INC. 1 ML 200 10 200 2000
    50419034458 Q9967 Locm 300-399mg/ml iodine,1ml Ultravist 300 BAYER HEALTHCARE PHARMACEUTICALS INC. 1 ML 500 8 500 4000
    50419034605 Q9967 Locm 300-399mg/ml iodine,1ml Ultravist 370 BAYER HEALTHCARE PHARMACEUTICALS INC. 1 ML 50 10 50 500
    50419034610 Q9967 Locm 300-399mg/ml iodine,1ml Ultravist 370 BAYER HEALTHCARE PHARMACEUTICALS INC. 1 ML 100 10 100 1000
    50419034615 Q9967 Locm 300-399mg/ml iodine,1ml Ultravist 370 BAYER HEALTHCARE PHARMACEUTICALS INC. 1 ML 150 10 150 1500
    50419034620 Q9967 Locm 300-399mg/ml iodine,1ml Ultravist 370 BAYER HEALTHCARE PHARMACEUTICALS INC. 1 ML 200 10 200 2000
    50419034625 Q9967 Locm 300-399mg/ml iodine,1ml Ultravist 370 BAYER HEALTHCARE PHARMACEUTICALS INC. 1 ML 250 10 250 2500
    50419034658 Q9967 Locm 300-399mg/ml iodine,1ml Ultravist 370 BAYER HEALTHCARE PHARMACEUTICALS INC. 1 ML 500 8 500 4000
    65219038305 Q9967 Locm 300-399mg/ml iodine,1ml IODIXANOL FRESENIUS KABI USA 1 ML 50 10 50 500
    65219038310 Q9967 Locm 300-399mg/ml iodine,1ml IODIXANOL FRESENIUS KABI USA 1 ML 100 10 100 1000
    65219038350 Q9967 Locm 300-399mg/ml iodine,1ml IODIXANOL FRESENIUS KABI USA 1 ML 150 10 150 1500
    65219038370 Q9967 Locm 300-399mg/ml iodine,1ml IODIXANOL FRESENIUS KABI USA 1 ML 200 10 200 2000
    70436012682 Q9967 Locm 300-399mg/ml iodine,1ml IOPAMIDOL SLATE RUN PHARMACEUTICALS, LLC 1 ML 15 10 15 150
    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