HCPCS J9017

Injection, arsenic trioxide, 1 mg

HCPCS Information

HCPCS Code: J9017
The Healthcare Common Procedure Coding System (HCPCS) is a set of unique alphanumeric codes used to report medical procedures and services to healthcare programs like Medicare and Medicaid. HCPCS codes are used in conjunction with NDC codes for billing and medical documentation puporses. For instance, HCPCS J9017 identifies the type of service or supply used while any of the 20 NDC codes below could be used to specify the exact drug used.
Short Description
Arsenic trioxide injection
Long Description
Injection, arsenic trioxide, 1 mg
Pricing Indicator
Drugs
Multiple Pricing Indicator
Not applicable as HCPCS priced under one methodology
Coverage Description
Carrier judgment
BETOS Type of Service
Chemotherapy
Medicare Payment Limit
$5.86
Medicare Co-Insurance Percentage
20.000%
HCPCS Classification
List of HCPCS codes for: Drugs Administered Other Than Oral Method, Chemotherapy Drugs (J-codes)

HCPCS Crossover to NDC Codes

The NDC codes below allow precise billing based on the specific manufacturer and medication used:

NDC Proprietary Name Non-Proprietary Name Dosage Form Route Name Company Name Status
0781-3498Arsenic Trioxide Arsenic TrioxideInjection, SolutionIntravenousSandoz IncACTIVE
14789-600Arsenic Trioxide Arsenic TrioxideInjectionIntravenousNexus Pharmaceuticals LlcACTIVE
23155-869Arsenic Trioxide Arsenic TrioxideInjectionIntravenousHeritage Pharma Labs Inc. D/b/a Avet Pharmaceuticals IncACTIVE
23155-870Arsenic Trioxide Arsenic TrioxideInjectionIntravenousHeritage Pharma Labs Inc. D/b/a Avet Pharmaceuticals IncACTIVE
25021-226Arsenic Trioxide Arsenic TrioxideInjectionIntravenousSagent PharmaceuticalsACTIVE
25021-227Arsenic Trioxide Arsenic TrioxideInjectionIntravenousSagent PharmaceuticalsACTIVE
50742-438Arsenic Trioxide Arsenic TrioxideInjectionIntravenousIngenus Pharmaceuticals, LlcACTIVE
55150-366Arsenic Trioxide Arsenic TrioxideInjection, SolutionIntravenousEugia Us LlcACTIVE
63323-637Arsenic Trioxide Arsenic TrioxideInjection, SolutionIntravenousFresenius Kabi Usa, LlcACTIVE
63459-601Trisenox Arsenic TrioxideInjection, SolutionIntravenousCephalon, LlcACTIVE
68382-997Arsenic Trioxide Arsenic TrioxideInjection, SolutionIntravenousZydus Pharmaceuticals Usa Inc.ACTIVE
69918-720Arsenic Trioxide Arsenic TrioxideInjection, SolutionIntravenousNordic Pharma, Inc.ACTIVE
70121-1483Arsenic Trioxide Arsenic TrioxideInjection, SolutionIntravenousAmneal Pharmaceuticals LlcACTIVE
70121-1658Arsenic Trioxide Arsenic TrioxideInjection, SolutionIntravenousAmneal Pharmaceuticals LlcACTIVE
70710-1610Arsenic Trioxide Arsenic TrioxideInjection, SolutionIntravenousZydus Pharmaceuticals Usa Inc.ACTIVE
70710-1895Arsenic Trioxide Arsenic TrioxideInjection, SolutionIntravenousZydus Pharmaceuticals Usa Inc.ACTIVE
70710-1896Arsenic Trioxide Arsenic TrioxideInjection, SolutionIntravenousZydus Pharmaceuticals Usa Inc.ACTIVE
70860-217Arsenic Trioxide Athenex Pharmaceutical Division, Llc
72205-171Arsenic Trioxide Arsenic TrioxideInjection, SolutionIntravenousNovadoz Pharmaceuticals LlcACTIVE
72603-339Arsenic Trioxide Arsenic TrioxideInjection, SolutionIntravenousNorthstar Rx LlcACTIVE