Delsym (dextromethorphan)
NDC Package 17856-0276-1

View Billable Units, 11-Digit Conversion Format, and RxNorm mappings
Table of Contents
    1. Package Information
    2. Frequently Asked Questions

Package Information

This product is EXCLUDED from the official NDC directory because the listing data was inactivated by the FDA.

Delsym (dextromethorphan) is shake bottle well before usemeasure only with dosing cup provideddo not use dosing cup with other productsdose as follows or as directed by a doctormL = milliliteradults and children 12 years of age and over10 mL every 12 hours, not to exceed 20 mL in 24 hourschildren 6 to under 12 years of age5 mL every 12 hours, not to exceed 10 mL in 24 hourschildren 4 to under 6 years of age2.5 mL every 12 hours, not to exceed 5 mL in 24 hourschildren under 4 years of agedo not use. Marketed by Atlantic Biologicals Corps, this product is identified by NDC 17856-0276 and is authorized under FDA application NDA018658.

Identification & Billing

NDC Package Code
17856-0276-1
Package Description
10 mL in 1 CUP
Product Code
17856-0276
11-Digit Billing Format
17856027601
RxNorm Crosswalk
  • RxCUI: 1373045 - dextromethorphan polistirex 30 MG in 5 mL 12HR Extended Release Oral Suspension
  • RxCUI: 1373045 - 12 HR dextromethorphan polistirex 6 MG/ML Extended Release Suspension
  • RxCUI: 1373045 - dextromethorphan polistirex (dextromethorphan HBr 30 MG) per 5 ML 12 HR Extended Release Suspension
  • RxCUI: 1373045 - dextromethorphan polistirex 6 MG/ML 12 HR Extended Release Suspension
  • RxCUI: 1373128 - Delsym 30 MG in 5 mL 12HR Extended Release Oral Suspension

Clinical Specifications

Proprietary Name
Delsym (dextromethorphan)
Dosage Form
-
Usage Information
Shake bottle well before usemeasure only with dosing cup provideddo not use dosing cup with other productsdose as follows or as directed by a doctormL = milliliteradults and children 12 years of age and over10 mL every 12 hours, not to exceed 20 mL in 24 hourschildren 6 to under 12 years of age5 mL every 12 hours, not to exceed 10 mL in 24 hourschildren 4 to under 6 years of age2.5 mL every 12 hours, not to exceed 5 mL in 24 hourschildren under 4 years of agedo not use

Regulatory & Marketing

Labeler Name
Atlantic Biologicals Corps
FDA Application #
NDA018658
Marketing Category
NDA - A product marketed under an approved New Drug Application.
Start Marketing Date
08-19-2011
Listing Expiration
12-31-2018
Exclude Flag
I
Sample Package
No

Hierarchy Structure

Code Lineage

The NDC Directory contains ONLY information on final marketed drugs submitted to FDA electronically by labelers. A labeler might be a manufacturer, re-packager or re-labeler. The product information included in the NDC directory does not indicate that FDA has verified the information provided by the product labeler. Assigned NDC numbers are not in any way an indication of FDA approval of the product.

* Please review the full disclaimer at the bottom of this page.

Frequently Asked Questions

What is the distribution configuration for this product package?

The code 17856-0276-1 identifies a specific commercial package of 10 ml in 1 cup of Delsym (dextromethorphan), labeled by Atlantic Biologicals Corps. This is formulated for use and contains as the active substance.

Is this product currently listed with the FDA?

This product code is currently listed as inactive or excluded from the primary directory. It was introduced to the market by Atlantic Biologicals Corps on August 19, 2011. The current certification is valid through December 31, 2018.

How is this Atlantic Biologicals Corps product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 17856027601. The table below illustrates the segment conversion from the 10-digit labeler code to the 11-digit provider format.

11-Digit Code Conversion

Billing payers usually require a 5-4-2 segment configuration. Below is the conversion from the 10-digit package format to the 11-digit billing format:

10-Digit Format (5-4-1)
17856-0276-1
11-Digit CMS (5-4-2)
17856-0276-01

Note: The zero is added to the Package segment to maintain the 5-4-2 structure.