Signature Select Pain Relieving Spray
NDC Package 21130-931-01

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

Package Information

Signature Select Pain Relieving (lidocaine hcl, benzalkonium chloride) sprays is ■Adults and children 2 years and older: Cleananddry affectedarea. This formulation utilizes a spray delivery system. Marketed by Safeway/albartsons, this product is identified by NDC 21130-931 and is authorized under FDA application M003.

Identification & Billing

NDC Package Code
21130-931-01
Package Description
148 mL in 1 BOTTLE, SPRAY
Product Code
21130-931
11-Digit Billing Format
21130093101
RxNorm Crosswalk
  • RxCUI: 2047877 - benzalkonium chloride 0.13 % / lidocaine HCl 4 % Topical Spray
  • RxCUI: 2047877 - benzalkonium chloride 1.3 MG/ML / lidocaine hydrochloride 40 MG/ML Topical Spray

Clinical Specifications

Proprietary Name
Signature Select Pain Relieving
Non-Proprietary Name
Lidocaine Hcl, Benzalkonium Chloride
Substance Name
Benzalkonium Chloride; Lidocaine Hydrochloride
Dosage Form
Spray - A liquid minutely divided as by a jet of air or steam.
Administration Route
Topical - Administration to a particular spot on the outer surface of the body. The E2B term TRANSMAMMARY is a subset of the term TOPICAL.
Active Ingredient(s)
Pharmacologic Class
Usage Information
■Adults and children 2 years and older: Cleananddry affectedarea. Shake well;spray small amount on the area 1 to 3 times daily. May be covered witha sterilebandage;let dry first. ■ Children under 2 years af age: ask a doctor

Regulatory & Marketing

Labeler Name
Safeway/albartsons
Product Type
Human Otc Drug
FDA Application #
M003
Marketing Category
OTC MONOGRAPH DRUG -
Start Marketing Date
10-01-2025
Listing Expiration
12-31-2026
Exclude Flag
N
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 21130-931-01 identifies a specific commercial package of 148 ml in 1 bottle, spray of Signature Select Pain Relieving, a human over the counter drug labeled by Safeway/albartsons. This spray is formulated for topical use and contains benzalkonium chloride; lidocaine hydrochloride as the active substance.

Is this product currently listed with the FDA?

Yes, this product is active and verified within the NDC Directory. It was introduced to the market by Safeway/albartsons on October 01, 2025. The current certification is valid through December 31, 2026.

How is this Safeway/albartsons product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 21130093101. 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 (5-3-2)
21130-931-01
11-Digit CMS (5-4-2)
21130-0931-01

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