Ultram Er
NDC Package 21695-913-30

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.

Ultram Er is indicated for the management of moderate to moderately severe chronic pain in adults who require around-the-clock treatment of their pain for an extended period of time. Marketed by Rebel Distributors Corp, this product is identified by NDC 21695-913 and is authorized under FDA application NDA021692.

Identification & Billing

NDC Package Code
21695-913-30
Package Description
30 TABLET, EXTENDED RELEASE in 1 BOTTLE
Product Code
21695-913
11-Digit Billing Format
21695091330
Billing Unit
EA - Billing unit of "each" is used when the product is dispensed in discreet units.
Units Per Package
30 EA
RxNorm Crosswalk
  • RxCUI: 833709 - traMADol HCl 100 MG 24HR Extended Release Oral Tablet
  • RxCUI: 833709 - 24 HR tramadol hydrochloride 100 MG Extended Release Oral Tablet
  • RxCUI: 833709 - tramadol hydrochloride 100 MG 24 HR Extended Release Oral Tablet
  • RxCUI: 833711 - traMADol HCl 200 MG 24HR Extended Release Oral Tablet
  • RxCUI: 833711 - 24 HR tramadol hydrochloride 200 MG Extended Release Oral Tablet

Clinical Specifications

Proprietary Name
Ultram Er
Dosage Form
-
Usage Information
ULTRAM ER is indicated for the management of moderate to moderately severe chronic pain in adults who require around-the-clock treatment of their pain for an extended period of time.

Regulatory & Marketing

Labeler Name
Rebel Distributors Corp
FDA Application #
NDA021692
Marketing Category
NDA - A product marketed under an approved New Drug Application.
Start Marketing Date
09-08-2005
Listing Expiration
12-31-2017
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 21695-913-30 identifies a specific commercial package of 30 tablet, extended release in 1 bottle of Ultram Er, labeled by Rebel Distributors Corp. This product is billed for "EA" each discreet unit and contains an estimated amount of 30 billable units per package. 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 Rebel Distributors Corp on September 08, 2005. The current certification is valid through December 31, 2017.

How is this Rebel Distributors Corp product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 21695091330. Quantities are measured in per "each", products billed on a per each basis are usually products dispensed in discreet units.. There are 30 total billable units per package. 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)
21695-913-30
11-Digit CMS (5-4-2)
21695-0913-30

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