Photrexa Viscous
NDC Package 25357-022-01

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 discontinued by the firm.

Photrexa Viscous is a . Marketed by Glaukos Corporation, this product is identified by NDC 25357-022 and is authorized under FDA application NDA203324.

Identification & Billing

NDC Package Code
25357-022-01
Package Description
10 POUCH in 1 BOX / 1 POUCH in 1 POUCH / 1 SYRINGE, GLASS in 1 POUCH / 3 mL in 1 SYRINGE, GLASS
Product Code
25357-022
11-Digit Billing Format
25357002201
Billing Unit
ML - Billing unit of "milliliter" is used when a product is measured by its liquid volume.

Clinical Specifications

Proprietary Name
Photrexa Viscous
Dosage Form
-

Regulatory & Marketing

Labeler Name
Glaukos Corporation
FDA Application #
NDA203324
Marketing Category
NDA - A product marketed under an approved New Drug Application.
Start Marketing Date
04-15-2016
End Marketing Date
06-19-2025
Listing Expiration
06-19-2025
Exclude Flag
D
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 25357-022-01 identifies a specific commercial package of 10 pouch in 1 box / 1 pouch in 1 pouch / 1 syringe, glass in 1 pouch / 3 ml in 1 syringe, glass of Photrexa Viscous, labeled by Glaukos Corporation. 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 Glaukos Corporation on April 15, 2016. The current certification is valid through June 19, 2025.

How is this Glaukos Corporation product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 25357002201. Quantities are measured in per "ml or milliliter", products billed per milliliter are usually products measured by liquid volume.. 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)
25357-022-01
11-Digit CMS (5-4-2)
25357-0022-01

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