Tissen Icm 10 Liquid
NDC Package 42491-1200-2

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

Package Information

Tissen Icm 10 (adenosine) liquids is directions:1. This formulation utilizes a liquid delivery system. Marketed by Dalim Tissen, this product is identified by NDC 42491-1200.

Identification & Billing

NDC Package Code
42491-1200-2
Package Description
8 CONTAINER in 1 CARTON / 13 mL in 1 CONTAINER (42491-1200-1)
Product Code
42491-1200
11-Digit Billing Format
42491120002

Clinical Specifications

Proprietary Name
Tissen Icm 10
Non-Proprietary Name
Adenosine
Substance Name
Adenosine
Dosage Form
Liquid - A dosage form consisting of a pure chemical in its liquid1 state. This dosage form term should not be applied to solutions.
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)
ADENOSINE .005 g/13mL
Pharmacologic Class
Usage Information
Directions:1. Wash the face and pat dry skin. Do not use toner before applying this product.2. Pull the facial mask out of the sterilized tube with the pincers provided.3. Unfold the mask and apply gently to face. Carefully position the mask around the eyes and mouth to cover localized lines and wrinkles. Press firmly in place and smooth out any bubbles.4. For best results, keep on face for 20 minutes. Then mist face with purified water to rehydrate the mask and keep contact with skin for another 20 minutes.5. Before the mask is completely dried, remove it gently from the bottom up.6. Apply Tissen NF-10 if desired prior to your regular moisturizer.7. Nighttime application of mask is recommended 1-2 times a week.8. Store in a refrigerator (2-15℃) after each use

Regulatory & Marketing

Labeler Name
Dalim Tissen
Product Type
Human Otc Drug
Marketing Category
UNAPPROVED DRUG OTHER - An unapproved drug product in a marketing category that is not reflected on a particular list.
Start Marketing Date
11-01-2019
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 42491-1200-2 identifies a specific commercial package of 8 container in 1 carton / 13 ml in 1 container (42491-1200-1) of Tissen Icm 10, a human over the counter drug labeled by Dalim Tissen. This liquid is formulated for topical use and contains adenosine 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 Dalim Tissen on November 01, 2019. The current certification is valid through December 31, 2026.

How is this Dalim Tissen product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 42491120002. 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)
42491-1200-2
11-Digit CMS (5-4-2)
42491-1200-02

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