Polytussin Dm Syrup
NDC Package 50991-132-16

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

Package Information

Polytussin Dm (dextromethorphan hbr, phenylephrine hcl, pyrilamine maleate) syrups is usestemporarily relieves these symptoms due to the common cold, hay fever (allergic rhinitis) or other upper respiratory allergies:runny nosesneezingitching of nose or throatitchy, watery eyescough due to minor throat and bronchial irritationnasal congestionreduces swelling of nasal passages. This formulation utilizes a syrup delivery system. Marketed by Poly Pharmaceuticals, Inc., this product is identified by NDC 50991-132 and is authorized under FDA application M012.

Identification & Billing

NDC Package Code
50991-132-16
Package Description
480 mL in 1 BOTTLE
Product Code
50991-132
11-Digit Billing Format
50991013216
Billing Unit
ML - Billing unit of "milliliter" is used when a product is measured by its liquid volume.
Units Per Package
480 ML
RxNorm Crosswalk
  • RxCUI: 2639753 - dextromethorphan HBr 7.5 MG / phenylephrine HCl 5 MG / pyrilamine maleate 12.5 MG in 5 mL Oral Solution
  • RxCUI: 2639753 - dextromethorphan hydrobromide 1.5 MG/ML / phenylephrine hydrochloride 1 MG/ML / pyrilamine maleate 2.5 MG/ML Oral Solution
  • RxCUI: 2639753 - dextromethorphan hydrobromide 7.5 MG / phenylephrine hydrochloride 5 MG / pyrilamine maleate 12.5 MG per 5 ML Oral Solution

Clinical Specifications

Proprietary Name
Polytussin Dm
Non-Proprietary Name
Dextromethorphan Hbr, Phenylephrine Hcl, Pyrilamine Maleate
Substance Name
Dextromethorphan Hydrobromide; Phenylephrine Hydrochloride; Pyrilamine Maleate
Dosage Form
Syrup - An oral solution containing high concentrations of sucrose or other sugars; the term has also been used to include any other liquid dosage form prepared in a sweet and viscid vehicle, including oral suspensions.
Administration Route
Oral - Administration to or by way of the mouth.
Active Ingredient(s)
Pharmacologic Class
Usage Information
Usestemporarily relieves these symptoms due to the common cold, hay fever (allergic rhinitis) or other upper respiratory allergies:runny nosesneezingitching of nose or throatitchy, watery eyescough due to minor throat and bronchial irritationnasal congestionreduces swelling of nasal passages

Regulatory & Marketing

Labeler Name
Poly Pharmaceuticals, Inc.
Product Type
Human Otc Drug
FDA Application #
M012
Marketing Category
OTC MONOGRAPH DRUG -
Start Marketing Date
06-08-2023
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.

Other Available Packages

The following commercial packages are registered under the same Product NDC (50991-132). Click a package code to view its specific billing and regulatory data.

50991-132-15
15 mL in 1 BOTTLE

* 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 50991-132-16 identifies a specific commercial package of 480 ml in 1 bottle of Polytussin Dm, a human over the counter drug labeled by Poly Pharmaceuticals, Inc.. This syrup is formulated for oral use and contains dextromethorphan hydrobromide; phenylephrine hydrochloride; pyrilamine maleate 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 Poly Pharmaceuticals, Inc. on June 08, 2023. The current certification is valid through December 31, 2026.

How is this Poly Pharmaceuticals, Inc. product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 50991013216. Quantities are measured in per "ml or milliliter", products billed per milliliter are usually products measured by liquid volume.. There are 480 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)
50991-132-16
11-Digit CMS (5-4-2)
50991-0132-16

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