Draximage Maa Injection, Powder, For Solution
NDC Package 65174-270-30

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

Package Information

Draximage Maa (kit for the preparation of technetium tc 99m albumin aggregated) injection is technetium Tc 99m Albumin Aggregated Injection is a lung imaging agent which may be used as an adjunct in the evaluation of pulmonary perfusion in adults and pediatric patients.Technetium Tc 99m Albumin Aggregated Injection may be used in adults as an imaging agent to aid in the evaluation of peritoneovenous (LeVeen) shunt patency. This formulation utilizes a injection, powder, for solution delivery system. Marketed by Jubilant Draximage Inc, this product is identified by NDC 65174-270 and is authorized under FDA application BLA017881.

Identification & Billing

NDC Package Code
65174-270-30
Package Description
30 INJECTION, POWDER, FOR SOLUTION in 1 KIT
Product Code
65174-270
11-Digit Billing Format
65174027030
Billing Unit
EA - Billing unit of "each" is used when the product is dispensed in discreet units.
Units Per Package
30 EA

Clinical Specifications

Proprietary Name
Draximage Maa
Non-Proprietary Name
Kit For The Preparation Of Technetium Tc 99m Albumin Aggregated
Substance Name
Albumin Aggregated
Dosage Form
Injection, Powder, For Solution - A sterile preparation intended for reconstitution to form a solution for parenteral use.
Administration Route
Intravenous - Administration within or into a vein or veins.
Active Ingredient(s)
ALBUMIN AGGREGATED 2.5 mg/1
Usage Information
Technetium Tc 99m Albumin Aggregated Injection is a lung imaging agent which may be used as an adjunct in the evaluation of pulmonary perfusion in adults and pediatric patients.Technetium Tc 99m Albumin Aggregated Injection may be used in adults as an imaging agent to aid in the evaluation of peritoneovenous (LeVeen) shunt patency.

Regulatory & Marketing

Labeler Name
Jubilant Draximage Inc
Product Type
Human Prescription Drug
FDA Application #
BLA017881
Marketing Category
BLA - A product marketed under an approved Biologic License Application.
Start Marketing Date
12-30-1987
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 65174-270-30 identifies a specific commercial package of 30 injection, powder, for solution in 1 kit of Draximage Maa, a human prescription drug labeled by Jubilant Draximage Inc. This product is billed for "EA" each discreet unit and contains an estimated amount of 30 billable units per package. This injection, powder, for solution is formulated for intravenous use and contains albumin aggregated 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 Jubilant Draximage Inc on December 30, 1987. The current certification is valid through December 31, 2026.

How is this Jubilant Draximage Inc product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 65174027030. 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)
65174-270-30
11-Digit CMS (5-4-2)
65174-0270-30

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