Giltuss Allergy Plus Solution
NDC Package 65852-017-04

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

Package Information

Giltuss Allergy Plus (chlorpheniramine maleate, dextromethorphan hydrobromide, phenylephrine hydrochloride) solution is directionsDo not take more than 6 doses in any 24 hours perioduse enclosed dosing cupKeep dosage cup for use with this productml= millilitersAdults and children 12 years & over 10 ml every 4 to 6 hoursChildren 6 to under 12 years of age 5 ml every 4 to 6 hoursChildren under 6 years of age Consult a doctorhildren under 6 years of age Consult a doctor. This formulation utilizes a solution delivery system. Marketed by Dextrum Laboratories Inc., this product is identified by NDC 65852-017 and is authorized under FDA application M012.

Identification & Billing

NDC Package Code
65852-017-04
Package Description
1 BOTTLE, PLASTIC in 1 CARTON / 118 mL in 1 BOTTLE, PLASTIC
Product Code
65852-017
11-Digit Billing Format
65852001704
RxNorm Crosswalk
  • RxCUI: 1363752 - chlorpheniramine maleate 2 MG / dextromethorphan HBr 10 MG / phenylephrine HCl 5 MG in 5 mL Oral Solution
  • RxCUI: 1363752 - chlorpheniramine maleate 0.4 MG/ML / dextromethorphan hydrobromide 2 MG/ML / phenylephrine hydrochloride 1 MG/ML Oral Solution
  • RxCUI: 1363752 - chlorpheniramine maleate 2 MG / dextromethorphan HBr 10 MG / phenylephrine HCl 5 MG per 5 ML Oral Solution

Clinical Specifications

Proprietary Name
Giltuss Allergy Plus
Non-Proprietary Name
Chlorpheniramine Maleate, Dextromethorphan Hydrobromide, Phenylephrine Hydrochloride
Substance Name
Chlorpheniramine Maleate; Dextromethorphan Hydrobromide; Phenylephrine Hydrochloride
Dosage Form
Solution - A clear, homogeneous liquid1 dosage form that contains one or more chemical substances dissolved in a solvent or mixture of mutually miscible solvents.
Administration Route
Oral - Administration to or by way of the mouth.
Active Ingredient(s)
Pharmacologic Class
Usage Information
DirectionsDo not take more than 6 doses in any 24 hours perioduse enclosed dosing cupKeep dosage cup for use with this productml= millilitersAdults and children 12 years & over 10 ml every 4 to 6 hoursChildren 6 to under 12 years of age 5 ml every 4 to 6 hoursChildren under 6 years of age Consult a doctorhildren under 6 years of age Consult a doctor

Regulatory & Marketing

Labeler Name
Dextrum Laboratories Inc.
Product Type
Human Otc Drug
FDA Application #
M012
Marketing Category
OTC MONOGRAPH DRUG -
Start Marketing Date
10-02-2018
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 65852-017-04 identifies a specific commercial package of 1 bottle, plastic in 1 carton / 118 ml in 1 bottle, plastic of Giltuss Allergy Plus, a human over the counter drug labeled by Dextrum Laboratories Inc.. This solution is formulated for oral use and contains chlorpheniramine maleate; dextromethorphan hydrobromide; phenylephrine hydrochloride 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 Dextrum Laboratories Inc. on October 02, 2018. The current certification is valid through December 31, 2026.

How is this Dextrum Laboratories Inc. product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 65852001704. 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)
65852-017-04
11-Digit CMS (5-4-2)
65852-0017-04

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