Lidocaine Hydrochloride
NDC Package 69103-5000-0

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 inactivated by the FDA.

Lidocaine Hydrochloride is clean affected area apply small amount not more than 3 times daily children under 2: consult a doctor. Marketed by Provision Medical, this product is identified by NDC 69103-5000 and is authorized under FDA application part348.

Identification & Billing

NDC Package Code
69103-5000-0
Package Description
.9 g in 1 PACKET
Product Code
69103-5000
11-Digit Billing Format
69103500000

Clinical Specifications

Proprietary Name
Lidocaine Hydrochloride
Dosage Form
-
Usage Information
Clean affected area apply small amount not more than 3 times daily children under 2: consult a doctor

Regulatory & Marketing

Labeler Name
Provision Medical
FDA Application #
part348
Marketing Category
OTC MONOGRAPH NOT FINAL - A product marketed pursuant to an Over-the-Counter (OTC) Drug Monograph that is not final.
Start Marketing Date
07-25-2022
Listing Expiration
12-31-2023
Exclude Flag
I
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 69103-5000-0 identifies a specific commercial package of .9 g in 1 packet of Lidocaine Hydrochloride, labeled by Provision Medical. 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 Provision Medical on July 25, 2022. The current certification is valid through December 31, 2023.

How is this Provision Medical product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 69103500000. 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)
69103-5000-0
11-Digit CMS (5-4-2)
69103-5000-00

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