Simethicone Capsule, Liquid Filled
NDC Package 79903-020-22

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

Package Information

Simethicone capsules is a medication used to relieve symptoms of extra gas such as belching, bloating, and feelings of pressure/discomfort in the stomach/gut. This formulation utilizes a capsule, liquid filled delivery system. Marketed by Walmart Inc., this product is identified by NDC 79903-020 and is authorized under FDA application M002.

Identification & Billing

NDC Package Code
79903-020-22
Package Description
60 CAPSULE, LIQUID FILLED in 1 BOTTLE
Product Code
79903-020
11-Digit Billing Format
79903002022
RxNorm Crosswalk

Clinical Specifications

Proprietary Name
Simethicone
Non-Proprietary Name
Simethicone
Substance Name
Dimethicone
Dosage Form
Capsule, Liquid Filled - A solid dosage form in which the drug is enclosed within a soluble, gelatin shell which is plasticized by the addition of a polyol, such as sorbitol or glycerin, and is therefore of a somewhat thicker consistency than that of a hard shell capsule; typically, the active ingredients are dissolved or suspended in a liquid vehicle.
Administration Route
Oral - Administration to or by way of the mouth.
Active Ingredient(s)
DIMETHICONE 250 mg/1
Pharmacologic Class
Skin Barrier Activity - [PE] (Physiologic Effect)
Usage Information
This product is used to relieve symptoms of extra gas such as belching, bloating, and feelings of pressure/discomfort in the stomach/gut. Simethicone helps break up gas bubbles in the gut.

Regulatory & Marketing

Labeler Name
Walmart Inc.
Product Type
Human Otc Drug
FDA Application #
M002
Marketing Category
OTC MONOGRAPH DRUG -
Start Marketing Date
12-18-2020
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.

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Frequently Asked Questions

What is the distribution configuration for this product package?

The code 79903-020-22 identifies a specific commercial package of 60 capsule, liquid filled in 1 bottle of Simethicone, a human over the counter drug labeled by Walmart Inc.. This capsule, liquid filled is formulated for oral use and contains dimethicone 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 Walmart Inc. on December 18, 2020. The current certification is valid through December 31, 2026.

What are the primary indications for this medication?

This product is used to relieve symptoms of extra gas such as belching, bloating, and feelings of pressure/discomfort in the stomach/gut. Simethicone helps break up gas bubbles in the gut.

How is this Walmart Inc. product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 79903002022. 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)
79903-020-22
11-Digit CMS (5-4-2)
79903-0020-22

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