Liquid Bandage Liquid
NDC Package 79903-485-30

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

Package Information

Liquid Bandage (benzethonium chloride and dyclonine hydrochloride) liquids is for adults and children 2 years of age and olderClean affected areaapply a small amount on the area 1-3 times dailylet drya second coating may be applied for extra protectionchildren under 2 years of age: consult a doctor. This formulation utilizes a liquid delivery system. Marketed by Wal-mart Stores, Inc., this product is identified by NDC 79903-485 and is authorized under FDA application M003.

Identification & Billing

NDC Package Code
79903-485-30
Package Description
29.6 mL in 1 BOTTLE, WITH APPLICATOR
Product Code
79903-485
11-Digit Billing Format
79903048530

Clinical Specifications

Proprietary Name
Liquid Bandage
Non-Proprietary Name
Benzethonium Chloride And Dyclonine Hydrochloride
Substance Name
Benzethonium Chloride; Dyclonine Hydrochloride
Dosage Form
Liquid - A dosage form consisting of a pure chemical in its liquid1 state. This dosage form term should not be applied to solutions.
Administration Route
Topical - Administration to a particular spot on the outer surface of the body. The E2B term TRANSMAMMARY is a subset of the term TOPICAL.
Active Ingredient(s)
Usage Information
For adults and children 2 years of age and olderClean affected areaapply a small amount on the area 1-3 times dailylet drya second coating may be applied for extra protectionchildren under 2 years of age: consult a doctor

Regulatory & Marketing

Labeler Name
Wal-mart Stores, Inc.
Product Type
Human Otc Drug
FDA Application #
M003
Marketing Category
OTC MONOGRAPH DRUG -
Start Marketing Date
01-12-2012
Listing Expiration
12-31-2027
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 79903-485-30 identifies a specific commercial package of 29.6 ml in 1 bottle, with applicator of Liquid Bandage, a human over the counter drug labeled by Wal-mart Stores, Inc.. This liquid is formulated for topical use and contains benzethonium chloride; dyclonine 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 Wal-mart Stores, Inc. on January 12, 2012. The current certification is valid through December 31, 2027.

How is this Wal-mart Stores, Inc. product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 79903048530. 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)
79903-485-30
11-Digit CMS (5-4-2)
79903-0485-30

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