Lidopro Patch
NDC Package 80425-0374-1

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

Package Information

Lidopro Patch (lidocaine, menthol, and methyl salicylate) patches is adults and children over 12 years:clean and dry the affected arearemove patch from plastic liner and place on the affected areause 1 patch for up to 12 hoursplace used patch on the liner when not in usere-use the patch up to 2 times.children 12 years or younger: ask a doctorDistributed by Advanced Rx Pharmacy of Tennessee, LLC. This formulation utilizes a patch delivery system. Marketed by Advanced Rx Pharmacy Of Tennessee, Llc, this product is identified by NDC 80425-0374 and is authorized under FDA application M017.

Identification & Billing

NDC Package Code
80425-0374-1
Package Description
15 POUCH in 1 BOX / 2 PATCH in 1 POUCH / 8500 mg in 1 PATCH
Product Code
80425-0374
11-Digit Billing Format
80425037401
Billing Unit
EA - Billing unit of "each" is used when the product is dispensed in discreet units.
Units Per Package
1 EA
RxNorm Crosswalk
  • RxCUI: 2675022 - lidocaine 4 % / menthol 0.5 % / methyl salicylate 0.1 % Medicated Patch
  • RxCUI: 2675022 - lidocaine 0.04 MG/MG / menthol 0.005 MG/MG / methyl salicylate 0.001 MG/MG Medicated Patch
  • RxCUI: 2675024 - LidoPro Patch 4 % / 0.5 % / 0.1 % Medicated Patch
  • RxCUI: 2675024 - lidocaine 0.04 MG/MG / menthol 0.005 MG/MG / methyl salicylate 0.001 MG/MG Medicated Patch [LidoPro Patch]
  • RxCUI: 2675024 - LidoPro Patch (lidocaine 4 % / menthol 0.5 % / methyl salicylate 0.1 % ) Medicated Patch

Clinical Specifications

Proprietary Name
Lidopro Patch
Non-Proprietary Name
Lidocaine, Menthol, And Methyl Salicylate
Substance Name
Lidocaine; Menthol; Methyl Salicylate
Dosage Form
Patch - A drug delivery system that often contains an adhesive backing that is usually applied to an external site on the body. Its ingredients either passively diffuse from, or are actively transported from, some portion of the patch. Depending upon the patch, the ingredients are either delivered to the outer surface of the body or into the body. A patch is sometimes synonymous with the terms ‘extended release film’ and ‘system’.
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)
Pharmacologic Class
Usage Information
Adults and children over 12 years:clean and dry the affected arearemove patch from plastic liner and place on the affected areause 1 patch for up to 12 hoursplace used patch on the liner when not in usere-use the patch up to 2 times.children 12 years or younger: ask a doctorDistributed by Advanced Rx Pharmacy of Tennessee, LLC

Regulatory & Marketing

Labeler Name
Advanced Rx Pharmacy Of Tennessee, Llc
Product Type
Human Otc Drug
FDA Application #
M017
Marketing Category
OTC MONOGRAPH DRUG -
Start Marketing Date
02-29-2024
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 80425-0374-1 identifies a specific commercial package of 15 pouch in 1 box / 2 patch in 1 pouch / 8500 mg in 1 patch of Lidopro Patch, a human over the counter drug labeled by Advanced Rx Pharmacy Of Tennessee, Llc. This product is billed for "EA" each discreet unit and contains an estimated amount of 1 billable units per package. This patch is formulated for topical use and contains lidocaine; menthol; methyl salicylate 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 Advanced Rx Pharmacy Of Tennessee, Llc on February 29, 2024. The current certification is valid through December 31, 2026.

How is this Advanced Rx Pharmacy Of Tennessee, Llc product billed for insurance claims?

For medical billing and reimbursement, this package follows the 11-digit CMS format: 80425037401. Quantities are measured in per "each", products billed on a per each basis are usually products dispensed in discreet units.. There are 1 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 (5-4-1)
80425-0374-1
11-Digit CMS (5-4-2)
80425-0374-01

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