J0643

Code

J0643

Description

Injection, leucovorin calcium, not otherwise specified, 1 mg

CMS HCPCS quarterly update

• 00143-9368-01 Leucovorin Calcium, Hikma Pharmaceuticals USA Inc.. Billable units per 11-digit NDC: 200.
• 00143-9552-01 Leucovorin Calcium, Hikma Pharmaceuticals USA Inc.. Billable units per 11-digit NDC: 350.
• 00143-9553-01 Leucovorin Calcium, Hikma Pharmaceuticals USA Inc.. Billable units per 11-digit NDC: 200.
• 00143-9554-01 Leucovorin Calcium, Hikma Pharmaceuticals USA Inc.. Billable units per 11-digit NDC: 100.
• 00143-9555-01 Leucovorin Calcium, Hikma Pharmaceuticals USA Inc.. Billable units per 11-digit NDC: 50.
• 25021-0813-10 Leucovorin Calcium, Sagent Pharmaceuticals. Billable units per 11-digit NDC: 500.
• 25021-0814-30 Leucovorin Calcium, Sagent Pharmaceuticals. Billable units per 11-digit NDC: 100.
• 25021-0815-30 Leucovorin Calcium, Sagent Pharmaceuticals. Billable units per 11-digit NDC: 200.
• 25021-0816-30 Leucovorin Calcium, Sagent Pharmaceuticals. Billable units per 11-digit NDC: 350.
• 25021-0816-67 Leucovorin Calcium, Sagent Pharmaceuticals. Billable units per 11-digit NDC: 350.
• 25021-0828-50 Leucovorin Calcium, Sagent Pharmaceuticals. Billable units per 11-digit NDC: 500.
• 63323-0631-10 Leucovorin Calcium, FreseniUS Kabi USA, LLC. Billable units per 11-digit NDC: 100.
• 63323-0631-50 Leucovorin Calcium, FreseniUS Kabi USA, LLC. Billable units per 11-digit NDC: 500.
• 63323-0710-50 Leucovorin Calcium, FreseniUS Kabi USA, LLC. Billable units per 11-digit NDC: 200.
• 63323-0711-00 Leucovorin Calcium, FreseniUS Kabi USA, LLC. Billable units per 11-digit NDC: 500.
• 67457-0528-10 Leucovorin Calcium, Mylan Institutional LLC. Billable units per 11-digit NDC: 100.
• 67457-0529-20 Leucovorin Calcium, Mylan Institutional LLC. Billable units per 11-digit NDC: 200.
• 67457-0530-35 Leucovorin Calcium, Mylan Institutional LLC. Billable units per 11-digit NDC: 350.
• 68001-0416-36 Leucovorin Calcium, BluePoint Laboratories. Billable units per 11-digit NDC: 100.
• 68001-0417-37 Leucovorin Calcium, BluePoint Laboratories. Billable units per 11-digit NDC: 200.
• 68001-0418-38 Leucovorin Calcium, BluePoint Laboratories. Billable units per 11-digit NDC: 350.
• 68001-0648-36 Leucovorin Calcium, BluePoint Laboratories. Billable units per 11-digit NDC: 100.
• 68001-0649-37 Leucovorin Calcium, BluePoint Laboratories. Billable units per 11-digit NDC: 200.
• 68001-0650-38 Leucovorin Calcium, BluePoint Laboratories. Billable units per 11-digit NDC: 350.
• 68462-0767-35 Leucovorin Calcium, Glenmark Pharmaceuticals Inc., Usa. Billable units per 11-digit NDC: 350.
• 70436-0116-82 Leucovorin Calcium, Slate Run Pharmaceuticals. Billable units per 11-digit NDC: 500.
• 70436-0117-80 Leucovorin Calcium, Slate Run Pharmaceuticals. Billable units per 11-digit NDC: 100.
• 70436-0118-80 Leucovorin Calcium, Slate Run Pharmaceuticals. Billable units per 11-digit NDC: 200.
• 70436-0119-80 Leucovorin Calcium, Slate Run Pharmaceuticals. Billable units per 11-digit NDC: 350.
• 70436-0120-80 Leucovorin Calcium, Slate Run Pharmaceuticals. Billable units per 11-digit NDC: 500.
• 71288-0160-10 Leucovorin Calcium, Meitheal Pharmaceuticals Inc.. Billable units per 11-digit NDC: 50.
• 71288-0161-20 Leucovorin Calcium, Meitheal Pharmaceuticals Inc.. Billable units per 11-digit NDC: 100.
• 71288-0162-30 Leucovorin Calcium, Meitheal Pharmaceuticals Inc.. Billable units per 11-digit NDC: 200.
• 71288-0163-30 Leucovorin Calcium, Meitheal Pharmaceuticals Inc.. Billable units per 11-digit NDC: 350.
• 71288-0164-50 Leucovorin Calcium, Meitheal Pharmaceuticals Inc.. Billable units per 11-digit NDC: 500.

Source: CMS ASP NDC-HCPCS crosswalk, effective October 1, 2026 through December 31, 2026.