J9017

Code

J9017

Description

Injection, arsenic trioxide, 1 mg

CMS HCPCS quarterly update

• 00781-3498-94 Arsenic Trioxide, Sandoz Inc.. Billable units per 11-digit NDC: 12.
• 00781-3498-95 Arsenic Trioxide, Sandoz Inc.. Billable units per 11-digit NDC: 120.
• 14789-0600-10 Arsenic Trioxide, Nexus Pharmaceuticals, LLC. Billable units per 11-digit NDC: 100.
• 23155-0869-41 Arsenic Trioxide, Heritage Pharmaceuticals Inc.. Billable units per 11-digit NDC: 100.
• 23155-0870-41 Arsenic Trioxide, Heritage Pharmaceuticals Inc.. Billable units per 11-digit NDC: 120.
• 25021-0226-10 Arsenic Trioxide, Sagent Pharmaceuticals. Billable units per 11-digit NDC: 100.
• 25021-0227-06 Arsenic Trioxide, Sagent Pharmaceuticals. Billable units per 11-digit NDC: 120.
• 50742-0438-10 Arsenic Trioxide, Ingenus Pharmaceuticals LLC. Billable units per 11-digit NDC: 10.
• 63323-0637-10 Arsenic Trioxide, FreseniUS Kabi USA, LLC. Billable units per 11-digit NDC: 100.
• 63459-0601-06 Trisenox, Cephalon, LLC. Billable units per 11-digit NDC: 120.
• 68382-0997-10 Arsenic Trioxide, Zydus Pharmaceuticals (USA) Inc.. Billable units per 11-digit NDC: 100.
• 69918-0720-02 Arsenic Trioxide, Nordic Pharma, Inc. Billable units per 11-digit NDC: 20.
• 69918-0720-10 Arsenic Trioxide, Nordic Pharma, Inc. Billable units per 11-digit NDC: 100.
• 70121-1483-07 Arsenic Trioxide, Amneal Pharmaceuticals, LLC. Billable units per 11-digit NDC: 100.
• 70121-1658-01 Arsenic Trioxide, Amneal Pharmaceuticals, LLC. Billable units per 11-digit NDC: 120.
• 70710-1610-06 Arsenic Trioxide, Zydus Pharmaceuticals (USA) Inc.. Billable units per 11-digit NDC: 120.
• 70710-1895-06 Arsenic Trioxide, Zydus Pharmaceuticals (USA) Inc.. Billable units per 11-digit NDC: 100.
• 70710-1896-06 Arsenic Trioxide, Zydus Pharmaceuticals (USA) Inc.. Billable units per 11-digit NDC: 120.
• 70860-0217-10 Arsenic Trioxide, Athenex Pharmaceutical Division, LLC. Billable units per 11-digit NDC: 10.
• 72205-0171-07 Arsenic Trioxide, Novadoz Pharmaceuticals LLC. Billable units per 11-digit NDC: 100.
• 72205-0172-07 Arsenic Trioxide, Novadoz Pharmaceuticals LLC. Billable units per 11-digit NDC: 120.
• 72603-0339-10 Arsenic Trioxide, Northstar RxLLC. Billable units per 11-digit NDC: 100.

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