Q9967

Code

Q9967

Description

Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml

CMS HCPCS quarterly update

• 00019-1323-06 Optiray 320, Liebel-Flarsheim Company LLC. Billable units per 11-digit NDC: 1250.
• 00019-1323-11 Optiray 320, Liebel-Flarsheim Company LLC. Billable units per 11-digit NDC: 1200.
• 00019-1323-16 Optiray 320, Liebel-Flarsheim Company LLC. Billable units per 11-digit NDC: 1800.
• 00019-1323-21 Optiray 320, Liebel-Flarsheim Company LLC. Billable units per 11-digit NDC: 2400.
• 00019-1323-52 Optiray 320, Liebel-Flarsheim Company LLC. Billable units per 11-digit NDC: 1000.
• 00019-1323-65 Ioversol Injection 678 MG/ML, Liebel-Flarsheim Company LLC. Billable units per 11-digit NDC: 3000.
• 00019-1323-78 Optiray 320, Liebel-Flarsheim Company LLC. Billable units per 11-digit NDC: 1000.
• 00019-1323-87 Optiray 320, Liebel-Flarsheim Company LLC. Billable units per 11-digit NDC: 2500.
• 00019-1323-90 Optiray 320, Liebel-Flarsheim Company LLC. Billable units per 11-digit NDC: 2000.
• 00019-1323-95 Optiray 320, Liebel-Flarsheim Company LLC. Billable units per 11-digit NDC: 1500.
• 00019-1333-06 Optiray 350, Liebel-Flarsheim Company LLC. Billable units per 11-digit NDC: 1250.
• 00019-1333-11 Optiray 350, Liebel-Flarsheim Company LLC. Billable units per 11-digit NDC: 1200.
• 00019-1333-16 Optiray 350, Liebel-Flarsheim Company LLC. Billable units per 11-digit NDC: 1800.
• 00019-1333-21 Optiray 350, Liebel-Flarsheim Company LLC. Billable units per 11-digit NDC: 2400.
• 00019-1333-65 Ioversol Injection 741 MG/ML, Liebel-Flarsheim Company LLC. Billable units per 11-digit NDC: 3000.
• 00019-1333-78 Optiray 350, Liebel-Flarsheim Company LLC. Billable units per 11-digit NDC: 1000.
• 00019-1333-87 Optiray 350, Liebel-Flarsheim Company LLC. Billable units per 11-digit NDC: 2500.
• 00019-1333-90 Optiray 350, Liebel-Flarsheim Company LLC. Billable units per 11-digit NDC: 2000.
• 00019-1333-95 Optiray 350, Liebel-Flarsheim Company LLC. Billable units per 11-digit NDC: 1500.
• 00270-1315-25 Isovue-300, Bracco Diagnostics Inc.. Billable units per 11-digit NDC: 300.
• 00270-1315-35 Isovue-300, Bracco Diagnostics Inc.. Billable units per 11-digit NDC: 1000.
• 00270-1315-45 Isovue-300, Bracco Diagnostics Inc.. Billable units per 11-digit NDC: 2000.
• 00270-1315-95 Isovue-300, Bracco Diagnostics Inc.. Billable units per 11-digit NDC: 3000.
• 00270-1316-35 Isovue-370, Bracco Diagnostics Inc.. Billable units per 11-digit NDC: 1000.
• 00270-1316-45 Isovue-370, Bracco Diagnostics Inc.. Billable units per 11-digit NDC: 2000.
• 00270-1316-95 Isovue-370, Bracco Diagnostics Inc.. Billable units per 11-digit NDC: 3000.
• 00270-1412-15 Isovue-M-300, Bracco Diagnostics Inc.. Billable units per 11-digit NDC: 150.
• 00270-7300-10 Iomeron, Bracco Diagnostics Inc.. Billable units per 11-digit NDC: 5600.
• 00270-7300-20 Iomeron, Bracco Diagnostics Inc.. Billable units per 11-digit NDC: 2000.
• 00407-1413-10 Omnipaque 300, GE Healthcare Inc.. Billable units per 11-digit NDC: 100.
• 00407-1413-48 Omnipaque 300 (Novaplus), GE Healthcare Inc.. Billable units per 11-digit NDC: 5000.
• 00407-1413-53 Omnipaque 300, GE Healthcare Inc.. Billable units per 11-digit NDC: 1250.
• 00407-1413-59 Omnipaque 300, GE Healthcare Inc.. Billable units per 11-digit NDC: 300.
• 00407-1413-61 Omnipaque 300, GE Healthcare Inc.. Billable units per 11-digit NDC: 500.
• 00407-1413-62 Omnipaque 300, GE Healthcare Inc.. Billable units per 11-digit NDC: 750.
• 00407-1413-63 Omnipaque 300, GE Healthcare Inc.. Billable units per 11-digit NDC: 1000.
• 00407-1413-65 Omnipaque 300, GE Healthcare Inc.. Billable units per 11-digit NDC: 1500.
• 00407-1413-66 Omnipaque 300, GE Healthcare Inc.. Billable units per 11-digit NDC: 2000.
• 00407-1413-68 Omnipaque 300, GE Healthcare Inc.. Billable units per 11-digit NDC: 5000.
• 00407-1413-69 Omnipaque 300, GE Healthcare Inc.. Billable units per 11-digit NDC: 1250.
• 00407-1413-72 Omnipaque 300, GE Healthcare Inc.. Billable units per 11-digit NDC: 5000.
• 00407-1413-86 Omnipaque 300, GE Healthcare Inc.. Billable units per 11-digit NDC: 500.
• 00407-1413-87 Omnipaque 300, GE Healthcare Inc.. Billable units per 11-digit NDC: 1000.
• 00407-1413-88 Omnipaque 300, GE Healthcare Inc.. Billable units per 11-digit NDC: 1500.
• 00407-1413-89 Omnipaque 300, GE Healthcare Inc.. Billable units per 11-digit NDC: 5000.
• 00407-1414-48 Omnipaque 350 (Novaplus), GE Healthcare Inc.. Billable units per 11-digit NDC: 5000.
• 00407-1414-72 Omnipaque 350, GE Healthcare Inc.. Billable units per 11-digit NDC: 5000.
• 00407-1414-76 Omnipaque 350, GE Healthcare Inc.. Billable units per 11-digit NDC: 1250.
• 00407-1414-82 Omnipaque 350, GE Healthcare Inc.. Billable units per 11-digit NDC: 500.
• 00407-1414-84 Omnipaque 350, GE Healthcare Inc.. Billable units per 11-digit NDC: 1000.
• 00407-1414-85 Omnipaque 350, GE Healthcare Inc.. Billable units per 11-digit NDC: 1250.
• 00407-1414-86 Omnipaque 350, GE Healthcare Inc.. Billable units per 11-digit NDC: 1500.
• 00407-1414-87 Omnipaque 350, GE Healthcare Inc.. Billable units per 11-digit NDC: 2000.
• 00407-1414-88 Omnipaque 350, GE Healthcare Inc.. Billable units per 11-digit NDC: 5000.
• 00407-1414-89 Omnipaque 350, GE Healthcare Inc.. Billable units per 11-digit NDC: 500.
• 00407-1414-90 Omnipaque 350, GE Healthcare Inc.. Billable units per 11-digit NDC: 750.
• 00407-1414-91 Omnipaque 350, GE Healthcare Inc.. Billable units per 11-digit NDC: 1000.
• 00407-1414-93 Omnipaque 350, GE Healthcare Inc.. Billable units per 11-digit NDC: 1500.
• 00407-1414-94 Omnipaque 350, GE Healthcare Inc.. Billable units per 11-digit NDC: 2000.
• 00407-1414-95 Omnipaque 350, GE Healthcare Inc.. Billable units per 11-digit NDC: 1250.
• 00407-1414-98 Omnipaque 350, GE Healthcare Inc.. Billable units per 11-digit NDC: 5000.
• 00407-2223-16 Visipaque 320, GE Healthcare Inc.. Billable units per 11-digit NDC: 500.
• 00407-2223-17 Visipaque 320, GE Healthcare Inc.. Billable units per 11-digit NDC: 1000.
• 00407-2223-19 Visipaque 320, GE Healthcare Inc.. Billable units per 11-digit NDC: 1500.
• 00407-2223-21 Visipaque 320, GE Healthcare Inc.. Billable units per 11-digit NDC: 2000.
• 00407-2223-23 Visipaque 320, GE Healthcare Inc.. Billable units per 11-digit NDC: 5000.
• 00407-2223-62 Visipaque 320, GE Healthcare Inc.. Billable units per 11-digit NDC: 500.
• 00407-2223-64 Visipaque 320, GE Healthcare Inc.. Billable units per 11-digit NDC: 1000.
• 00407-2223-66 Visipaque 320, GE Healthcare Inc.. Billable units per 11-digit NDC: 1500.
• 00407-2223-67 Visipaque 320, GE Healthcare Inc.. Billable units per 11-digit NDC: 2000.
• 50419-0344-05 Ultravist 300, Bayer HealthCare Pharmaceuticals Inc.. Billable units per 11-digit NDC: 500.
• 50419-0344-10 Ultravist 300, Bayer HealthCare Pharmaceuticals Inc.. Billable units per 11-digit NDC: 1000.
• 50419-0344-12 Ultravist 300, Bayer HealthCare Pharmaceuticals Inc.. Billable units per 11-digit NDC: 1250.
• 50419-0344-15 Ultravist 300, Bayer HealthCare Pharmaceuticals Inc.. Billable units per 11-digit NDC: 1500.
• 50419-0344-21 Ultravist 300, Bayer HealthCare Pharmaceuticals Inc.. Billable units per 11-digit NDC: 2000.
• 50419-0344-23 Ultravist 300, Bayer HealthCare Pharmaceuticals Inc.. Billable units per 11-digit NDC: 2000.
• 50419-0344-58 Ultravist 300, Bayer HealthCare Pharmaceuticals Inc.. Billable units per 11-digit NDC: 4000.
• 50419-0344-65 Ultravist 300, Bayer HealthCare Pharmaceuticals Inc.. Billable units per 11-digit NDC: 4000.
• 50419-0346-05 Ultravist 370, Bayer HealthCare Pharmaceuticals Inc.. Billable units per 11-digit NDC: 500.
• 50419-0346-10 Ultravist 370, Bayer HealthCare Pharmaceuticals Inc.. Billable units per 11-digit NDC: 1000.
• 50419-0346-15 Ultravist 370, Bayer HealthCare Pharmaceuticals Inc.. Billable units per 11-digit NDC: 1500.
• 50419-0346-20 Ultravist 370, Bayer HealthCare Pharmaceuticals Inc.. Billable units per 11-digit NDC: 2000.
• 50419-0346-25 Ultravist 370, Bayer HealthCare Pharmaceuticals Inc.. Billable units per 11-digit NDC: 2500.
• 50419-0346-28 Ultravist 370, Bayer HealthCare Pharmaceuticals Inc.. Billable units per 11-digit NDC: 2000.
• 50419-0346-58 Ultravist 370, Bayer HealthCare Pharmaceuticals Inc.. Billable units per 11-digit NDC: 4000.
• 50419-0346-65 Ultravist 370, Bayer HealthCare Pharmaceuticals Inc.. Billable units per 11-digit NDC: 4000.
• 65219-0383-05 Iodixanol, FreseniUS Kabi USA, LLC. Billable units per 11-digit NDC: 500.
• 65219-0383-10 Iodixanol, FreseniUS Kabi USA, LLC. Billable units per 11-digit NDC: 1000.
• 65219-0383-50 Iodixanol, FreseniUS Kabi USA, LLC. Billable units per 11-digit NDC: 1500.
• 65219-0383-70 Iodixanol, FreseniUS Kabi USA, LLC. Billable units per 11-digit NDC: 2000.
• 70436-0126-82 Iodixanol, Slate Run Pharmaceuticals. Billable units per 11-digit NDC: 150.
• 70436-0127-82 Iopamidol, Slate Run Pharmaceuticals. Billable units per 11-digit NDC: 1000.
• 70436-0219-52 Iopamidol, Slate Run Pharmaceuticals. Billable units per 11-digit NDC: 300.
• 70436-0219-62 Iopamidol, Slate Run Pharmaceuticals. Billable units per 11-digit NDC: 500.
• 70436-0219-82 Iopamidol, Slate Run Pharmaceuticals. Billable units per 11-digit NDC: 1000.

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