INOMAX billing codes for reimbursement

National Drug Codes (NDCs)

  • 64693-002-01 Size D portable aluminum cylinder containing 353 liters at STP of nitric oxide gas in 800 ppm concentration in nitrogen (delivered volume 344 liters).
  • 64693-002-02 Size 88 aluminum cylinder containing 1963 liters at STP of nitric oxide gas in 800 ppm concentration in nitrogen (delivered volume 1918 liters).

ICD-10-CM Procedure Code

  • 3E0F7SD Administration of inhaled nitric oxide (nitric oxide therapy).

Billing Revenue Codes

  • 636 Drug requiring detailed HCPCS coding 250 Pharmacy: general 259 Pharmacy: other

Healthcare Common Procedure Coding System (HCPCS)

  • J3490 Unclassified drug

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