Two NDC codes currently associated with procedure code 90378 are listed below:

·         Drug Name - Palivizumab (Synagis) 100MG/1ML Vial NDC – 60574411301

·         Drug Name - Palivizumab (Synagis) 50MG/0.5ML Vial NDC – 60574411401

Providers can access specific instructions for entering the NDC on the UB-04 CMS-1450, CMS-1500, and Family Planning 2017 claim forms by viewing the NDC web page. This information was also published in the May/June 2008 Texas Medicaid Bulletin, No. 215 and the May 2008 CSHCN Services Program Provider Bulletin, No. 66.

For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.