PEG-3350 and Electrolytes NDC 10572-100

NDC codes

FDA NDC Directory

Product NDC (as listed)10572-100Labeler and product segments. Claims need a package NDC.

Product NDC at billing width10572-0100Add the package segment from the table below.

Package NDCs as listed with the FDA, and the 11-digit 5-4-2 form used on claims. The highlighted digit is the added leading zero.
Package NDC	11-digit (billing)	Package	Copy
10572-100-01	10572010001	4 L in 1 JUG (10572-100-01)Marketed from Jul 1, 2009

How the 11-digit form is made: The product segment has 3 digits, so one leading zero is added to it (5-3-2 → 5-4-2). Formatting the NDC does not by itself make it billable — the product, package and quantity must match what was dispensed or administered, and payer rules apply. Conversion rules

Product information

Brand name (proprietary): PEG-3350 and Electrolytes
Generic name (nonproprietary): polyethylene glycol 3350, sodium sulfate anhydrous, sodium bicarbonate, sodium chloride, potassium chloride
Active ingredients: Polyethylene glycol 3350 — 236 g/4LSodium sulfate anhydrous — 22.74 g/4LSodium bicarbonate — 6.74 g/4LSodium chloride — 5.86 g/4LPotassium chloride — 2.97 g/4L
Dosage form: Powder, For solution
Route: Oral
Labeler: Affordable Pharmaceuticals, LLC
Product type: Prescription drug
Marketing category: NDA authorized genericApplication NDA 019011
Marketing start: Jul 1, 2009
Listing expires: Dec 31, 2026
Other FDA classes: Increased Large Intestinal Motility (Physiologic effect)Increased Large Intestinal Motility (Physiologic effect)Increased Large Intestinal Motility (Physiologic effect)Increased Large Intestinal Motility (Physiologic effect)Inhibition Large Intestine Fluid/Electrolyte Absorption (Physiologic effect)Inhibition Large Intestine Fluid/Electrolyte Absorption (Physiologic effect)Inhibition Large Intestine Fluid/Electrolyte Absorption (Physiologic effect)Inhibition Large Intestine Fluid/Electrolyte Absorption (Physiologic effect)Osmotic Activity (Mechanism)Osmotic Activity (Mechanism)Osmotic Activity (Mechanism)Osmotic Activity (Mechanism)Osmotic Activity (Mechanism)Potassium Compounds (Chemical structure)Stimulation Large Intestine Fluid/Electrolyte Secretion (Physiologic effect)
Identifiers: Product ID 10572-100_e9bdf1ea-2513-c298-e053-2a95a90a601eSPL ID e9bdf1ea-2513-c298-e053-2a95a90a601eSPL set ID 448db7a5-1fea-4bf3-b1f5-e9d027a36603RxCUI 966920UNII G2M7P15E5P, 36KCS0R750, 8MDF5V39QO, 451W47IQ8X, 660YQ98I10
Pharmacologic class: Osmotic Laxative; Potassium Salt

Billing references

What Med-Code can say about coding this product, and where each statement comes from. Nothing here is inferred from the name alone.

HCPCS codeNo match

No HCPCS code in Med-Code's directory. Oral products like this are usually dispensed by a pharmacy and billed by NDC.

NDC on a medical claim

N410572010001 followed by a unit qualifier and the quantity

Package 10572-0100-01. Unit qualifiers: F2 (international unit), GR (gram), ME (milligram), ML (milliliter), UN (unit (each)). The qualifier and quantity depend on what was given. About the N4 qualifier

Product label

Current FDA label (SPL), effective Sep 28, 2022.

Indications (excerpt from the label)

PEG-3350 and Electrolytes for Oral Solution is indicated for bowel cleansing prior to colonoscopy and barium enema X-ray examination in adults. PEG-3350 and Electrolytes for Oral Solution is a combination of PEG 3350, an osmotic laxative, and electrolytes indicated for cleansing of the colon in preparation for colonoscopy and barium enema X-ray examination in adults ( 1 )

Excerpt only. Read the full label for complete information.

Full label on DailyMed (opens in a new tab)

Other NDCs under NDA 019011

Products listed under the same FDA application: other strengths and forms, and repackagers who relabel the same product.

FDA NDC Directory listings under NDA 019011
Product	Strength	Form · route	Labeler	Product NDC
PEG 3350 and Electrolytespolyethylene glycol 3350, sodium sulfate anhydrous, sodium bicarbonate, sodium chloride, potassium chloride	Polyethylene glycol 3350 236 g/4L + 4 more ingredients	Powder, For solutionOral	Wilshire Pharmaceuticals, Inc.	52536-236
GoLYTELYpolyethylene glycol 3350, sodium sulfate anhydrous, sodium bicarbonate, sodium chloride, potassium chloride	Polyethylene glycol 3350 236 g/4L + 4 more ingredients	Powder, For solutionOral	Braintree Laboratories, Inc.	52268-100
PEG 3350 and Electrolytespolyethylene glycol 3350, sodium sulfate anhydrous, sodium bicarbonate, sodium chloride, potassium chloride	Polyethylene glycol 3350 236 g/4L + 4 more ingredients	Powder, For solutionOral	A-S Medication Solutions	50090-8020
PEG-3350 and Electrolytespolyethylene glycol 3350, sodium sulfate anhydrous, sodium bicarbonate, sodium chloride, potassium chloride	Polyethylene glycol 3350 236 g/4L + 4 more ingredients	Powder, For solutionOral	A-S Medication Solutions	50090-6521
GoLYTELYpolyethylene glycol 3350, sodium sulfate anhydrous, sodium bicarbonate, sodium chloride, potassium chloride	Polyethylene glycol 3350 236 g/4L + 4 more ingredients	Powder, For solutionOral	Azurity Pharmaceuticals, Inc.	24338-236