Phoxillum B22K4/0 NDC 24571-117

NDC codes

FDA NDC Directory

Product NDC (as listed)24571-117Labeler and product segments. Claims need a package NDC.

Product NDC at billing width24571-0117Add 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
24571-117-06	24571011706	2 BAG in 1 CASE (24571-117-06) / 5 L in 1 BAGMarketed from Jan 13, 2015

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): Phoxillum B22K4/0Suffix: B22K4/0
Generic name (nonproprietary): magnesium chloride, sodium chloride, sodium bicarbonate, potassium chloride, and sodium phosphate dibasic dihydrate
Active ingredients: Magnesium chloride — 3.05 g/LSodium chloride — 6.95 g/LSodium bicarbonate — 2.21 g/LPotassium chloride — .314 g/LSodium phosphate, Dibasic — .187 g/L
Dosage form: Injection
Route: Intravenous
Labeler: Vantive US Healthcare LLC
Product type: Prescription drug
Marketing category: NDA — New Drug ApplicationApplication NDA 207026
Marketing start: Jan 13, 2015
Listing expires: Dec 31, 2027
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)Inhibition Small Intestine Fluid/Electrolyte Absorption (Physiologic effect)Magnesium Ion Exchange 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 24571-117_3744e93f-f360-485a-bad4-948c168127c2SPL ID 3744e93f-f360-485a-bad4-948c168127c2SPL set ID 7f675fee-8940-4ece-bb0c-75ac79d8708cUNII 33X04XA5AT, 8MDF5V39QO, M4I0D6VV5M, 5SL0G7R0OK, 660YQ98I10, GR686LBA74, 02F3473H9O, 451W47IQ8X
Pharmacologic class: Calculi Dissolution Agent; 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 drug-specific HCPCS code in Med-Code's directory for this product. The directory is curated and not complete — check the current CMS HCPCS file before billing.

Administration

Drug administration (CPT 96360–96549)

When a clinician administers the drug, the administration is reported separately. Codes in this range cover hydration, therapeutic injections and infusions, and chemotherapy or other complex drug administration. The right code depends on route, duration and drug type, and self-administered drugs are not billed this way.

How CPT relates to drug billing

NDC on a medical claim

N424571011706 followed by a unit qualifier and the quantity

Package 24571-0117-06. 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 May 31, 2025.

Indications (excerpt from the label)

PRISMASOL and PHOXILLUM solutions are indicated in pediatric and adult patients for use as a replacement solution in Continuous Renal Replacement Therapy (CRRT) to replace plasma volume removed by ultrafiltration and to correct electrolyte and acid-base imbalances. They may also be used in case of drug poisoning when CRRT is used to remove dialyzable substances. PRISMASOL and PHOXILLUM solutions are indicated: • As a replacement solution in Continuous Renal Replacement Therapy (CRRT) and in case of drug poisoning when CRRT is used to remove dialyzable substances ( 1 )

Excerpt only. Read the full label for complete information.

Full label on DailyMed (opens in a new tab)

Other NDCs under NDA 207026

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

FDA NDC Directory listings under NDA 207026
Product	Strength	Form · route	Labeler	Product NDC
Phoxillum Bk4/2.5calcium chloride, magnesium chloride, sodium chloride, sodium bicarbonate, potassium chloride, and sodium phosphate dibasic dihydrate	Calcium chloride 3.68 g/L + 5 more ingredients	InjectionIntravenous	Vantive US Healthcare LLC	24571-116