Tissen ICM 10 (adenosine) NDC 42491-1200

NDC codes

FDA NDC Directory

Product NDC (as listed)42491-1200Labeler and product segments. Claims need a package NDC.

Product NDC at billing width42491-1200Add 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
42491-1200-2	42491120002	8 CONTAINER in 1 CARTON (42491-1200-2) / 13 mL in 1 CONTAINER (42491-1200-1)Marketed from Nov 1, 2019

How the 11-digit form is made: The package segment has 1 digit, so one leading zero is added to it (5-4-1 → 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): Tissen ICM 10
Generic name (nonproprietary): adenosine
Active ingredients: Adenosine — .005 g/13mL
Dosage form: Liquid
Route: Topical
Labeler: Dalim Tissen
Product type: Over-the-counter drug
Marketing category: Unapproved drug (other)
Marketing start: Nov 1, 2019
Listing expires: Dec 31, 2026
Other FDA classes: Adenosine Receptor Agonists (Mechanism)
Identifiers: Product ID 42491-1200_27b81aae-a8b6-27c4-e063-6394a90accf4SPL ID 27b81aae-a8b6-27c4-e063-6394a90accf4SPL set ID a2f648e2-0f8e-4635-9169-3185e8fbeb92UNII K72T3FS567
Pharmacologic class: Adenosine Receptor Agonist

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. Topical products like this are usually dispensed by a pharmacy and billed by NDC.

NDC on a medical claim

N442491120002 followed by a unit qualifier and the quantity

Package 42491-1200-02. 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 Nov 25, 2024.

Indications (excerpt from the label)

Uses Uses: Decrease the appearance of fine lines, wrinkles, scarring and discolorations of the skin

Excerpt only. Read the full label for complete information.

Full label on DailyMed (opens in a new tab)