NDC codes

FDA NDC Directory
Product NDC (as listed)58264-0004Labeler and product segments. Claims need a package NDC.
Product NDC at billing width58264-0004Add 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 NDC11-digit (billing)PackageCopy
58264-0004-15826400040129.57 mL in 1 BOTTLE, GLASS (58264-0004-1)Marketed from Jan 1, 1990

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)
D-4
Generic name (nonproprietary)
quinine arsenite, phosphoric acid, matricaria chamomilla, citrullus colocynthis fruit pulp, mercuric chloride, veratrum album root, baptisia tinctoria, ferrosoferric phosphate, nerium oleander leaf, and toxicodendron pubescens leaf
Active ingredients
Quinine arsenite — 12 [hp_X]/mLPhosphoric acid — 3 [hp_X]/mLMatricaria chamomilla — 4 [hp_X]/mLCitrullus colocynthis fruit pulp — 6 [hp_X]/mLMercuric chloride — 5 [hp_X]/mLVeratrum album root — 6 [hp_X]/mLBaptisia tinctoria — 4 [hp_X]/mLFerrosoferric phosphate — 8 [hp_X]/mLNerium oleander leaf — 6 [hp_X]/mLToxicodendron pubescens leaf — 4 [hp_X]/mL
Dosage form
Solution
Route
Sublingual
Product type
Over-the-counter drug
Marketing category
Unapproved homeopathic
Marketing start
Listing expires
Identifiers
Product ID 58264-0004_2b9ea1fc-59a3-8189-e063-6394a90a9ae6SPL ID 2b9ea1fc-59a3-8189-e063-6394a90a9ae6SPL set ID 45577059-73f4-4302-b299-3e356aaf959aUNII 42QO5P0NLM, E4GA8884NN, G0R4UBI2ZZ, 23H32AOH17, 53GH7MZT1R, QNS6W5US1Z, 5K1UO2888Y, 91GQH8I5F7, 7KV510R6H6, 6IO182RP7A
Pharmacologic class
Antimalarial

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

NDC on a medical claim

N458264000401 followed by a unit qualifier and the quantity

Package 58264-0004-01. 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 .

Indications (excerpt from the label)

INDICATIONS Diarrhea.

Excerpt only. Read the full label for complete information.

Full label on DailyMed (opens in a new tab)

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