Active substance: Acetaminophen, Aspirin (NSAID) and Caffeine
Excedrin migraine (Acetaminophen, Aspirin (NSAID) and Caffeine) NDC 67414-239 converts to 67414-0239-02 for billing and bills under J0131 at 10 mg = 1 Unit.
Calculate the exact number of billable HCPCS units to report on CMS-1500 / 837P claims based on the patient dose and single-dose vial waste.
| Formulation / role | Package NDC | Product NDC | 11-digit HIPAA | Packaging detail | Copy |
|---|---|---|---|---|---|
| 250 mg/1, 250 mg/1, 65 mg/1 | 67414-239-02 | 67414-239 | 67414-0239-02 | 2000 POUCH in 1 BOX (67414-239-02) / 2 TABLET, FILM COATED in 1 POUCH | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2040-01 | 0067-2040 | 00067-2040-01 | 2 TABLET, FILM COATED in 1 POUCH (0067-2040-01) | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2040-02 | 0067-2040 | 00067-2040-02 | 1 BOTTLE in 1 CARTON (0067-2040-02) / 24 TABLET, FILM COATED in 1 BOTTLE | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2040-03 | 0067-2040 | 00067-2040-03 | 1 BOTTLE in 1 CARTON (0067-2040-03) / 30 TABLET, FILM COATED in 1 BOTTLE | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2040-04 | 0067-2040 | 00067-2040-04 | 1 BOTTLE in 1 CARTON (0067-2040-04) / 50 TABLET, FILM COATED in 1 BOTTLE | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2040-05 | 0067-2040 | 00067-2040-05 | 1 BOTTLE in 1 CARTON (0067-2040-05) / 100 TABLET, FILM COATED in 1 BOTTLE | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2040-06 | 0067-2040 | 00067-2040-06 | 1 BOTTLE in 1 CARTON (0067-2040-06) / 125 TABLET, FILM COATED in 1 BOTTLE | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2040-07 | 0067-2040 | 00067-2040-07 | 1 BOTTLE in 1 CARTON (0067-2040-07) / 200 TABLET, FILM COATED in 1 BOTTLE | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2040-08 | 0067-2040 | 00067-2040-08 | 1 BOTTLE in 1 CARTON (0067-2040-08) / 250 TABLET, FILM COATED in 1 BOTTLE | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2040-09 | 0067-2040 | 00067-2040-09 | 1 BOTTLE in 1 CARTON (0067-2040-09) / 300 TABLET, FILM COATED in 1 BOTTLE | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2040-11 | 0067-2040 | 00067-2040-11 | 1 VIAL in 1 PACKAGE (0067-2040-11) / 8 TABLET, FILM COATED in 1 VIAL | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 85237-1871-1 | 85237-1871 | 85237-1871-01 | 1 POUCH in 1 BLISTER PACK (85237-1871-1) / 2 TABLET, FILM COATED in 1 POUCH | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 85237-1871-2 | 85237-1871 | 85237-1871-02 | 2 POUCH in 1 BLISTER PACK (85237-1871-2) / 2 TABLET, FILM COATED in 1 POUCH | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 85237-1871-3 | 85237-1871 | 85237-1871-03 | 25 POUCH in 1 BOX, UNIT-DOSE (85237-1871-3) / 2 TABLET, FILM COATED in 1 POUCH | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 85237-1871-4 | 85237-1871 | 85237-1871-04 | 50 POUCH in 1 BOX, UNIT-DOSE (85237-1871-4) / 2 TABLET, FILM COATED in 1 POUCH | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 85237-1871-7 | 85237-1871 | 85237-1871-07 | 3 POUCH in 1 BLISTER PACK (85237-1871-7) / 2 TABLET, FILM COATED in 1 POUCH (85237-1871-0) | |
| Inner component | 85237-1871-0 | 85237-1871 | 85237-1871-00 | Inner component of kit (85237-1871-7) | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2035-20 | 0067-2035 | 00067-2035-20 | 1 BOTTLE in 1 CARTON (0067-2035-20) / 20 TABLET, COATED in 1 BOTTLE | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2035-80 | 0067-2035 | 00067-2035-80 | 1 BOTTLE in 1 CARTON (0067-2035-80) / 80 TABLET, COATED in 1 BOTTLE | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 67751-243-02 | 67751-243 | 67751-0243-02 | 2 POUCH in 1 CARTON (67751-243-02) / 2 TABLET, FILM COATED in 1 POUCH | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 66715-6449-3 | 66715-6449 | 66715-6449-03 | 2 POUCH in 1 CARTON (66715-6449-3) / 2 TABLET, FILM COATED in 1 POUCH | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 66715-6549-2 | 66715-6549 | 66715-6549-02 | 3 POUCH in 1 CARTON (66715-6549-2) / 2 TABLET, FILM COATED in 1 POUCH | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2042-01 | 0067-2042 | 00067-2042-01 | 1 BOTTLE in 1 CARTON (0067-2042-01) / 24 TABLET, FILM COATED in 1 BOTTLE | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2042-02 | 0067-2042 | 00067-2042-02 | 1 BOTTLE in 1 CARTON (0067-2042-02) / 30 TABLET, FILM COATED in 1 BOTTLE | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2042-03 | 0067-2042 | 00067-2042-03 | 1 BOTTLE in 1 CARTON (0067-2042-03) / 50 TABLET, FILM COATED in 1 BOTTLE | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2042-04 | 0067-2042 | 00067-2042-04 | 1 BOTTLE in 1 CARTON (0067-2042-04) / 100 TABLET, FILM COATED in 1 BOTTLE | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2042-05 | 0067-2042 | 00067-2042-05 | 1 BOTTLE in 1 CARTON (0067-2042-05) / 125 TABLET, FILM COATED in 1 BOTTLE | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2042-06 | 0067-2042 | 00067-2042-06 | 1 BOTTLE in 1 CARTON (0067-2042-06) / 200 TABLET, FILM COATED in 1 BOTTLE | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2042-07 | 0067-2042 | 00067-2042-07 | 1 BOTTLE in 1 CARTON (0067-2042-07) / 250 TABLET, FILM COATED in 1 BOTTLE | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2042-08 | 0067-2042 | 00067-2042-08 | 300 TABLET, FILM COATED in 1 BOTTLE (0067-2042-08) | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 50090-6093-0 | 50090-6093 | 50090-6093-00 | 1 CASE in 1 CARTON (50090-6093-0) / 576 TABLET, FILM COATED in 1 CASE | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2039-02 | 0067-2039 | 00067-2039-02 | 2 TABLET, FILM COATED in 1 POUCH (0067-2039-02) | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2039-24 | 0067-2039 | 00067-2039-24 | 1 BOTTLE in 1 CARTON (0067-2039-24) / 24 TABLET, FILM COATED in 1 BOTTLE | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2039-30 | 0067-2039 | 00067-2039-30 | 1 BOTTLE in 1 CARTON (0067-2039-30) / 30 TABLET, FILM COATED in 1 BOTTLE | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2039-33 | 0067-2039 | 00067-2039-33 | 1 BOTTLE in 1 CARTON (0067-2039-33) / 300 TABLET, FILM COATED in 1 BOTTLE | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2039-50 | 0067-2039 | 00067-2039-50 | 1 BOTTLE in 1 CARTON (0067-2039-50) / 50 TABLET, FILM COATED in 1 BOTTLE | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2039-77 | 0067-2039 | 00067-2039-77 | 1 BOTTLE in 1 CARTON (0067-2039-77) / 250 TABLET, FILM COATED in 1 BOTTLE | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2039-83 | 0067-2039 | 00067-2039-83 | 1 BOTTLE in 1 CARTON (0067-2039-83) / 125 TABLET, FILM COATED in 1 BOTTLE | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2039-91 | 0067-2039 | 00067-2039-91 | 1 BOTTLE in 1 CARTON (0067-2039-91) / 100 TABLET, FILM COATED in 1 BOTTLE | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-2039-92 | 0067-2039 | 00067-2039-92 | 1 BOTTLE in 1 CARTON (0067-2039-92) / 200 TABLET, FILM COATED in 1 BOTTLE | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 0067-8201-03 | 0067-8201 | 00067-8201-03 | 1 BOTTLE in 1 CARTON (0067-8201-03) / 300 TABLET, FILM COATED in 1 BOTTLE | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 66715-9749-2 | 66715-9749 | 66715-9749-02 | 2 POUCH in 1 CARTON (66715-9749-2) / 2 TABLET, FILM COATED in 1 POUCH | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 66715-9749-3 | 66715-9749 | 66715-9749-03 | 3 POUCH in 1 CARTON (66715-9749-3) / 2 TABLET, FILM COATED in 1 POUCH | |
| 250 mg/1, 250 mg/1, 65 mg/1 | 66715-9749-8 | 66715-9749 | 66715-9749-08 | 30 POUCH in 1 BOX, UNIT-DOSE (66715-9749-8) / 2 TABLET, FILM COATED in 1 POUCH |
Taken from the manufacturer's FDA Structured Product Labeling submission. This is the label as filed, not a summary.