Diagnostic agents - Therapeutic Classification

Diagnostic Agents - Drugs


Generic Name(s)	Strength	Dosage Form	ICD Code
Aminohippurate Sodium	10 mL vials	Injection	Y57.6
Corticotropin			Y57.6
Edrophonium Injection	15 mL vials	Injection	Y57.6
Florbetapir F 18	10 mL, 30 mL, or 50 mL vials	Injection	Y57.6
Fludeoxyglucose F 18 Injection	10 - 100 mCi/mL	Injection	Y57.6
Hexaminolevulinate Hydrochloride			Y57.6
Insoluble Prussian blue	0.5gm	Capsule	Y57.6
Iobenguane I 123 Injection	2 mCi/mL	Injection	Y57.6
Iodixanol			Y57.6
Ioflupane I 123			Y57.6
Ioversol Injection	20x125 mL	Injection	Y57.6
Ioxilan	300mgl/mL, 350mgI/mL	Injection	Y57.6
Loxaglate			Y57.6
Lymphazurin	1% / 5 ml single dose Vial	Injection	Y57.6
Macimorelin	60 mg	Granules for oral solution
Mangafodipir	0.01 mmol/ml	Injection	Y57.6
Metyrapone	250mg	Capsules	Y57.6
Phentolamine Mesylate	10mg/1ml	Injection	Y57.6
Phosphocol	15 millicuries	Suspension	Y57.6
Protirelin	1 mL	Injection	Y57.6
Regadenoson	0.4mg/5 mL	Injection	Y57.6
Sincalide	5mcg/vial	Injection	Y57.6
Technetium Tc 99m Depreotide Injection		Injection	Y57.6
Technetium Tc99m Exametazime Injection	0.45 µM	Injection	Y57.6
Technetium Tc99m Medronate Injection			Y57.6
Technetium Tc99m sestamibi			Y57.6
Thallous Chloride Tl-201 Injection	37 MBq (1 mCi)	Injection	Y57.6
Tricarbocyanine	25mg/50ml	Injection	Y57.6

Radiocontrast Agent
Generic Name(s)	Strength	Dosage Form	ICD Code
Diatrizoate			Y57.6

Radiopaque agent
Generic Name(s)	Strength	Dosage Form	ICD Code
Gadobenate- Dimeglumine			Y57.6
Gadobutrol	7.5ml/vial	Injection	Y57.6
Gadodiamide	5ml, 10ml, 15ml	Injection	Y57.6
Gadofosveset Trisodium Injection	0.25 mmol/mL	Injection	Y57.6
Gadoversetamide Injection	5ml, 10ml, 15ml, 20ml/vial	Injection	Y57.6
Gadoxetate Disodium Injection	10 mL single-dose vials	Injection	Y57.6
Hexaminolevulinate Hydrochloride			Y57.6