J0295 HCPCS code: Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm
J0295 is the HCPCS Level II code for injection, ampicillin sodium/sulbactam sodium, per 1.5 gm. In 2024 Medicare paid an average of $1.44 per service for J0295 across 6,227 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 12 per day on outpatient hospital claims. Medicare volume rose 8% from 2022 to 2024 (5,791 to 6,227 services). In 2024, about 315 clinicians billed Medicare for J0295 for 562 beneficiaries; Texas, Florida, California accounted for 69% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 1995-01-01 |
| Last action effective | 2019-01-01 |
Who bills J0295 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 315 |
| Medicare beneficiaries | 562 |
| States with claims | 13 |
| Share of services in top 3 states (Texas, Florida, California) | 69% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0295, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 5,791 | 577 | $2.39 | $1.89 |
| 2023 | 5,898 | 551 | $2.03 | $1.60 |
| 2024 | 6,227 | 562 | $1.83 | $1.44 |
States with the most J0295 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 1,549 | $1.42 |
| Florida | 735 | $1.56 |
| California | 725 | $1.56 |
| New Jersey | 617 | $0.99 |
| Illinois | 190 | $1.48 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 12 | Clinical: Data |
| practitioner claims | 12 | Clinical: Data |
What changed for J0295
- 1995-01-01: J0295 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code J0295?
J0295 is the HCPCS Level II code for injection, ampicillin sodium/sulbactam sodium, per 1.5 gm. Short descriptor: "Ampicillin sulbactam 1.5 gm".
How much does Medicare pay for J0295?
In 2024, the average Medicare payment was $1.44 per service (average allowed $1.83).
Does Medicare cover J0295?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J0295 can be billed per day?
12 on outpatient hospital claims; 12 on practitioner claims (NCCI medically unlikely edits).
Related J02 codes
- J0200 — Injection, alatrofloxacin mesylate, 100 mg
- J0202 — Injection, alemtuzumab, 1 mg
- J0205 — Injection, alglucerase, per 10 units
- J0206 — Injection, allopurinol sodium, 1 mg
- J0207 — Injection, amifostine, 500 mg
- J0208 — Injection, sodium thiosulfate (pedmark), 100 mg
- J0209 — Injection, sodium thiosulfate (hope), 100 mg
- J0210 — Injection, methyldopate hcl, up to 250 mg
- J0211 — Injection, sodium nitrite 3 mg and sodium thiosulfate 125 mg (nithiodote)
- J0215 — Injection, alefacept, 0.5 mg
- J0216 — Injection, alfentanil hydrochloride, 500 micrograms
- J0217 — Injection, velmanase alfa-tycv, 1 mg
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under J0295
- Watch J0295 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0295
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.