J0456 HCPCS code: Injection, azithromycin, 500 mg
J0456 is the HCPCS Level II code for injection, azithromycin, 500 mg. In 2024 Medicare paid an average of $1.71 per service for J0456 across 817 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 4 per day on outpatient hospital claims. In 2024, about 179 clinicians billed Medicare for J0456 for 406 beneficiaries; California, New Jersey, Florida accounted for 67% 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 | 2000-01-01 |
| Last action effective | 2000-01-01 |
Who bills J0456 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 179 |
| Medicare beneficiaries | 406 |
| States with claims | 10 |
| Share of services in top 3 states (California, New Jersey, Florida) | 67% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0456, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 823 | 405 | $2.75 | $2.14 |
| 2023 | 922 | 426 | $2.26 | $1.75 |
| 2024 | 817 | 406 | $2.19 | $1.71 |
States with the most J0456 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 179 | $1.84 |
| New Jersey | 140 | $1.36 |
| Florida | 116 | $1.73 |
| Maryland | 45 | $1.80 |
| Texas | 37 | $1.78 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 4 | Prescribing Information |
| practitioner claims | 4 | Prescribing Information |
What changed for J0456
- 2000-01-01: J0456 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 J0456?
J0456 is the HCPCS Level II code for injection, azithromycin, 500 mg. Short descriptor: "Azithromycin".
How much does Medicare pay for J0456?
In 2024, the average Medicare payment was $1.71 per service (average allowed $2.19).
Does Medicare cover J0456?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J0456 can be billed per day?
4 on outpatient hospital claims; 4 on practitioner claims (NCCI medically unlikely edits).
Related J04 codes
- J0400 — Injection, aripiprazole, intramuscular, 0.25 mg
- J0401 — Injection, aripiprazole (abilify maintena), 1 mg
- J0402 — Injection, aripiprazole (abilify asimtufii), 1 mg
- J0457 — Injection, aztreonam, 100 mg
- J0458 — Injection, aztreonam/avibactam, 7.5 mg/2.5 mg (10 mg)
- J0461 — Injection, atropine sulfate, 0.01 mg
- J0462 — Injection, atropine sulfate, not therapeutically equivalent to j0461, 0.01 mg
- J0463 — Injection, atropine sulfate (fresenius and therapeutically equivalent), 0.01 mg
- J0470 — Injection, dimercaprol, per 100 mg
- J0475 — Injection, baclofen, 10 mg
- J0476 — Injection, baclofen, 50 mcg for intrathecal trial
- J0480 — Injection, basiliximab, 20 mg
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Next steps
- Run a reimbursement report for a device billed under J0456
- Watch J0456 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0456
Sources: CMS HCPCS Level II release October 2026; 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.