J0691 HCPCS code: Injection, lefamulin, 1 mg
J0691 is the HCPCS Level II code for injection, lefamulin, 1 mg. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 300 per day on outpatient hospital claims.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2020-07-01 |
| Last action effective | 2024-01-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 300 | Prescribing Information |
| practitioner claims | 300 | Prescribing Information |
What changed for J0691
- 2020-07-01: J0691 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 J0691?
J0691 is the HCPCS Level II code for injection, lefamulin, 1 mg. Short descriptor: "Inj lefamulin 1 mg".
Does Medicare cover J0691?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J0691 can be billed per day?
300 on outpatient hospital claims; 300 on practitioner claims (NCCI medically unlikely edits).
Related J06 codes
- J0600 — Injection, edetate calcium disodium, up to 1000 mg
- J0601 — Sevelamer carbonate (renvela or therapeutically equivalent), oral, 20 mg (for esrd on dialysis)
- J0602 — Sevelamer carbonate (renvela or therapeutically equivalent), oral, powder, 20 mg (for esrd on dialysis)
- J0603 — Sevelamer hydrochloride (renagel or therapeutically equivalent), oral, 20 mg (for esrd on dialysis)
- J0604 — Cinacalcet, oral, 1 mg, (for esrd on dialysis)
- J0605 — Sucroferric oxyhydroxide, oral, 5 mg (for esrd on dialysis)
- J0606 — Injection, etelcalcetide, 0.1 mg
- J0607 — Lanthanum carbonate, oral, 5 mg (for esrd on dialysis)
- J0608 — Lanthanum carbonate, oral, powder, 5 mg, not therapeutically equivalent to j0607 (for esrd on dialysis)
- J0609 — Ferric citrate, oral, 3 mg ferric iron, (for esrd on dialysis)
- J0610 — Injection, calcium gluconate (fresenius kabi), per 10 ml
- J0611 — Injection, calcium gluconate (wg critical care), per 10 ml
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Next steps
- Run a reimbursement report for a device billed under J0691
- Watch J0691 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0691
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.