J0694 HCPCS code: Injection, cefoxitin sodium, 1 gm
J0694 is the HCPCS Level II code for injection, cefoxitin sodium, 1 gm. In 2024 Medicare paid an average of $3.61 per service for J0694 across 3,665 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 27% from 2022 to 2024 (2,875 to 3,665 services). In 2024, about 118 clinicians billed Medicare for J0694 for 487 beneficiaries; Florida, California, Texas accounted for 96% 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 | 1992-01-01 |
| Last action effective | 1997-01-01 |
Who bills J0694 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 118 |
| Medicare beneficiaries | 487 |
| States with claims | 6 |
| Share of services in top 3 states (Florida, California, Texas) | 96% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0694, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 2,875 | 582 | $4.71 | $3.68 |
| 2023 | 1,627 | 514 | $4.96 | $3.78 |
| 2024 | 3,665 | 487 | $4.63 | $3.61 |
States with the most J0694 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 2,232 | $3.69 |
| California | 360 | $3.43 |
| Texas | 207 | $3.31 |
| Georgia | 56 | $3.78 |
| Alabama | 42 | $3.05 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 12 | Prescribing Information |
| practitioner claims | 8 | Prescribing Information |
What changed for J0694
- 1992-01-01: J0694 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 J0694?
J0694 is the HCPCS Level II code for injection, cefoxitin sodium, 1 gm. Short descriptor: "Cefoxitin sodium injection".
How much does Medicare pay for J0694?
In 2024, the average Medicare payment was $3.61 per service (average allowed $4.63).
Does Medicare cover J0694?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J0694 can be billed per day?
12 on outpatient hospital claims; 8 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 J0694
- Watch J0694 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0694
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.