J0696 HCPCS code: Injection, ceftriaxone sodium, per 250 mg
J0696 is the HCPCS Level II code for injection, ceftriaxone sodium, per 250 mg. In 2024 Medicare paid an average of $0.33 per service for J0696 across 2,331,712 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 16 per day on outpatient hospital claims. Medicare volume fell 4% from 2022 to 2024 (2,425,676 to 2,331,712 services). In 2024, about 59,579 clinicians billed Medicare for J0696 for 374,494 beneficiaries; Texas, Florida, Alabama accounted for 33% 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 | 1990-01-01 |
| Last action effective | 1997-01-01 |
Who bills J0696 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 59,579 |
| Medicare beneficiaries | 374,494 |
| States with claims | 57 |
| Share of services in top 3 states (Texas, Florida, Alabama) | 33% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0696, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 2,425,676 | 384,461 | $0.49 | $0.36 |
| 2023 | 2,436,098 | 391,008 | $0.51 | $0.37 |
| 2024 | 2,331,712 | 374,494 | $0.45 | $0.33 |
States with the most J0696 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 300,853 | $0.32 |
| Florida | 269,754 | $0.35 |
| Alabama | 208,906 | $0.30 |
| Mississippi | 178,092 | $0.30 |
| California | 159,566 | $0.34 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 16 | Prescribing Information |
| practitioner claims | 16 | Prescribing Information |
What changed for J0696
- 1990-01-01: J0696 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 J0696?
J0696 is the HCPCS Level II code for injection, ceftriaxone sodium, per 250 mg. Short descriptor: "Ceftriaxone sodium injection".
How much does Medicare pay for J0696?
In 2024, the average Medicare payment was $0.33 per service (average allowed $0.45).
Does Medicare cover J0696?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J0696 can be billed per day?
16 on outpatient hospital claims; 16 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
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 J0696
- Watch J0696 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0696
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.