J0698 HCPCS code: Injection, cefotaxime sodium, per gm
J0698 is the HCPCS Level II code for injection, cefotaxime sodium, per gm. In 2024 Medicare paid an average of $5.84 per service for J0698 across 805 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 5% from 2022 to 2024 (765 to 805 services). In 2024, about 90 clinicians billed Medicare for J0698 for 478 beneficiaries; Arizona, California, Missouri accounted for 80% 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 | 1991-01-01 |
| Last action effective | 1997-01-01 |
Who bills J0698 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 90 |
| Medicare beneficiaries | 478 |
| States with claims | 7 |
| Share of services in top 3 states (Arizona, California, Missouri) | 80% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0698, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 765 | 451 | $6.48 | $5.03 |
| 2023 | 869 | 577 | $6.77 | $5.16 |
| 2024 | 805 | 478 | $7.68 | $5.84 |
States with the most J0698 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Arizona | 292 | $7.53 |
| California | 164 | $7.42 |
| Missouri | 143 | $3.56 |
| Texas | 92 | $3.92 |
| Michigan | 26 | $3.80 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 12 | Prescribing Information |
| practitioner claims | 10 | Clinical: Data |
What changed for J0698
- 1991-01-01: J0698 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 J0698?
J0698 is the HCPCS Level II code for injection, cefotaxime sodium, per gm. Short descriptor: "Cefotaxime sodium injection".
How much does Medicare pay for J0698?
In 2024, the average Medicare payment was $5.84 per service (average allowed $7.68).
Does Medicare cover J0698?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J0698 can be billed per day?
12 on outpatient hospital claims; 10 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 J0698
- Watch J0698 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0698
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.