HCPCS code J0295 — Ampicillin sulbactam 1.5 gm. Status: Active. Effective Jan 1, 2019. Source: CMS HCPCS Level II.

J0295

Active

Ampicillin sulbactam 1.5 gm

Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm

Category: Drugs

Section: J-codes: Drugs Administered Other Than Oral Method

Effective: Jan 1, 2019

Code type: alphanumeric

OPPS Status: N — Items / services packaged into APC rates

Maximum units of J0295 Medicare will pay for one beneficiary on one date of service. Claims exceeding the MUE are denied or returned for review.

Service Type	Max Units / Day	Adjudication	Rationale
DME Supplier	0	3 — Date of Service Edit: Clinical	CMS Policy
Outpatient Hospital	12	3 — Date of Service Edit: Clinical	Clinical: Data
Practitioner Services	12	3 — Date of Service Edit: Clinical	Clinical: Data

Source: CMS Medicare NCCI Medically Unlikely Edits

National Drug Codes (NDCs) mapped to this HCPCS code.

Search Medicare's official policy database for Local (LCD) and National (NCD) Coverage Determinations covering this code.

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Data sourced from CMS. Updated quarterly.

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