Summary & Overview
HCPCS J0291: Plazomicin Injection, 5 mg
HCPCS Level II code J0291 denotes a 5 mg unit of plazomicin administered by injection. Plazomicin is an aminoglycoside-class antibiotic used for serious Gram-negative infections that may be resistant to other agents; as an injectable specialty antimicrobial, accurate coding is essential for claims processing, utilization tracking, and formulary management. Nationally, J0291 is relevant for hospital outpatient departments, inpatient encounters where drug charges are reported, and infusion clinics that administer parenteral antimicrobials.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical context, expected sites of service, and the types of benchmarks and policy considerations typically associated with high-cost injectable antibiotics. The publication outlines coding considerations, common modifier usage (listed separately), and payer coverage patterns when available. It also highlights areas where policy updates, prior authorization requirements, or formulary placement commonly affect billing and utilization.
This summary is written for a national audience and focuses on the operational and clinical implications of using HCPCS Level II code J0291 for plazomicin 5 mg administration.
Billing Code Overview
HCPCS Level II code J0291 represents an injectable antimicrobial: plazomicin, 5 mg. The service type is injection/infusion drug administration, typically furnished in acute care settings, inpatient hospitals, outpatient infusion centers, and specialty clinics where intravenous antimicrobials are administered.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult hospitalized or seen in an outpatient infusion center with a documented serious gram-negative bacterial infection (for example, complicated urinary tract infection or hospital-acquired/ventilator-associated Gram-negative sepsis) requiring intravenous aminoglycoside therapy where plazomicin is selected based on susceptibility testing and patient renal function. The clinical workflow: the prescribing clinician documents indication, dose (expressed in milligrams; J0291 units represent 5 mg increments), and renal dosing adjustments in the medical record. Pharmacy compounds the ordered dose and performs medication verification and counseling. Nursing administers the intravenous infusion or injection per facility protocol, monitors vital signs and renal function, and documents medication administration in the chart. Laboratory testing (blood cultures, renal function, therapeutic drug monitoring if indicated) and clinical reassessments occur during therapy. Billing uses HCPCS Level II code J0291 reported in 5 mg units with applicable modifier(s) to reflect service circumstances or provider status.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Casts for professional component (Not typical for drugs) | Data not available in the input. |