Summary & Overview
HCPCS J0458: Aztreonam/Avibactam Injection, 10 mg
HCPCS Level II code J0458 denotes the injection of aztreonam/avibactam (7.5 mg/2.5 mg; 10 mg vial), an intravenous combination used to treat serious gram-negative infections including resistant organisms. Nationally, this code matters because it captures billing for a high-cost, specialty antimicrobial often used in hospital and infusion settings, where proper coding affects clinical documentation, payer authorization, and aggregate utilization reporting.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will gain an overview of how J0458 is used across typical sites of care, baseline benchmarks for utilization and reimbursement where available, and clinical context relevant to antimicrobial stewardship and inpatient/outpatient infusion billing. The publication outlines policy updates that commonly affect coverage and prior authorization for specialty antimicrobials, practical considerations for coding and claim submission, and related service-line implications for hospital pharmacy and infusion centers.
This summary equips clinicians, coding professionals, and revenue staff with a concise reference to the code’s clinical meaning, payer landscape, and the types of operational and policy details that typically accompany billing for specialty intravenous antibiotics. Data not available in the input is identified where applicable.
Billing Code Overview
HCPCS Level II code J0458 represents an injection formulation of aztreonam/avibactam, 7.5 mg/2.5 mg (10 mg). This code corresponds to administration of a combined beta-lactamase–resistant monobactam antibiotic paired with a beta-lactamase inhibitor for intravenous antimicrobial therapy.
Service Type: Intravenous antimicrobial injection
Typical Site of Service: Hospital inpatient, hospital outpatient, or infusion center
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is a hospitalized adult with a confirmed or suspected severe Gram-negative infection caused by multidrug-resistant organisms (for example, complicated intra-abdominal infection or hospital-acquired/ventilator-associated pneumonia) when culture and susceptibility results indicate organisms susceptible to aztreonam/avibactam. The patient often has failed prior empiric therapy or has limited options due to allergies or resistance. Medication is prepared in the hospital pharmacy as an intravenous infusion or injection and administered by an inpatient nursing team in an acute care setting, step-down unit, or intensive care unit. Clinical workflow includes: obtaining cultures, reviewing susceptibility reports, infectious disease consultation to authorize aztreonam/avibactam, pharmacy sterile compounding of the J0458 product, medication administration documentation, and monitoring for adverse reactions and therapeutic response. Dose, frequency, and duration are determined by infection type, renal function, and clinical response. Discharge planning may include outpatient parenteral antimicrobial therapy if continued therapy is needed at home with appropriate infusion support services.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier specified (placeholder) | Use when no additional billing modifier applies and the payer requires a placeholder code if requested. |