Summary & Overview
HCPCS J0558: Penicillin G Benzathine and Procaine Injection, 100,000 Units
HCPCS Level II code J0558 designates the intramuscular injection of a combined formulation of penicillin G benzathine and penicillin G procaine, billed per 100,000 units. This medication is used for bacterial infections where long-acting and intermediate-acting penicillin components are indicated, making the code relevant for outpatient antibiotic administration and infectious disease management. Nationally, accurate coding of combination antibiotic injections supports appropriate reimbursement, clinical documentation, and public health reporting.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarks for payer coverage and reimbursement practices, a concise clinical context for the medication formulation, common billing modifiers used with injectable drugs, and notes on typical sites of service where the injection is administered. The publication also highlights coding nuances that affect service line classification and billing workflows.
The content is aimed at billing managers, practice administrators, and health policy analysts seeking a concise reference for J0558, including payer coverage patterns, administrative considerations, and the clinical setting in which this HCPCS Level II code is most often used. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code J0558 represents an injection formulation combining penicillin G benzathine and penicillin G procaine, measured per 100,000 units. This billing code denotes a medication administration service for intramuscular antibiotic therapy.
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Service type: Medication injection
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Typical site of service: Ambulatory clinic, physician office, urgent care, or outpatient setting where intramuscular injections are administered
Clinical & Coding Specifications
Clinical Context
A 28-year-old adult presents to an outpatient clinic with acute onset of sore throat, fever, tender anterior cervical lymphadenopathy, and a positive rapid antigen test for Group A Streptococcus. The clinician determines intramuscular long-acting penicillin is indicated for definitive treatment and to ensure adherence. The medication administered is a single intramuscular injection of benzathine and procaine penicillin formulation, dosed per package (penicillin G benzathine and penicillin G procaine, 100,000 units per billing unit). The workflow includes medication verification, informed consent, allergy screening for beta-lactams, preparation and aseptic technique for intramuscular deltoid or gluteal administration, post-injection observation for immediate allergic reaction, and documentation of lot number, expiration date, injection site, and administered units in the medical record. Typical sites of service are outpatient clinic, urgent care center, emergency department, community health clinic, and public health STI clinics when indicated for syphilis prophylaxis or treatment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier used / default | Use when no specific modifier applies. |
| 11 | Professional component | Use when reporting a service attributable to the physician/provider component if applicable to a bundled service. |