Summary & Overview
HCPCS Level II J0690: Injection, Cefazolin Sodium, 500 mg
HCPCS Level II code J0690 denotes a 500 mg injectable dose of cefazolin sodium, an intravenous or intramuscular cephalosporin antibiotic commonly used for perioperative prophylaxis and treatment of susceptible bacterial infections. Nationally, accurate coding for parenteral antibiotics like cefazolin is important for clinical documentation, inventory management, and payer reimbursement across acute and outpatient settings.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of how J0690 is applied in practice, typical sites of service where the code is used, and what to expect in payer coverage patterns. The publication outlines benchmarks related to utilization and payment (where available), recent policy considerations affecting drug coding and billing, and clinical context relevant to use of parenteral cefazolin.
This summary provides clinicians, billing professionals, and policy analysts with a clear reference for the code’s clinical meaning, payer landscape, and the types of data and policy topics addressed in the full publication. Data not available in the input will be noted where applicable in subsequent sections.
Billing Code Overview
HCPCS Level II code J0690 represents injection, cefazolin sodium, 500 mg. This code describes a single-dose drug administration of cefazolin sodium formulated for parenteral injection. The service type is medication administration (antibiotic injection) delivered by injectable route. The typical site of service for this code includes outpatient infusion centers, hospital inpatient and outpatient settings, emergency departments, and physician offices where parenteral antibiotic therapy is administered.
Clinical & Coding Specifications
Clinical Context
A 65-year-old man presents for preoperative evaluation prior to total knee arthroplasty. The orthopedic surgeon orders perioperative intravenous antibiotic prophylaxis. Pharmacy prepares and administers J0690 (Injection, cefazolin sodium, 500 mg) in the operating room shortly before incision per institutional prophylaxis protocol. The patient has a documented penicillin allergy history that is non-anaphylactic; allergy review permits cefazolin after discussion with anesthesia. The workflow includes medication verification by the pharmacist, bedside nurse administration via IV push or infusion, documentation of lot number and time, and recording the administered dose in the anesthesia record and operative note. Postoperative monitoring for allergic reaction occurs in the PACU. Billing for the drug uses J0690 with appropriate modifiers indicating the service setting or circumstances (for example, outpatient hospital, bilateral procedure, or an unrelated service).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Data not listed in provided modifier list | Data not available in the input. |