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    v1.0.28
    OpenPayerBilling CodesDrugs Administered Other than Oral MethodHCPCS hcpcs-j0691-lefamulin-injection-1mg
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    HCPCS Level II J0691: Injection, lefamulin, 1 mg

    HCPCS Level II code J0691 describes an injectable formulation of lefamulin, billed per 1 mg; the service represents administration of an intravenous or parenteral antibiotic formulation used for systemic treatment of bacterial infections and is typically provided in hospital inpatient, emergency department, or outpatient infusion settings depending on clinical need.

    For related coverage guidance, see recent payer policy updates: Epithelial Cell Cytology in Breast Cancer Risk Assessment, Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only), Antibody-Drug Conjugates.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult presenting to an outpatient infusion center or hospital outpatient department with a bacterial community-acquired pneumonia or other indicated acute bacterial infection requiring intravenous or intramuscular administration of the pleuromutilin antibiotic lefamulin. The patient often has failed or is intolerant to first-line oral antibiotics, has significant comorbidities (for example chronic obstructive pulmonary disease or heart failure) that warrant parenteral therapy, or requires a single-dose parenteral course prior to transition to oral therapy. Clinical workflow: patient evaluation with history and physical, chest imaging and relevant labs, order for antimicrobial therapy specifying J0691 (lefamulin, per mg), pharmacy preparation and dose calculation using body weight and renal/hepatic considerations, administration by an appropriately credentialed clinician (RN or physician) in an ambulatory infusion center, observation for immediate adverse reactions, documentation of lot number and units administered, and discharge instructions with follow-up and transition to oral therapy when indicated.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    96365Intravenous infusion, therapeutic, prophylactic, or diagnostic; initial, up to 1 hourUsed for documentation and billing of the initial IV infusion session when lefamulin is administered IV over a monitored period
    96366Each additional hour (List separately in addition to code for primary service)Used when the infusion requires extended monitoring beyond the initial hour during administration of IV lefamulin
    96372Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscularUsed when lefamulin is administered by intramuscular injection instead of IV
    36415Collection of venous blood by venipuncturePerformed for baseline labs, cultures, or monitoring prior to or after parenteral antibiotic administration
    99070Supplies and materials (e.g., saline flush, syringe) used for patient care not usually included with the serviceBilled for additional single-use supplies required for preparation and administration of J0691

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    363A00000XPhysician AssistantA physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and…
    363L00000XNurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
    163W00000XRegistered Nurse(1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive…
    3336C0003XCommunity/Retail PharmacyA pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance wit…
    2080I0007XPediatric Clinical & Laboratory Immunology PhysicianA pediatrician who specializes in clinical and laboratory immunology disease management.
    283Q00000XPsychiatric HospitalAn organization including a physical plant and personnel that provides multidisciplinary diagnostic and treatment mental health services to patients r…
    222Z00000XOrthotistA health care professional who is specifically educated and trained to manage comprehensive orthotic patient care, including musculoskeletal and neuro…
    251V00000XVoluntary or Charitable AgencyAgencies · Voluntary or Charitable

    Related Payer Policy Updates

    Specialty: Hematology/Oncology1 / 3

    4 rows

    PolicyPayerEffective Date
    Epithelial Cell Cytology in Breast Cancer Risk AssessmentOscar Health2026-10-01
    Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only)UnitedHealthcare2026-08-01
    Antibody-Drug ConjugatesPremera Bluecross2026-08-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for Indiana Only)UnitedHealthcare2026-08-01

    Related Codes

    HCPCS-J0013-ESKETAMINE-NASAL-SPRAY-1MG

    HCPCS Level II J0013: Esketamine Nasal Spray, 1 mg

    HCPCS-J0120-INJECTION-TETRACYCLINE-250MG

    HCPCS Level II J0120: Injection, Tetracycline, up to 250 mg

    HCPCS-J0121-OMADACYCLINE-INJECTION-1MG

    HCPCS Level II J0121: Omadacycline Injection, 1 mg

    HCPCS-J0122-ERAVACYCLINE-INJECTION-1MG

    HCPCS Level II J0122: Injection, eravacycline, 1 mg

    HCPCS-J0129-ABATACEPT-INJECTION-10MG-PHYSICIAN-SUPERVISED

    HCPCS Level II J0129: Abatacept Injection, 10 mg

    HCPCS-J0130-INJECTION-ABCIXIMAB-10MG

    HCPCS Level II J0130: Injection abciximab, 10 mg

    HCPCS-J0131-INJECTION-ACETAMINOPHEN-10MG-PARENTERAL-ANALGESIC

    HCPCS Level II J0131: Injection, Acetaminophen 10 mg

    HCPCS-J0132-INJECTION-ACETYLCYSTEINE-100MG-INJECTABLE-MEDICATION

    HCPCS Level II J0132: Injection, Acetylcysteine 100 mg

    HCPCS-J0133-ACYCLOVIR-INJECTION-5MG

    HCPCS Level II J0133: Injection, Acyclovir 5 mg

    HCPCS-J0134-ACETAMINOPHEN-INJECTION-FRESENIUS-KABI-10MG

    HCPCS Level II J0134: Injection, Acetaminophen (10 mg)

    Showing 1–10 of 991

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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