Summary & Overview
HCPCS J0694: Cefoxitin Sodium Injection, 1 gm
HCPCS Level II code J0694 designates a 1 gm injection of cefoxitin sodium, an intravenous or intramuscular cephalosporin antibiotic used for treatment and surgical prophylaxis. Nationally, injectable antimicrobial agents like cefoxitin are significant due to their role in inpatient and procedural care, antimicrobial stewardship considerations, and hospital drug acquisition and billing practices. This code captures the drug product rather than administration technique.
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 clinical context for cefoxitin use, typical sites of service where J0694 applies, and the types of benchmarks and policy issues often associated with HCPCS drug codes—such as drug pricing, billing validity, and payer coverage patterns. The publication outlines common billing modifiers and mapping gaps when available, and it flags where input data are missing.
What readers will learn: the clinical purpose of J0694, where the code is commonly billed, the main payer landscape addressed in the national context, and which operational and policy topics commonly affect injectable drug HCPCS billing. Data not available in the input are explicitly noted where relevant.
Billing Code Overview
HCPCS Level II code J0694 represents an injection of cefoxitin sodium, dosed per 1 gm. The service is an injectable antibiotic administration, typically provided as a single-dose medication for treatment or prophylaxis of bacterial infections.
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Service type: Injectable drug administration
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Typical site of service: Hospital inpatient, hospital outpatient, emergency department, ambulatory surgical center, or other settings where parenteral antibiotics are administered
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 56-year-old male presenting to the emergency department with fever, right lower quadrant abdominal pain, and leukocytosis consistent with suspected intra-abdominal infection or perforated appendicitis. After clinical evaluation and imaging, the surgical team diagnoses a complicated intra-abdominal infection and proceeds to urgent operative intervention. Intraoperatively, the surgeon obtains cultures and administers perioperative intravenous antimicrobials; cefoxitin sodium is selected for broad-spectrum coverage against Gram-negative and anaerobic organisms. The medication is prepared by pharmacy as J0694 (Injection, cefoxitin sodium, 1 gm) and delivered to the OR or post-anesthesia care unit for administration. Documentation includes indication, dose in grams, route (IV), time of administration, lot number, and administering clinician. Typical workflow steps: pre-op antibiotic order entry, pharmacy compounding/verification, bedside administration by an RN with documentation of the CMS-required medication administration details, and linkage of the J0694 code to the surgical encounter for facility billing. The typical site of service is the hospital inpatient operating room or emergency department with transition to inpatient ward or observation unit.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug has been discarded/partial dose not administered |