Summary & Overview
HCPCS J0695: Injection, Ceftolozane 50 mg and Tazobactam 25 mg
HCPCS Level II code J0695 designates an injection of ceftolozane 50 mg combined with tazobactam 25 mg, an intravenous antibacterial formulation used to treat serious Gram-negative infections. Nationally, this code matters for hospitals, infusion centers, and payers because it identifies a high-cost, IV-administered antimicrobial requiring appropriate billing for drug acquisition and administration. Accurate use of J0695 supports claim processing, utilization tracking, and monitoring of antimicrobial therapies.
Key payers addressed in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the drug combination, typical sites of service where J0695 is billed, commonly applied modifiers, and what is and is not available in the input data. The publication provides national benchmarks, coding guidance, and policy context relevant to reimbursement and utilization management for this IV antibiotic. Where payer-specific terms and coverage nuances exist, those are summarized to assist revenue cycle and clinical teams in aligning billing practices with payer requirements.
Data not available in the input for some items, including associated taxonomies, ICD-10 diagnoses, related codes, and detailed service line information.
Billing Code Overview
HCPCS Level II code J0695 represents an injection of ceftolozane 50 mg and tazobactam 25 mg, a combination antibacterial agent used for intravenous treatment of certain serious bacterial infections. The service type is drug administration via injection for systemic antibacterial therapy. The typical site of service is inpatient or outpatient hospital settings, including infusion centers and emergency departments, where intravenous antibiotics are administered.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with a history of chronic obstructive pulmonary disease and type 2 diabetes is admitted to the hospital with fever, productive cough, and progressive dyspnea. Chest imaging and laboratory results are consistent with a hospital-acquired Gram-negative pneumonia with suspected multidrug-resistant Pseudomonas aeruginosa. The infectious disease consult recommends intravenous ceftolozane-tazobactam for targeted therapy. Pharmacy compounds the dose and the medication is administered as an intravenous infusion in the inpatient infusion suite. Documentation includes the billed HCPCS Level II code J0695 per 50 mg ceftolozane/25 mg tazobactam unit, indication, dose administered, lot and vial control information, route, infusion start and stop times, patient weight if weight-based dosing applied, and any relevant modifier to indicate administration circumstances (e.g., outpatient hospital observation, delivery of discarded drug waste). Typical workflow: order by prescribing physician, verification and preparation by pharmacy, administration by registered nurse, monitoring for adverse reaction, and documentation in the medical record for billing using J0695 with appropriate units and modifiers.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug discarded/unused portion |