Summary & Overview
HCPCS J0742: Injection, Imipenem/Cilastatin/Relebactam
HCPCS Level II code J0742 identifies the injectable fixed-dose combination of imipenem 4 mg, cilastatin 4 mg, and relebactam 2 mg. This code is used to bill for parenteral administration of a novel beta-lactam/beta-lactamase inhibitor combination that addresses multidrug-resistant Gram-negative infections. Nationally, accurate coding for single-agent combination antibiotics is important for claims adjudication, utilization tracking, and antimicrobial stewardship programs.
Key payers in this coverage context include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for this antimicrobial, typical sites of service where the product is administered, and common billing considerations tied to HCPCS Level II coding. The publication summarizes how payers commonly approach coverage and prior authorization for new parenteral antimicrobials, outlines benchmarking points for service line utilization and drug acquisition cost impacts, and flags policy topics to monitor such as changes to payer medical policies and Medicare billing guidance.
The analysis is intended for revenue-cycle, pharmacy, and clinical leaders seeking concise reference on coding, billing workflow implications, and the payer environment relevant to J0742. Data not available in the input is identified where applicable.
Billing Code Overview
HCPCS Level II code J0742 describes an injection formulation combining imipenem 4 mg, cilastatin 4 mg, and relebactam 2 mg. This represents an intravenous antibacterial agent packaged as a fixed-dose combination for parenteral administration.
Service type: Intravenous antibiotic infusion/injection
Typical site of service: Hospital inpatient and outpatient settings, emergency department, and infusion centers
Clinical & Coding Specifications
Clinical Context
A 68-year-old hospitalized patient with a history of chronic obstructive pulmonary disease and recent broad-spectrum antibiotic exposure develops hospital-acquired pneumonia with Gram-negative rods on culture and concern for carbapenem-resistant organisms. The infectious disease team recommends treatment with imipenem/cilastatin/relebactam administered intravenously. The medication is prepared by pharmacy in the inpatient or observation setting and delivered to the bedside. Nursing verifies patient identity, obtains informed consent per facility policy if required, assesses IV access and allergy history, programs the infusion pump, and documents dose, lot number, and administration times in the electronic medical record. Doses are billed per unit using HCPCS Level II code J0742 (each unit = imipenem 4 mg, cilastatin 4 mg, relebactam 2 mg). Typical sites of service include inpatient hospital (acute care), observation, and emergency department when admitted. The typical patient scenario includes IV infusion over the recommended timeframe with monitoring for infusion-related reactions, renal function adjustment, and concurrent microbiology-guided therapy adjustments.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Not typically appended; used when no specific modifier applies |