Summary & Overview
HCPCS Level II J0743: Cilastatin Sodium–Imipenem Injection, 250 mg
HCPCS Level II code J0743 represents an intravenous antibiotic injection combining cilastatin sodium with imipenem, billed per 250 mg. This code is important nationally because it captures utilization and reimbursement for a broad-spectrum, parenteral antibacterial commonly used in serious or resistant infections in acute care and infusion settings. Accurate coding of J0743 affects hospital drug expense reporting, outpatient infusion claims, and Medicare Part B/Part A drug billing where applicable.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarks for utilization and reimbursement patterns, discussion of where this drug is typically administered (hospital inpatient, outpatient infusion, emergency department), and clinical context regarding its role as a broad-spectrum intravenous antibiotic. The publication also outlines common billing considerations and documentation elements tied to parenteral antibiotic administration. Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service-line specifics are noted as unavailable where applicable.
Billing Code Overview
HCPCS Level II code J0743 describes an injectable antibiotic combination of cilastatin sodium and imipenem, billed per 250 mg unit. This medication is an intravenous antibacterial agent used to treat a range of serious bacterial infections caused by susceptible organisms.
Service Type: Drug administration (parenteral medication)
Typical Site of Service: Hospital inpatient or outpatient infusion settings, including emergency departments and infusion centers, where intravenous antibiotics are administered for serious infections.
Clinical & Coding Specifications
Clinical Context
A typical patient is a hospitalized adult with a serious gram-negative or mixed bacterial infection requiring intravenous broad-spectrum therapy. The patient may present with complicated intra-abdominal infection, complicated urinary tract infection, hospital-acquired pneumonia, ventilator-associated pneumonia, or severe sepsis where empiric therapy for multi-drug resistant organisms is indicated. A clinician orders J0743 (imipenem with cilastatin, per 250 mg) to be administered by intermittent IV infusion or IV push per institutional policy. Pharmacy compounds or dispenses the dose, documents lot and expiration, and the bedside nurse verifies the order, performs allergy and compatibility checks, obtains IV access, and administers the medication while monitoring for infusion-related reactions. Typical workflow steps: medication order entry -> pharmacy verification and preparation -> administration with documentation of route, dose, time, and any adverse reactions -> antimicrobial stewardship review for de-escalation based on culture results.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Service not specified as distinct | Not typically appended; use per payer rules when no specific modifier applies |