Summary & Overview
HCPCS J1335: Injection, ertapenem sodium, 500 mg
HCPCS Level II code J1335 denotes the 500 mg injection of ertapenem sodium, a broad-spectrum carbapenem antibiotic used for serious bacterial infections requiring parenteral therapy. Nationally, accurate coding for high-cost injectable antimicrobials like ertapenem matters for clinical documentation, pharmacy inventory control, and payer reimbursement pathways. This code is relevant across acute and outpatient infusion settings where intravenous antibiotics are administered.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code represents, typical sites of service, and payer coverage context. The publication summarizes common billing considerations, usual modifiers encountered in practice, and how J1335 fits into outpatient and hospital drug billing workflows. It also provides clinical context linking the code to parenteral antibiotic administration and highlights areas where payer policies and reimbursement policies may influence billing practice.
The document provides national-level benchmarks and policy summaries, clarifies coding scope for medication-specific billing, and outlines what to expect in payer coverage language. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code J1335 represents an injection of ertapenem sodium, 500 mg. This code is used to bill for the medication formulation and strength as supplied for parenteral administration.
Service type: Injectable antibiotic therapy
Typical site of service: Outpatient infusion centers, hospital outpatient departments, emergency departments, and other settings where parenteral antibiotic administration occurs
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with a history of diabetes mellitus and recent hip fracture presents with signs of a complicated intra-abdominal infection after an exploratory laparotomy. The surgical team decides to administer a broad-spectrum parenteral carbapenem while culture results are pending. Pharmacy prepares J1335 (injection, ertapenem sodium, 500 mg) for intravenous administration. The patient receives once-daily dosing under inpatient acute care orders in the hospital infusion unit. Nursing documents medication administration in the electronic health record, including lot number and route, and the charge capture team posts the HCPCS Level II code J1335 with appropriate modifiers for billing based on payer requirements and clinical circumstances.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
AA | Anesthesia services by anesthesiologist | Data not available in the input. |
22 |