Summary & Overview
HCPCS J1364: Injection, Erythromycin Lactobionate, per 500 mg
HCPCS Level II code J1364 denotes the injection of erythromycin lactobionate, billed per 500 mg unit. As an HCPCS Level II drug code, J1364 is relevant for facility and professional billing when erythromycin is administered parenterally. Nationally, injectable antibiotic billing codes like J1364 matter for hospital pharmacy accounting, outpatient infusion billing, and payer coverage determinations for antimicrobial therapy.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for parenteral erythromycin use, typical sites of service where J1364 is billed, and the common payer landscape for coverage and claims processing.
The publication summarizes billing benchmarks where available, outlines policy and reimbursement considerations relevant to HCPCS Level II drug coding, and provides operational details for provider billing teams. Data not available in the input will be noted where applicable.
Billing Code Overview
HCPCS Level II code J1364 represents an injection of erythromycin lactobionate, per 500 mg. This HCPCS code is used to bill for administration of the specified antibiotic formulation.
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Service type: Parenteral antibiotic administration (intravenous or intramuscular injectable medication)
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Typical site of service: Hospital inpatient, hospital outpatient, emergency department, and acute care clinics where injectable antibiotics are administered; also applicable in outpatient infusion centers and physician office settings equipped for injections.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with community-acquired pneumonia presents to the hospital emergency department with fever, productive cough, and shortness of breath. The patient has a documented severe allergy to macrolide oral formulations but requires an intravenous macrolide for treatment due to suspected atypical pathogens and intolerance to first-line agents. The admitting physician orders intravenous erythromycin lactobionate, dosed per 500 mg vial increments, to be administered in the inpatient setting. Nursing verifies medication order, ensures venous access (peripheral IV or existing central line), prepares the reconstituted solution per pharmacy standards, and administers the injection or infusion over the recommended time while monitoring vital signs. Pharmacy documents lot number and prepares billing for the drug using HCPCS Level II code J1364 for each 500 mg unit provided. Clinical monitoring includes assessment for QT prolongation risk, drug interactions, and gastrointestinal or infusion-related adverse reactions. Discharge planning includes transition to appropriate oral antibiotics when clinically indicated and documentation of the administered parenteral erythromycin dose in the medication administration record for billing reconciliation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug or biological amount discarded/not administered to any patient | Use when part of the drug vial is discarded and the payer allows reporting of discarded amounts separately for single‑use vial drugs. |