Summary & Overview
HCPCS Level II S0040: Injection of Ticarcillin and Clavulanate, 3.1 g
HCPCS Level II code S0040 denotes the injection of ticarcillin disodium with clavulanate potassium, 3.1 grams — a parenteral antibiotic combination used to treat susceptible bacterial infections. Nationally, accurate coding for high-cost injectable antimicrobials matters for claims processing, clinical documentation, and antimicrobial stewardship oversight.
This analysis covers major national payers: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on clinical context for the drug combination, typical sites of service where the injection is administered, and the relevance of precise HCPCS Level II coding for billing and utilization tracking.
The publication provides benchmarks and payer coverage context where available, flags common billing modifiers associated with injectable drug administration, and highlights policy considerations affecting reimbursement and prior authorization practices. It also outlines documentation elements that support medical necessity for parenteral antibiotic therapy. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code S0040 describes injection of ticarcillin disodium and clavulanate potassium, 3.1 grams. This service represents the administration of a combination intravenous antibiotic agent used for treatment of susceptible bacterial infections.
Service type: Intravenous injectable antibiotic therapy
Typical site of service: Hospital inpatient and outpatient settings, emergency departments, and other clinical infusion sites where parenteral antibiotics are administered
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an outpatient infusion clinic, emergency department, or hospital inpatient unit with a moderate-to-severe bacterial infection where broad-spectrum intravenous beta-lactam/beta-lactamase inhibitor therapy is indicated. The patient may have complicated skin and soft tissue infection, complicated urinary tract infection, intra-abdominal infection, or hospital-acquired/ventilator-associated pneumonia where local formulary includes ticarcillin-clavulanate. The clinical workflow: physician documents indication and orders S0040 (Injection, ticarcillin disodium and clavulanate potassium, 3.1 grams). Nursing verifies allergy history and renal function, prepares the dose per pharmacy reconstitution instructions, obtains IV access, and administers per facility dosing guidelines. Vital signs are monitored during and after infusion for infusion reaction. Pharmacy documents lot number and expiration; billing posts S0040 along with appropriate visit CPT codes and applicable modifier(s) to reflect circumstances such as unusual services, multiple procedures, or patient status.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard billing when no other modifier applies |