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HCPCS J0290 · Level II · Part B drug

HCPCS J0290: Injection, ampicillin sodium, 500 mg

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: ASP payment limits October 2026 (effective October 1, 2026); MUE and NCCI edits 2026 Q4 (effective October 1, 2026); OPPS Addendum B July 2026 (effective July 1, 2026). Next CMS release: January 1, 2027 (ASP, MUE, NCCI and OPPS quarterly updates).

Key facts for J0290

Billing unit
500 MG
Ampicillin 500 mg inj
ASP payment limit
$0.619
October 2026; +0.8% vs July 2026
Practitioner MUE
24
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J0290 is the Level II code for Injection, ampicillin sodium, 500 mg, billed per 500 MG. The Medicare Part B ASP payment limit for October 2026 is $0.619 per billing unit, up 0.8% from July 2026. The practitioner MUE allows up to 24 units per date of service (MAI 3). Under OPPS it carries status indicator N. J0290 is billed in units of 500 MG; the quantity administered, the NDC package and the units on the claim must reconcile, which is the check that prevents CARC 16 and 151 returns on this line. The ASP crosswalk maps 64 NDCs to it, sold as Ampicillin Sodium by Henry Schein Inc., Sandoz Inc., Heritage Pharmaceuticals Inc.. No current Billing and Coding Article lists J0290, so coverage follows the FDA label, compendia and any applicable NCD.

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for J0290 at $0.619 per 500 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.614 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J0290
QuarterPayment limitPerCoinsurance
October 2026$0.619500 MG20%
July 2026$0.614500 MG—
Source: CMS Medicare Part B Drug Payment Limit File. Commercial and Medicaid payers set their own rates.

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk maps 64 NDCs from 15 labelers to J0290. Report the NDC in the claim's drug segment and bill the number of J0290 units that equals the quantity administered divided by 500 MG; the last column gives units per full package.

NDCs that crosswalk to J0290
NDCDrug nameLabelerPackage sizeBilling units / package
00404-9803-99Ampicillin SodiumHenry Schein Inc.1 × 12
00404-9816-99Ampicillin SodiumHenry Schein Inc.1 × 12
00404-9818-99Ampicillin SodiumHenry Schein Inc.1 × 14
00781-3402-95Ampicillin SodiumSandoz Inc.1 × 105
00781-3404-95Ampicillin SodiumSandoz Inc.1 × 1020
00781-3407-95Ampicillin SodiumSandoz Inc.1 × 1010
00781-3408-95Ampicillin SodiumSandoz Inc.1 × 1040
00781-3409-95Ampicillin SodiumSandoz Inc.1 × 10200
00781-3412-92Ampicillin SodiumSandoz Inc.1 × 1020
00781-3413-92Ampicillin SodiumSandoz Inc.1 × 1040
00781-9242-95Ampicillin SodiumSandoz Inc.1 × 105
00781-9261-95Ampicillin SodiumSandoz Inc.1 × 1020
00781-9273-95Ampicillin SodiumSandoz Inc.1 × 1040
00781-9402-95Ampicillin SodiumSandoz Inc.1 × 105
00781-9404-95Ampicillin SodiumSandoz Inc.1 × 1020
00781-9407-95Ampicillin SodiumSandoz Inc.1 × 1010
00781-9408-95Ampicillin SodiumSandoz Inc.1 × 1040
00781-9409-95Ampicillin SodiumSandoz Inc.1 × 10200
00781-9412-92Ampicillin SodiumSandoz Inc.1 × 1020
00781-9413-92Ampicillin SodiumSandoz Inc.1 × 1040
23155-0915-41Ampicillin SodiumHeritage Pharmaceuticals Inc.1 × 1010
23155-0916-41Ampicillin SodiumHeritage Pharmaceuticals Inc.1 × 1020
23155-0917-41Ampicillin SodiumHeritage Pharmaceuticals Inc.1 × 1040
25021-0134-10Ampicillin SodiumSagent Pharmaceuticals1 × 105
25021-0135-10Ampicillin SodiumSagent Pharmaceuticals1 × 1010
25021-0136-10Ampicillin SodiumSagent Pharmaceuticals1 × 1020
25021-0137-20Ampicillin SodiumSagent Pharmaceuticals1 × 1040
25021-0197-99Ampicillin SodiumSagent Pharmaceuticals1 × 120
44567-0100-10Ampicillin SodiumWG Critical Care, LLC1 × 105
44567-0101-10Ampicillin SodiumWG Critical Care, LLC1 × 1010
44567-0102-10Ampicillin SodiumWG Critical Care, LLC1 × 1020
44567-0103-10Ampicillin SodiumWG Critical Care, LLC1 × 1040
44567-0104-01Ampicillin SodiumWG Critical Care, LLC1 × 120
50090-4552-00Ampicillin SodiumA-S Medication Solutions1 × 14
51662-1560-03Ampicillin SodiumHF Acquisition Co. LLC, DBA HealthFirst1 × 1040
51662-1595-03Ampicillin SodiumHF Acquisition Co. LLC, DBA HealthFirst1 × 105
55150-0113-10Ampicillin SodiumEugia US LLC1 × 1020
55150-0114-20Ampicillin SodiumEugia US LLC1 × 1040
55150-0115-99Ampicillin SodiumEugia US LLC1 × 10200
65219-0014-10Ampicillin SodiumFreseniUS Kabi USA, LLC1 × 105
65219-0016-10Ampicillin SodiumFreseniUS Kabi USA, LLC1 × 1010
65219-0018-10Ampicillin SodiumFreseniUS Kabi USA, LLC1 × 1020
65219-0020-23Ampicillin SodiumFreseniUS Kabi USA, LLC1 × 1040
66794-0220-41Ampicillin SodiumPiramal Critical Care Inc1 × 105
66794-0222-41Ampicillin SodiumPiramal Critical Care Inc1 × 1020
66794-0223-41Ampicillin SodiumPiramal Critical Care Inc1 × 1040
66794-0224-15Ampicillin SodiumPiramal Critical Care Inc1 × 120
70860-0112-15Ampicillin SodiumAthenex Pharmaceutical Division, LLC1 × 105
70860-0113-15Ampicillin SodiumAthenex Pharmaceutical Division, LLC1 × 1010
70860-0114-15Ampicillin SodiumAthenex Pharmaceutical Division, LLC1 × 1020
70860-0115-26Ampicillin SodiumAthenex Pharmaceutical Division, LLC1 × 1040
70860-0118-99Ampicillin SodiumAthenex Pharmaceutical Division, LLC1 × 120
72485-0421-10Ampicillin SodiumArmas Pharmaceuticals Inc.1 × 1020
72485-0422-10Ampicillin SodiumArmas Pharmaceuticals Inc.1 × 1040
72485-0423-10Ampicillin SodiumArmas Pharmaceuticals Inc.1 × 120
72572-0016-10Ampicillin SodiumCivica, Inc.1 × 1020
72572-0017-10Ampicillin SodiumCivica, Inc.1 × 1040
72572-0093-10Ampicillin SodiumCivica, Inc.1 × 1020
72572-0094-10Ampicillin SodiumCivica, Inc.1 × 1040
72603-0221-10Ampicillin SodiumNorthstar RxLLC1 × 1010
Showing 60 of 64 NDCs.

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J0290. For practitioners the limit is 24 units per date of service with adjudication indicator 3, a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation that the quantity was medically reasonable.

MUE values for J0290 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services243 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital243 Date of Service Edit: ClinicalClinical: Data
DME supplier03 Date of Service Edit: ClinicalCMS Policy

NCCI edits and add-on relationships

No active practitioner PTP pair lists J0290 as a column-1 or column-2 code in v323r0. Drug supply codes are rarely bundled; the administration codes billed with them are where PTP edits usually apply.

J0290 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

No current Billing and Coding Article lists J0290 in its HCPCS table. Coverage then follows the drug's FDA label, compendia and any National Coverage Determination; check the Medicare Coverage Database before administering off-label.

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, J0290 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J0290 and how to prevent them

CARC 16 · M119

NDC missing, invalid or not matched to the HCPCS code

CARC 151 · N362

units billed exceed the MUE for the date of service

CARC 50 · N115

diagnosis not covered by the applicable coverage article or LCD

How QuickIntell checks J0290 before the claim leaves

QuickCode validates the NDC-to-unit conversion against the current ASP crosswalk, checks units against every published MUE setting and flags PTP and add-on conflicts on the same claim. QuickRCM routes CARC 16, 151 and 50 denials on drug lines with the matching coverage article attached so the appeal starts with evidence.

Explore QuickCodeExplore QuickRCMBook a demo

Frequently asked questions — HCPCS J0290

What does HCPCS code J0290 describe?

J0290 is defined by CMS as "Injection, ampicillin sodium, 500 mg". Each billing unit represents 500 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J0290 in October 2026?

The ASP-based payment limit is $0.619 per 500 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.614.

How many units of J0290 can be billed per day?

The practitioner Medically Unlikely Edit is 24 units per date of service with adjudication indicator 3 (3 Date of Service Edit: Clinical). MAI 3 edits can be appealed with documentation that the units were medically reasonable. CMS cites "Clinical: Data" as the rationale.

Which NDCs map to J0290?

The October 2026 ASP crosswalk lists 64 NDCs from 15 labelers: Ampicillin Sodium (Henry Schein Inc.); Ampicillin Sodium (Sandoz Inc.); Ampicillin Sodium (Heritage Pharmaceuticals Inc.); Ampicillin Sodium (Sagent Pharmaceuticals). For example NDC 00404-9803-99 is a 1 package equal to 2 billing units. The crosswalk's billing-units-per-package figure converts each package into J0290 units.

Does J0290 have NCCI bundling edits?

No active practitioner PTP pairs list J0290 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still apply.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-01. Verify against the primary file before billing or contracting decisions.

Disclaimer

This page is an operational reference compiled from CMS publications: the Medicare Part B drug payment limit and NDC crosswalk files, NCCI MUE and add-on edit tables, aggregate PTP statistics, OPPS Addendum B and the Medicare Coverage Database. Payment limits are Medicare national amounts; commercial and Medicaid payers differ. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.