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HCPCS J0690 · Level II · Part B drug

HCPCS J0690: Injection, cefazolin 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 J0690

Billing unit
500 MG
Cefazolin sodium injection
ASP payment limit
$0.781
October 2026; -1.9% vs July 2026
Practitioner MUE
16
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J0690 is the Level II code for Injection, cefazolin sodium, 500 mg, billed per 500 MG. The Medicare Part B ASP payment limit for October 2026 is $0.781 per billing unit, down 1.9% from July 2026. The practitioner MUE allows up to 16 units per date of service (MAI 3). Under OPPS it carries status indicator N. J0690 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 37 NDCs to it, sold as Cefazolin Sodium, Cefazolin Sodium in Dextrose by Hikma Pharmaceuticals USA Inc., B. Braun Medical Inc., Henry Schein Inc.. No current Billing and Coding Article lists J0690, 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 J0690 at $0.781 per 500 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.796 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J0690
QuarterPayment limitPerCoinsurance
October 2026$0.781500 MG20%
July 2026$0.796500 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 37 NDCs from 11 labelers to J0690. Report the NDC in the claim's drug segment and bill the number of J0690 units that equals the quantity administered divided by 500 MG; the last column gives units per full package.

NDCs that crosswalk to J0690
NDCDrug nameLabelerPackage sizeBilling units / package
00143-9261-10Cefazolin SodiumHikma Pharmaceuticals USA Inc.1 × 10200
00143-9262-25Cefazolin SodiumHikma Pharmaceuticals USA Inc.1 × 2550
00143-9923-90Cefazolin SodiumHikma Pharmaceuticals USA Inc.1 × 2525
00143-9924-90Cefazolin SodiumHikma Pharmaceuticals USA Inc.1 × 2550
00143-9983-03Cefazolin SodiumHikma Pharmaceuticals USA Inc.1 × 10200
00264-3103-11Cefazolin Sodium in DextroseB. Braun Medical Inc.50 × 2448
00264-3105-11Cefazolin Sodium in DextroseB. Braun Medical Inc.50 × 2496
00264-3107-11Cefazolin Sodium in DextroseB. Braun Medical Inc.1 × 24144
00404-9833-99Cefazolin SodiumHenry Schein Inc.1 × 12
00404-9834-99Cefazolin SodiumHenry Schein Inc.1 × 12
00404-9835-99Cefazolin SodiumHenry Schein Inc.1 × 11
00409-2585-01Cefazolin SodiumPfizer Inc1 × 2550
00781-3450-95Cefazolin SodiumSandoz Inc.1 × 1010
00781-3451-95Cefazolin SodiumSandoz Inc.1 × 1020
00781-3451-96Cefazolin SodiumSandoz Inc.10 × 2550
00781-3452-95Cefazolin SodiumSandoz Inc.1 × 10200
25021-0100-10Cefazolin SodiumSagent Pharmaceuticals1 × 2525
25021-0100-66Cefazolin SodiumSagent Pharmaceuticals1 × 2525
25021-0101-10Cefazolin SodiumSagent Pharmaceuticals1 × 2550
25021-0101-67Cefazolin SodiumSagent Pharmaceuticals1 × 2550
25021-0102-69Cefazolin SodiumSagent Pharmaceuticals1 × 10200
25021-0102-99Cefazolin SodiumSagent Pharmaceuticals1 × 10200
44567-0120-25Cefazolin SodiumWG Critical Care, LLC1 × 2550
44567-0706-25Cefazolin SodiumWG Critical Care, LLC1 × 2525
44567-0707-25Cefazolin SodiumWG Critical Care, LLC1 × 2550
44567-0708-10Cefazolin SodiumWG Critical Care, LLC1 × 10200
50090-4256-00Cefazolin SodiumA-S Medication Solutions1 × 2550
60505-6142-05Cefazolin SodiumApotex Corp1 × 2550
60505-6143-04Cefazolin SodiumApotex Corp1 × 10200
60505-6231-05Cefazolin SodiumApotex Corp1 × 25100
60505-6243-04Cefazolin SodiumApotex Corp1 × 2550
60505-6244-04Cefazolin SodiumApotex Corp1 × 10200
60505-6266-05Cefazolin SodiumApotex Corp1 × 25150
63323-0237-10Cefazolin SodiumFreseniUS Kabi USA, LLC1 × 2550
63323-0238-61Cefazolin SodiumFreseniUS Kabi USA, LLC1 × 10200
72572-0055-25Cefazolin SodiumCivica, Inc.1 × 2550
72572-0056-10Cefazolin SodiumCivica, Inc.1 × 10200

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J0690. For practitioners the limit is 16 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 J0690 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services163 Date of Service Edit: ClinicalClinical: Society Comment
Facility outpatient hospital163 Date of Service Edit: ClinicalClinical: Society Comment
DME supplier163 Date of Service Edit: ClinicalClinical: Society Comment

NCCI edits and add-on relationships

No active practitioner PTP pair lists J0690 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.

J0690 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 J0690 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, J0690 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J0690 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 J0690 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 J0690

What does HCPCS code J0690 describe?

J0690 is defined by CMS as "Injection, cefazolin 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 J0690 in October 2026?

The ASP-based payment limit is $0.781 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 $0.796.

How many units of J0690 can be billed per day?

The practitioner Medically Unlikely Edit is 16 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: Society Comment" as the rationale.

Which NDCs map to J0690?

The October 2026 ASP crosswalk lists 37 NDCs from 11 labelers: Cefazolin Sodium (Hikma Pharmaceuticals USA Inc.); Cefazolin Sodium in Dextrose (B. Braun Medical Inc.); Cefazolin Sodium (Henry Schein Inc.); Cefazolin Sodium (Pfizer Inc). For example NDC 00143-9261-10 is a 1 package equal to 200 billing units. The crosswalk's billing-units-per-package figure converts each package into J0690 units.

Does J0690 have NCCI bundling edits?

No active practitioner PTP pairs list J0690 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.