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HCPCS J0696 · Level II · Part B drug

HCPCS J0696: Injection, ceftriaxone sodium, per 250 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 J0696

Billing unit
250 MG
Ceftriaxone sodium injection
ASP payment limit
$0.39
October 2026; -3.5% 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 J0696 is the Level II code for Injection, ceftriaxone sodium, per 250 mg, billed per 250 MG. The Medicare Part B ASP payment limit for October 2026 is $0.39 per billing unit, down 3.5% from July 2026. The practitioner MUE allows up to 16 units per date of service (MAI 3). Under OPPS it carries status indicator N. J0696 is billed in units of 250 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 61 NDCs to it, sold as Ceftriaxone, Ceftriaxone in D5W by Hikma Pharmaceuticals USA Inc., B. Braun Medical Inc., Baxter Healthcare Corporation. No current Billing and Coding Article lists J0696, 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 J0696 at $0.39 per 250 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.404 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J0696
QuarterPayment limitPerCoinsurance
October 2026$0.39250 MG20%
July 2026$0.404250 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 61 NDCs from 11 labelers to J0696. Report the NDC in the claim's drug segment and bill the number of J0696 units that equals the quantity administered divided by 250 MG; the last column gives units per full package.

NDCs that crosswalk to J0696
NDCDrug nameLabelerPackage sizeBilling units / package
00143-9678-01CeftriaxoneHikma Pharmaceuticals USA Inc.1 × 140
00143-9856-25CeftriaxoneHikma Pharmaceuticals USA Inc.1 × 25200
00143-9857-25CeftriaxoneHikma Pharmaceuticals USA Inc.1 × 25100
00143-9858-25CeftriaxoneHikma Pharmaceuticals USA Inc.1 × 2550
00143-9859-25CeftriaxoneHikma Pharmaceuticals USA Inc.1 × 2525
00264-3153-11Ceftriaxone in D5WB. Braun Medical Inc.1 × 2496
00264-3155-11Ceftriaxone in D5WB. Braun Medical Inc.1 × 24192
00338-5002-41Ceftriaxone in D5WBaxter Healthcare Corporation50 × 2496
00338-5003-41Ceftriaxone in D5WBaxter Healthcare Corporation50 × 24192
00409-7332-01CeftriaxonePfizer Inc1 × 1040
00409-7332-20CeftriaxonePfizer Inc1 × 1040
00409-7333-04CeftriaxonePfizer Inc1 × 1040
00409-7333-49CeftriaxonePfizer Inc1 × 1040
00409-7334-10CeftriaxonePfizer Inc1 × 140
00409-7334-20CeftriaxonePfizer Inc1 × 140
00409-7335-03CeftriaxonePfizer Inc1 × 1080
00409-7335-20CeftriaxonePfizer Inc1 × 1080
00409-7336-04CeftriaxonePfizer Inc1 × 1080
00409-7337-01CeftriaxonePfizer Inc1 × 1010
00409-7337-20CeftriaxonePfizer Inc1 × 1010
00409-7338-01CeftriaxonePfizer Inc1 × 1020
00409-7338-20CeftriaxonePfizer Inc1 × 1020
00781-3206-85CeftriaxoneSandoz Inc.1 × 11
00781-3206-95CeftriaxoneSandoz Inc.1 × 1010
00781-3207-85CeftriaxoneSandoz Inc.1 × 12
00781-3207-95CeftriaxoneSandoz Inc.1 × 1020
00781-3208-85CeftriaxoneSandoz Inc.1 × 14
00781-3208-95CeftriaxoneSandoz Inc.1 × 1040
00781-3209-95CeftriaxoneSandoz Inc.1 × 1080
00781-3210-46CeftriaxoneSandoz Inc.1 × 140
25021-0105-10CeftriaxoneSagent Pharmaceuticals1 × 2550
25021-0105-66CeftriaxoneSagent Pharmaceuticals1 × 2550
25021-0106-10CeftriaxoneSagent Pharmaceuticals1 × 25100
25021-0106-67CeftriaxoneSagent Pharmaceuticals1 × 25100
25021-0107-20CeftriaxoneSagent Pharmaceuticals1 × 25200
25021-0107-68CeftriaxoneSagent Pharmaceuticals1 × 25200
25021-0108-69CeftriaxoneSagent Pharmaceuticals1 × 140
25021-0108-99CeftriaxoneSagent Pharmaceuticals1 × 140
44567-0700-25CeftriaxoneWG Critical Care, LLC1 × 2550
44567-0701-25CeftriaxoneWG Critical Care, LLC1 × 25100
44567-0701-95CeftriaxoneWG Critical Care, LLC1 × 25100
44567-0702-25CeftriaxoneWG Critical Care, LLC1 × 25200
44567-0702-95CeftriaxoneWG Critical Care, LLC1 × 25200
44567-0703-01CeftriaxoneWG Critical Care, LLC1 × 140
50090-0944-00CeftriaxoneA-S Medication Solutions1 × 1020
50090-0945-00CeftriaxoneA-S Medication Solutions1 × 1040
50090-1875-00CeftriaxoneA-S Medication Solutions1 × 1010
50090-2444-00CeftriaxoneA-S Medication Solutions1 × 11
50090-3810-01CeftriaxoneA-S Medication Solutions1 × 1040
50090-3838-00CeftriaxoneA-S Medication Solutions1 × 12
50090-4689-00CeftriaxoneA-S Medication Solutions1 × 1010
60505-6148-04CeftriaxoneApotex Corp1 × 1040
60505-6149-04CeftriaxoneApotex Corp1 × 1080
60505-6150-05CeftriaxoneApotex Corp1 × 140
60505-6151-01CeftriaxoneApotex Corp1 × 1010
60505-6151-04CeftriaxoneApotex Corp1 × 11
60505-6152-01CeftriaxoneApotex Corp1 × 1020
60505-6152-04CeftriaxoneApotex Corp1 × 12
63323-0346-10CeftriaxoneFreseniUS Kabi USA, LLC1 × 25100
72572-0061-25CeftriaxoneCivica, Inc.1 × 25100
Showing 60 of 61 NDCs.

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J0696. 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 J0696 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services163 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital163 Date of Service Edit: ClinicalPrescribing Information
DME supplier03 Date of Service Edit: ClinicalCMS Policy

NCCI edits and add-on relationships

No active practitioner PTP pair lists J0696 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.

J0696 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 J0696 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, J0696 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J0696 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 J0696 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 J0696

What does HCPCS code J0696 describe?

J0696 is defined by CMS as "Injection, ceftriaxone sodium, per 250 mg". Each billing unit represents 250 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J0696 in October 2026?

The ASP-based payment limit is $0.39 per 250 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.404.

How many units of J0696 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 "Prescribing Information" as the rationale.

Which NDCs map to J0696?

The October 2026 ASP crosswalk lists 61 NDCs from 11 labelers: Ceftriaxone (Hikma Pharmaceuticals USA Inc.); Ceftriaxone in D5W (B. Braun Medical Inc.); Ceftriaxone in D5W (Baxter Healthcare Corporation); Ceftriaxone (Pfizer Inc). For example NDC 00143-9678-01 is a 1 package equal to 40 billing units. The crosswalk's billing-units-per-package figure converts each package into J0696 units.

Does J0696 have NCCI bundling edits?

No active practitioner PTP pairs list J0696 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.