Skip to main content
HCPCS J0713 · Level II · Part B drug

HCPCS J0713: Injection, ceftazidime, per 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 J0713

Billing unit
500 MG
Inj ceftazidime per 500 mg
ASP payment limit
$1.549
October 2026; +7.4% vs July 2026
Practitioner MUE
12
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J0713 is the Level II code for Injection, ceftazidime, per 500 mg, billed per 500 MG. The Medicare Part B ASP payment limit for October 2026 is $1.549 per billing unit, up 7.4% from July 2026. The practitioner MUE allows up to 12 units per date of service (MAI 3). Under OPPS it carries status indicator N. J0713 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 15 NDCs to it, sold as Tazicef, Ceftazidime by Pfizer Inc, Sagent Pharmaceuticals, WG Critical Care, LLC. No current Billing and Coding Article lists J0713, 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 J0713 at $1.549 per 500 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $1.443 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J0713
QuarterPayment limitPerCoinsurance
October 2026$1.549500 MG20%
July 2026$1.443500 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 15 NDCs from 3 labelers to J0713. Report the NDC in the claim's drug segment and bill the number of J0713 units that equals the quantity administered divided by 500 MG; the last column gives units per full package.

NDCs that crosswalk to J0713
NDCDrug nameLabelerPackage sizeBilling units / package
00409-5082-10TazicefPfizer Inc1 × 1020
00409-5082-16TazicefPfizer Inc1 × 2550
00409-5084-11TazicefPfizer Inc1 × 1040
00409-5086-11TazicefPfizer Inc1 × 10120
00409-5092-16TazicefPfizer Inc1 × 2550
00409-5093-11TazicefPfizer Inc1 × 1040
25021-0127-20CeftazidimeSagent Pharmaceuticals1 × 2550
25021-0127-66CeftazidimeSagent Pharmaceuticals1 × 2550
25021-0128-50CeftazidimeSagent Pharmaceuticals1 × 1040
25021-0128-67CeftazidimeSagent Pharmaceuticals1 × 1040
25021-0129-69CeftazidimeSagent Pharmaceuticals1 × 672
25021-0129-99CeftazidimeSagent Pharmaceuticals1 × 672
44567-0235-25CeftazidimeWG Critical Care, LLC1 × 2550
44567-0236-10CeftazidimeWG Critical Care, LLC1 × 1040
44567-0237-06CeftazidimeWG Critical Care, LLC1 × 672

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J0713. For practitioners the limit is 12 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 J0713 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services123 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital123 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 J0713 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.

J0713 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 J0713 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, J0713 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J0713 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 J0713 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 J0713

What does HCPCS code J0713 describe?

J0713 is defined by CMS as "Injection, ceftazidime, per 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 J0713 in October 2026?

The ASP-based payment limit is $1.549 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 $1.443.

How many units of J0713 can be billed per day?

The practitioner Medically Unlikely Edit is 12 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 J0713?

The October 2026 ASP crosswalk lists 15 NDCs from 3 labelers: Tazicef (Pfizer Inc); Ceftazidime (Sagent Pharmaceuticals); Ceftazidime (WG Critical Care, LLC). For example NDC 00409-5082-10 is a 1 package equal to 20 billing units. The crosswalk's billing-units-per-package figure converts each package into J0713 units.

Does J0713 have NCCI bundling edits?

No active practitioner PTP pairs list J0713 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.