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    HCPCS Details

    HCPC J0295
    Short Description Ampicillin sulbactam 1.5 gm
    Long Description Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm
    Pricing indicator 51
    Coverage code D
    ASC payment group code
    BETOS2 code O1E
    Action code N
    Type of service 1
    Effective date 2019-01-01
    Date Added 1995-01-01

    HCPCS/NDC Cross-Walk

    NDC HCPC Description Drug Name Labeler Name HCPCS Dosage PKG Size PKG QTY Bill Units Bill Units PKG
    00049001383 J0295 Ampicillin sulbactam 1.5 gm Unasyn 1.5Gm PFIZER INC. 1.5 GM 1 10 1 10
    00049001483 J0295 Ampicillin sulbactam 1.5 gm Unasyn 3Gm PFIZER INC. 1.5 GM 1 10 2 20
    00049002428 J0295 Ampicillin sulbactam 1.5 gm Unasyn 15Gm PFIZER INC. 1.5 GM 1 1 10 10
    00409298703 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam PFIZER INC. 1.5 GM 1 10 2 20
    00641611610 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam HIKMA PHARMACEUTICALS USA INC. 1.5 GM 1 10 1 10
    00641611710 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam HIKMA PHARMACEUTICALS USA INC. 1.5 GM 1 10 2 20
    00641611801 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam HIKMA PHARMACEUTICALS USA INC. 1.5 GM 1 1 10 10
    25021014220 J0295 Ampicillin sulbactam 1.5 gm AMPICILLIN-SULBACTAM SAGENT PHARMACEUTICALS INC 1.5 GM 1 10 10 10
    25021014330 J0295 Ampicillin sulbactam 1.5 gm AMPICILLIN-SULBACTAM SAGENT PHARMACEUTICALS INC 1.5 GM 1 10 20 20
    25021014499 J0295 Ampicillin sulbactam 1.5 gm AMPICILLIN-SULBACTAM SAGENT PHARMACEUTICALS INC 1.5 GM 30 1 10 10
    25021018899 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam SAGENT PHARMACEUTICALS INC 1.5 GM 1 1 10 10
    44567015010 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam WG CRITICAL CARE LLC 1.5 GM 1 10 2 20
    44567021110 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam WG CRITICAL CARE 1.5 GM 1 10 2 20
    44567021201 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam WG CRITICAL CARE 1.5 GM 1 1 10 10
    55150011610 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam EUGIA US LLC 1.5 GM 1 10 1 10
    55150011620 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam AUROMEDICS PHARMA LLC 1.5 GM 1 10 1 10
    55150011710 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam EUGIA US LLC 1.5 GM 1 10 2 20
    55150011720 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam AUROMEDICS PHARMA LLC 1.5 GM 1 10 2 20
    55150011801 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam EUGIA US LLC 1.5 GM 1 1 10 10
    55150011899 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam AUROMEDICS PHARMA LLC 1.5 GM 1 1 10 10
    66794020641 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam PIRAMAL CRITICAL CARE 1.5 GM 1 10 1 10
    66794020741 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam PIRAMAL CRITICAL CARE 1.5 GM 1 10 2 20
    66794020815 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam PIRAMAL CRITICAL CARE 1.5 GM 1 1 10 10
    66794024141 J0295 Ampicillin sulbactam 1.5 gm AMPICILLIN-SULBACTAM PIRAMAL CRITICAL CARE 1.5 GM 1 10 1 10
    66794024241 J0295 Ampicillin sulbactam 1.5 gm AMPICILLIN-SULBACTAM PIRAMAL CRITICAL CARE 1.5 GM 1 10 2 20
    66794024315 J0295 Ampicillin sulbactam 1.5 gm AMPICILLIN-SULBACTAM PIRAMAL CRITICAL CARE 1.5 GM 1 1 10 10
    67457034810 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam MYLAN INSTITUTIONAL LLC 1.5 GM 1 10 1 10
    67457034910 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam MYLAN INSTITUTIONAL LLC 1.5 GM 1 10 2 20
    67457064910 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam MYLAN INSTITUTIONAL LLC 1.5 GM 1 1 10 10
    70594008102 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam XELLIA PHARMACEUTICALS USA, LLC 1.5 GM 1 10 1 10
    70594008202 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam XELLIA PHARMACEUTICALS USA, LLC 1.5 GM 1 10 2 20
    70594008301 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam XELLIA PHARMACEUTICALS USA, LLC 1.5 GM 1 1 10 10
    71288000520 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam MEITHEAL PHARMACEUTICALS, INC. 1.5 GM 1 10 1 10
    71288000630 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam MEITHEAL PHARMACEUTICALS, INC. 1.5 GM 1 10 2 20
    71288000775 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam MEITHEAL PHARMACEUTICALS, INC. 1.5 GM 1 1 10 10
    71288003121 J0295 Ampicillin sulbactam 1.5 gm AMPICILLIN-SULBACTAM MEITHEAL PHARMACEUTICALS, INC. 1.5 GM 1 10 1 10
    71288003221 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam MEITHEAL PHARMACEUTICALS 1.5 GM 1 10 2 20
    72485041710 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam ARMAS PHARMACEUTICALS, INC. 1.5 GM 1 10 2 20
    72572002110 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam CIVICA, INC. 1.5 GM 1 10 1 10
    72572002210 J0295 Ampicillin sulbactam 1.5 gm Ampicillin-Sulbactam CIVICA, INC. 1.5 GM 1 10 2 20
    The ASP crosswalks are maintained by the Division of Data Analysis and Market Based Pricing to support ASP-based Medicare Part B payments only. The crosswalks are intended to help the public (including entities that submit manufacturer ASP data and providers who bill for drugs) understand which drug products (identified by NDCs) are assigned to which HCPCS billing codes. The crosswalks are not intended to be a comprehensive list of all drugs/NDCs available in the United States. The NDC to HCPCS Crosswalk also includes information on the NDC package size and the number of billable units (as defined by the HCPCS code descriptor). Comments on the file may be sent to [email protected].

    HCPCS Billing Calculator

    Dosage given to patient (per dose)
    HCPCS Dosage 1.5 GM
    HCPCS/CPT Billing Units 1
    Total doses ordered
    Billing Units 1

    Drug Details

    • The combination of ampicillin and sulbactam injection is used to treat certain infections caused by bacteria, including infections of the skin, female reproductive organs, and abdomen (stomach area). Ampicillin is in a class of medications called penicillin-like antibiotics. It works by stopping the growth of bacteria. Sulbactam is in a class of medications called beta-lactamase inhibitors. It works by preventing bacteria from destroying ampicillin.

    • Antibiotics such as ampicillin and sulbactam injection will not work for colds, flu, or other viral infections. Using antibiotics when they are not needed increases your risk of getting an infection later that resists antibiotic treatment.