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J0295

J0295 – Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm · NDC Crosswalk & Billing Units

HCPCS Level II J-code · Medicare Part B drug billing
J-code ● 58 NDCs crosswalked per 1.5 GM $1.451/unit ASP+6%

This page is curated, coded, and maintained by

Compiled from public FDA, CMS, DailyMed, NADAC, and related drug data sources. Editorial policy

📋 J0295 summary

J0295 is a HCPCS Level II J-code used to bill ampicillin sodium/sulbactam sodium, per 1.5 gm, billed per 1.5 GM. The number of billing units to report depends on the dose administered and the NDC/package billed — use the calculator below.

Brand names associated with J0295: Ampicillin-Sulbactam*, Unasyn, Ampicillin And Sulbactam

Code J0295 Billing unit 1.5 GM Payment limit $1.451/unit NDC-Crosswalk 58 Quarter Q3 2026 RxCUI Atlas Trace the drug concept →

⚠ An NDC↔HCPCS crosswalk and a published payment limit do not guarantee payer coverage or payment. Always verify the current payer policy and claim format before billing.

🗂️ Key billing facts

HCPCS codeJ0295
DescriptorInjection, ampicillin sodium/sulbactam sodium, per 1.5 gm
Billing unit1.5 GM
Payment limit / unit$1.451
Est. ASP / unit$1.369 est.
Mapped NDCs58
Data periodQ3 2026
Last updated2026-08-20

💊 About Ampicillin and Sulbactam Injection DRUG GUIDE

Ampicillin and sulbactam for injection is used to treat bacterial infections in three main areas: skin and skin structure infections, intra-abdominal (belly) infections, and gynecological infections.

It specifically targets bacteria that produce beta-lactamases — enzymes that would normally break down and disable ampicillin on its own.Because it contains ampicillin, it can also treat infections caused by bacteria that are already susceptible to ampicillin, meaning it can handle mixed infections without needing a second antibiotic added.

Read the full Ampicillin and Sulbactam Injection drug guide →
Clinical overview from our editorial drug guide for Ampicillin and Sulbactam Injection. For billing reference, see the sections above.

🧾 Billing & reimbursement HCPCS · CMS · EFF. Q3 2026

📅 Payment limits effective Q3 2026 — from the CMS Medicare Part B Payment Limit File (revised quarterly).
Medicare payment limit / unit
$1.451
Est. ASP / unit
$1.369 est.
Est. after 2% sequester
$1.422
HCPCS dosage
1.5 GM
The CMS payment limit is the Medicare Part B drug allowance (ASP + 6%, statutory). After the 2% federal sequester the effective payment is ≈ ASP + 4.3%; estimated ASP = payment limit ÷ 1.06. Source: CMS Medicare Part B Payment Limit File (quarterly), Q3 2026.
Full HCPCS code details (official CMS record)
Long descriptionInjection, ampicillin sodium/sulbactam sodium, per 1.5 gm
CoverageD — Special coverage instructions apply
Pricing indicator51 — Drug — priced under the ASP methodology
Type of service1 — Medical care
BETOS-2O1E
ASC payment group—
Action codeN — No maintenance this year
Effective date2019-01-01
Date added1995-01-01
Source: CMS HCPCS Level II code file (imported via admin).

🧮 Dosing & billing-units calculator HCPCS UNITS

One billing unit of J0295 = 1.5 gm. Enter a regimen to convert dose → billing units and project a full course.
Billing units = dose ÷ HCPCS unit size. Most payers require whole units — round per the payer's policy. “Est. Medicare pay” uses the current payment limit. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (JZ when none is discarded) where allowed. Always verify payer-specific rounding before billing.

🔁 NDCs that bill under J0295 WITH EST. MEDICARE PAY

58 NDCs map to J0295. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($1.451/unit) × that package's bill units.
NDC (11-digit)DrugLabelerPackageStrength Bill units Est. pay / pkg NADAC / unit StatusSource
00049-0013-83 UNASYN ampicillin sodium and sulbactam 1 g/1; .5 g/1 INJECTION, POWDER, FOR SOLUTION Roerig 10 VIAL in 1 CARTON (0049-0013-83) / 1 IN... 1 g/1; .5 g/1 10 $14.51 — ● Active CMS + PDAC
00049-0014-83 UNASYN ampicillin sodium and sulbactam 2 g/1; 1 g/1 INJECTION, POWDER, FOR SOLUTION Roerig 10 VIAL in 1 CARTON (0049-0014-83) / 1 IN... 2 g/1; 1 g/1 20 $29.02 — ● Active CMS + PDAC
00049-0024-28 UNASYN ampicillin sodium and sulbactam 100 mg/mL; 50 mg/mL INJECTION, POWDER, FOR SOLUTION Roerig 1 VIAL, PHARMACY BULK PACKAGE in 1 CARTON... 100 mg/mL; 50 mg/mL 10 $14.51 — Obsolete CMS ASP
00409-2689-01 Ampicillin and Sulbactam 1 g/1; .5 g/1 INJECTION, POWDER, FOR SOLUTION Hospira, 10 VIAL in 1 TRAY (0409-2689-01) / 1 INJE... 1 g/1; .5 g/1 10 $14.51 — ● Active CMS + PDAC
00409-2987-03 Ampicillin and Sulbactam 2 g/1; 1 g/1 INJECTION, POWDER, FOR SOLUTION Hospira, 10 VIAL in 1 TRAY (0409-2987-03) / 1 INJE... 2 g/1; 1 g/1 20 $29.02 — Obsolete CMS + PDAC
00641-6116-10 Ampicillin and Sulbactam 1 g/1.5g; .5 g/1.5g INJECTION, POWDER, FOR SOLUTION Hikma 10 VIAL in 1 CARTON (0641-6116-10) / 1.5... 1 g/1.5g; .5 g/1.5g 10 $14.51 — ● Active CMS ASP
00641-6117-10 Ampicillin and Sulbactam 2 g/3g; 1 g/3g INJECTION, POWDER, FOR SOLUTION Hikma 10 VIAL in 1 CARTON (0641-6117-10) / 3 g... 2 g/3g; 1 g/3g 20 $29.02 — ● Active CMS ASP
00641-6118-01 Ampicillin and Sulbactam 100 mg/mL; 50 mg/mL INJECTION, POWDER, FOR SOLUTION Hikma 100 mL in 1 VIAL, PHARMACY BULK PACKAGE (0... 100 mg/mL; 50 mg/mL 10 $14.51 — ● Active CMS ASP
25021-0142-20 ampicillin and sulbactam 1 g/1; .5 g/1 INJECTION, POWDER, FOR SOLUTION Sagent 10 VIAL in 1 CARTON (25021-142-20) / 1 IN... 1 g/1; .5 g/1 10 $14.51 — ● Active CMS ASP
25021-0143-30 ampicillin and sulbactam 2 g/1; 1 g/1 INJECTION, POWDER, FOR SOLUTION Sagent 10 VIAL in 1 CARTON (25021-143-30) / 1 IN... 2 g/1; 1 g/1 20 $29.02 — ● Active CMS ASP
25021-0144-99 ampicillin and sulbactam 100 mg/mL; 50 mg/mL INJECTION, POWDER, FOR SOLUTION Sagent 1 BOTTLE in 1 CARTON (25021-144-99) / 100... 100 mg/mL; 50 mg/mL 10 $14.51 — ● Active CMS ASP
25021-0188-99 Ampicillin-Sulbactam Sagent — — 10 $14.51 — — CMS + PDAC
44567-0150-10 Ampicillin and Sulbactam 1 g/1; 2 g/1 INJECTION, POWDER, FOR SOLUTION WG 10 VIAL in 1 CARTON (44567-150-10) / 1 IN... 1 g/1; 2 g/1 20 $29.02 — ● Active CMS + PDAC
44567-0210-10 Ampicillin and Sulbactam 1 g/1; .5 g/1 INJECTION, POWDER, FOR SOLUTION WG 10 VIAL in 1 CARTON (44567-210-10) / 1 IN... 1 g/1; .5 g/1 10 $14.51 — ● Active CMS ASP
44567-0211-10 Ampicillin and Sulbactam 1 g/1; 2 g/1 INJECTION, POWDER, FOR SOLUTION WG 10 VIAL in 1 CARTON (44567-211-10) / 1 IN... 1 g/1; 2 g/1 20 $29.02 — ● Active CMS ASP
44567-0212-01 Ampicillin and Sulbactam 10 g/1; 5 g/1 INJECTION, POWDER, FOR SOLUTION WG 1 VIAL, PHARMACY BULK PACKAGE in 1 CARTON... 10 g/1; 5 g/1 10 $14.51 — ● Active CMS ASP
55150-0116-10 Ampicillin and Sulbactam 1 g/1; .5 g/1 INJECTION, POWDER, FOR SOLUTION Eugia 10 VIAL in 1 CARTON (55150-116-10) / 1 IN... 1 g/1; .5 g/1 10 $14.51 — ● Active CMS + PDAC
55150-0116-20 Ampicillin and Sulbactam 1 g/1; .5 g/1 INJECTION, POWDER, FOR SOLUTION Eugia 10 VIAL in 1 CARTON (55150-116-20) / 1 IN... 1 g/1; .5 g/1 10 $14.51 — ● Active CMS ASP
55150-0117-10 Ampicillin and Sulbactam 2 g/1; 1 g/1 INJECTION, POWDER, FOR SOLUTION Eugia 10 VIAL in 1 CARTON (55150-117-10) / 1 IN... 2 g/1; 1 g/1 20 $29.02 — ● Active CMS + PDAC
55150-0117-20 Ampicillin and Sulbactam 2 g/1; 1 g/1 INJECTION, POWDER, FOR SOLUTION Eugia 10 VIAL in 1 CARTON (55150-117-20) / 1 IN... 2 g/1; 1 g/1 20 $29.02 — ● Active CMS ASP
55150-0118-01 Ampicillin and Sulbactam 100 mg/mL; 50 mg/mL INJECTION, POWDER, FOR SOLUTION Eugia 1 VIAL, PHARMACY BULK PACKAGE in 1 CARTON... 100 mg/mL; 50 mg/mL 10 $14.51 — ● Active CMS + PDAC
55150-0118-99 Ampicillin and Sulbactam 100 mg/mL; 50 mg/mL INJECTION, POWDER, FOR SOLUTION Eugia 1 VIAL, PHARMACY BULK PACKAGE in 1 CARTON... 100 mg/mL; 50 mg/mL 10 $14.51 — ● Active CMS ASP
66794-0206-41 Ampicillin-Sulbactam Piramal — — 10 $14.51 — — CMS + PDAC
66794-0207-41 Ampicillin-Sulbactam Piramal — — 20 $29.02 — — CMS + PDAC
66794-0208-15 Ampicillin-Sulbactam Piramal — — 10 $14.51 — — CMS + PDAC
71288-0005-20 Ampicillin-Sulbactam Meitheal — — 10 $14.51 — — CMS + PDAC
71288-0006-30 Ampicillin-Sulbactam Meitheal — — 20 $29.02 — — CMS + PDAC
71288-0007-75 Ampicillin-Sulbactam Meitheal — — 10 $14.51 — — CMS + PDAC
71288-0031-21 Ampicillin and Sulbactam 1 g/1; .5 g/1 INJECTION, POWDER, FOR SOLUTION Meitheal 10 VIAL, SINGLE-DOSE in 1 CARTON (71288-03... 1 g/1; .5 g/1 10 $14.51 — ● Active CMS + PDAC
71288-0031-92 Ampicillin and Sulbactam 1 g/1; .5 g/1 INJECTION, POWDER, FOR SOLUTION Meitheal 10 VIAL, SINGLE-DOSE in 1 CARTON (71288-03... 1 g/1; .5 g/1 10 $14.51 — ● Active CMS + PDAC
71288-0032-21 Ampicillin and Sulbactam 2 g/1; 1 g/1 INJECTION, POWDER, FOR SOLUTION Meitheal 10 VIAL, SINGLE-DOSE in 1 CARTON (71288-03... 2 g/1; 1 g/1 20 $29.02 — ● Active CMS + PDAC
71288-0032-92 Ampicillin and Sulbactam 2 g/1; 1 g/1 INJECTION, POWDER, FOR SOLUTION Meitheal 10 VIAL, SINGLE-DOSE in 1 CARTON (71288-03... 2 g/1; 1 g/1 20 $29.02 — ● Active CMS + PDAC
71288-0033-75 Ampicillin and Sulbactam 10 g/1; 5 g/1 INJECTION, POWDER, FOR SOLUTION Meitheal 1 BOTTLE in 1 CARTON (71288-033-75) / 1 I... 10 g/1; 5 g/1 10 $14.51 — ● Active CMS + PDAC
71288-0033-91 Ampicillin and Sulbactam 10 g/1; 5 g/1 INJECTION, POWDER, FOR SOLUTION Meitheal 1 BOTTLE in 1 CARTON (71288-033-91) / 1 I... 10 g/1; 5 g/1 10 $14.51 — ● Active CMS + PDAC
72485-0416-10 Ampicillin Sodium and Sulbactam 1 g/1; .5 g/1 INJECTION, POWDER, FOR SOLUTION Armas 10 VIAL in 1 CARTON (72485-416-10) / 1 IN... 1 g/1; .5 g/1 10 $14.51 — ● Active CMS + PDAC
72485-0417-10 Ampicillin Sodium and Sulbactam 2 g/1; 1 g/1 INJECTION, POWDER, FOR SOLUTION Armas 10 VIAL in 1 CARTON (72485-417-10) / 1 IN... 2 g/1; 1 g/1 20 $29.02 — ● Active CMS + PDAC
72485-0418-15 Ampicillin Sodium and Sulbactam 10 g/15g; 5 g/15g INJECTION, POWDER, FOR SOLUTION Armas 1 BOTTLE in 1 CARTON (72485-418-15) / 15... 10 g/15g; 5 g/15g 10 $14.51 — ● Active CMS ASP
72572-0021-10 Ampicillin-Sulbactam Civica, — — 10 $14.51 — — CMS + PDAC
72572-0022-10 Ampicillin-Sulbactam Civica, — — 20 $29.02 — — CMS + PDAC
72572-0136-10 ampicillin sodium and sulbactam 2 g/1; 1 g/1 INJECTION, POWDER, FOR SOLUTION Civica, 10 VIAL in 1 CARTON (72572-136-10) / 1 IN... 2 g/1; 1 g/1 20 $29.02 — ● Active CMS + PDAC
72603-0220-10 Ampicillin and Sulbactam 1 g/1; .5 g/1 INJECTION, POWDER, FOR SOLUTION NorthStar 10 VIAL, SINGLE-DOSE in 1 CARTON (72603-22... 1 g/1; .5 g/1 10 $14.51 — ● Active CMS + PDAC
72603-0335-10 Ampicillin and Sulbactam 2 g/1; 1 g/1 INJECTION, POWDER, FOR SOLUTION NorthStar 10 VIAL, SINGLE-DOSE in 1 CARTON (72603-33... 2 g/1; 1 g/1 20 $29.02 — ● Active CMS + PDAC
72603-0444-01 Ampicillin and Sulbactam 10 g/1; 5 g/1 INJECTION, POWDER, FOR SOLUTION NorthStar 10 BOTTLE in 1 CARTON (72603-444-01) / 1... 10 g/1; 5 g/1 100 $145.10 — ● Active CMS + PDAC
83634-0108-99 Ampicillin and Sulbactam 10 g/1; 5 g/1 INJECTION, POWDER, FOR SOLUTION Avenacy, 1 BOTTLE in 1 CARTON (83634-108-99) / 1 I... 10 g/1; 5 g/1 10 $14.51 — ● Active CMS ASP
83634-0110-20 Ampicillin and Sulbactam 2 g/1; 1 g/1 INJECTION, POWDER, FOR SOLUTION Avenacy, 10 VIAL, SINGLE-DOSE in 1 CARTON (83634-11... 2 g/1; 1 g/1 20 $29.02 — ● Active CMS + PDAC
83634-0109-20 Ampicillin and Sulbactam 1 g/1; .5 g/1 INJECTION, POWDER, FOR SOLUTION Avenacy, 10 VIAL, SINGLE-DOSE in 1 CARTON (83634-10... 1 g/1; .5 g/1 1 $1.45 — ● Active PDAC
70594-0083-01 AMPICILLIN-SULBACTAM (PHARMACY BULK, USP,PF) 10 GM-5 GM Unknown — — 10 $14.51 — — PDAC
70594-0081-02 AMPICILLIN AND SULBACTAM 1 GM-0.5 GM Unknown — — 1 $1.45 — — PDAC
70594-0082-02 AMPICILLIN AND SULBACTAM 2 GM-1 GM Unknown — — 2 $2.90 — — PDAC
66794-0243-15 AMPICILLIN-SULBACTAM NOVALUS (PHARMACY BULK,USP,PF) 10 GM-5 GM Unknown — — 10 $14.51 — — PDAC
66794-0242-41 AMPICILLIN-SULBACTAM NOVALUS (PF,LATEX-FREE) 2 GM-1 GM Unknown — — 2 $2.90 — — PDAC
25021-0187-30 AMPICILLIN-SULBACTAM (USP, SDV,PF,LATEX-FREE) 2 GM-1 GM Unknown — — 2 $2.90 — — PDAC
25021-0186-20 AMPICILLIN-SULBACTAM (USP, SDV,PF,LATEX-FREE) 1 GM-0.5 GM Unknown — — 1 $1.45 — — PDAC
67457-0348-10 AMPICILLIN-SULBACTAM 1 GM-0.5 GM Unknown — — 1 $1.45 — — PDAC
67457-0349-10 AMPICILLIN-SULBACTAM 2 GM-1 GM Unknown — — 2 $2.90 — — PDAC
67457-0349-03 AMPICILLIN-SULBACTAM 2 GM-1 GM Unknown — — 2 $2.90 — — PDAC
67457-0649-10 AMPICILLIN-SULBACTAM 10 GM-5 GM Unknown — — 10 $14.51 — — PDAC
00781-3033-95 AMPICILLIN AND SULBACTAM (USP) 2 GM-1 GM Unknown — — 2 $2.90 — — PDAC
NDC→HCPCS mappings come from the CMS ASP NDC-HCPCS crosswalk; additional DME MAC / DMEPOS mappings come from PDAC and are labeled separately. NADAC from CMS (weekly). “Status” reflects the product's marketing / obsolete flag in the NDC directory. Presence or absence here does not determine Medicare coverage. Linked NDCs open the full product page.

📊 Medicare utilization & spend CMS · PART B · 2026 (Q1)

Period
Total Part B spend
$1.3K
Claims
256
Beneficiaries
150
Spend / beneficiary
$8.90
Spend / claim
$5.22
Trend by period
Where J0295 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #757 of 824
#752 ADRENALIN(J0169) J0169 $1.6K #753 NALBUPHINE HCL J2300 $1.5K #754 NITROGLYCERIN IN D5W... J2305 $1.5K #755 AMPHADASE J3470 $1.4K #756 TIGAN J3250 $1.4K #757 AMPICILLIN-SULBACTAM... J0295 $1.3K #758 HYDRALAZINE HCL J0360 $1.3K #759 DOXY 100* J1271 $1.3K #760 CYTARABINE J9100 $1.2K #761 POSACONAZOLE J1837 $1.2K #762 BUMETANIDE J1939 $1.2K
Total claims — #514 of 824
#509 CYTAL, PER SQUARE CE... Q4166 272 #510 ACESSO TL, PER SQ CM... Q4300 265 #511 LEVOLEUCOVORIN CALCI... J0641 264 #512 VENDAJE AC, PER SQ C... Q4279 264 #513 ALLOPLY, PER SQ CM** Q4323 257 #514 AMPICILLIN-SULBACTAM... J0295 256 #515 RAMPART DL MATRIX PE... Q4347 256 #516 ALBUTEROL SULFATE(J7... J7612 254 #517 KEDRAB 90377 253 #518 CIDOFOVIR J0740 253 #519 CYTARABINE J9100 253

Full breakdown by period (2)
PeriodTotal spendBeneficiariesClaims$/beneficiary$/claim
2026 (Q1) $1.3K 150 256 $8.90 $5.22
2025 (Q1-Q4) $5.6K 577 986 $9.64 $5.64
Provider-administered (Part B) spend, calculated for the whole HCPCS code (CMS does not publish Medicare spend per individual NDC). Self-administered use is covered under Part D instead. A blank patient count means fewer than 11 people — CMS hides counts that small to protect privacy. Source: CMS Medicare Quarterly Part B Spending by Drug (data.cms.gov), updated quarterly.

📈 Medicare Part B claims detail CMS PSPS · 2024

Calendar-year 2024 Medicare Part B fee-for-service activity for this HCPCS code, summed across all carriers, localities and specialties (CMS Physician/Supplier Procedure Summary). A “service” is one billed line/unit — not one claim — so counts run higher than claim counts.
Allowed charges
$4.7K
Medicare paid
$4K
Submitted services
30,605
Denial rate
89.9%
Allowed / service
$1.54
Submitted charges
$565.9K
Source: CMS Physician/Supplier Procedure Summary (PSPS), CY2024 — Medicare Part B carrier + DME fee-for-service claims (excludes Medicare Advantage). Figures are for the whole HCPCS code, which may cover uses beyond this drug. ⚠ CMS hides any figure covering fewer than 11 patients (a privacy rule), so totals — especially denials and low-volume codes — run a little low.

🗺️ Where J0295 is utilized CMS · BY PROVIDER · 2024

Medicare Part B services for this code by the rendering provider's state — 717 services across 6 states & territories in 2024 (CMS reports include DC and U.S. territories). Switch to per 100k to compare states fairly regardless of population. Hover or tap a state for its top ZIP codes.
Hover or tap a state to see its numbers + top ZIP codes.
Per-capita = services ÷ 2023 state population × 100,000 (so high-population states aren't automatically "hotter"). Counts reflect the provider's location, not the patient's. Providers with fewer than 11 patients are hidden by CMS for privacy, so totals run low and per-100k can be noisy in small states — read this as relative geography, not exact counts. Source: CMS Medicare Physician & Other Practitioners — by Provider and Service, 2024.

📊 What bills under J0295

J-codes are billing codes often used for drugs billed under the medical benefit. This connects the billing code to the NDC package records it covers, by ingredient and labeler.

NDC products by ingredient
Ampicillin sodium and Sulbactam so... 11
Ampicillin Sodium and Sulbactam So... 9
ampicillin sodium and sulbactam so... 5
Ampicillin and Sulbactam 2
ampicillin sodium, sulbactam sodiu... 2
ampicillin and sulbactam 2
NDC products by labeler
Meitheal Pharmaceuticals Inc. 9
Eugia US LLC 6
Roerig 4
NorthStar Rx, LLC 3
Hospira, Inc 2
WG Critical Care, LLC 2
Armas Pharmaceuticals Inc. 2
Avenacy, LLC 2

🗃️ Data sources & freshness

Every figure on this page is computed from public datasets. Here's what each section draws on and how current it is.
HCPCS code & descriptor
CMS HCPCS Level II code file
Loaded
Payment limit & billing unit
CMS Medicare Part B ASP Pricing File (quarterly)
Q3 2026 · as of 2026-08-20
NDC ↔ HCPCS crosswalk
CMS ASP NDC-HCPCS crosswalk + DMEPDAC (PDAC)
58 NDCs mapped
NADAC acquisition cost
CMS National Average Drug Acquisition Cost (weekly)
Not available for mapped NDCs
Utilization & spend
CMS Part B Spending by Drug · PSPS · Physician & Other Practitioners
Latest data year 2026
Figures are estimates for reference and may lag the source files. Always verify against the current CMS files and your payer's policy before submitting claims.

⚠️ Practical billing caveats

  • A crosswalk is not coverage. An NDC mapping or a published payment limit does not guarantee a payer will cover or pay this code. Check the specific plan's policy.
  • Units ≠ milligrams. Bill the number of HCPCS units (dose ÷ the code's unit size), not the milligram dose. Use the calculator above.
  • Discarded drug. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (and JZ when nothing is discarded) where the payer allows.
  • Rounding & partial units. Many payers require whole units; round per the payer's policy, not automatically up.
  • The code can cover more than this drug. Some HCPCS codes span multiple products or strengths — confirm the exact code for the product administered.
  • Figures lag. ASP limits change quarterly and utilization data are released with a delay. Verify against the current CMS files before billing.

❓ J0295 billing FAQ

What is HCPCS code J0295?
J0295 is a HCPCS Level II J-code used to bill Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J0295?
One unit of J0295 represents 1.5 GM. Report the number of units equal to the dose administered divided by 1.5 GM.
How many units of J0295 should I bill?
Divide the dose administered by the code's unit size (1.5 GM) to get the number of billing units, then round per your payer's policy. The calculator on this page converts a dose into billing units and projects a full course.
How much does Medicare pay for J0295?
The Medicare Part B payment limit is $1.451 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $1.422 per unit. Payment limits are revised quarterly.
Which NDCs bill under J0295?
58 NDCs currently map to J0295 in the CMS ASP NDC-HCPCS crosswalk. See the NDC crosswalk table above for each product, package, billing units and estimated reimbursement.
Does a crosswalk mean J0295 is covered?
No. An NDC-to-HCPCS crosswalk and a published payment limit do not guarantee coverage or payment. Coverage depends on the payer, the diagnosis and the site of care — always verify the current policy before billing.
For professional billing reference only — verify against the current CMS files before submitting claims.