J0697
J0697 – Injection, sterile cefuroxime sodium, per 750 mg · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 6 NDCs crosswalked per 750 MG $2.044/unit ASP+6%
📋 J0697 summary
J0697 is a HCPCS Level II J-code used to bill sterile cefuroxime sodium, per 750 mg, billed per 750 MG. 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 J0697: Cefuroxime
Code J0697
Billing unit 750 MG Payment limit $2.044/unit NDC-Crosswalk 6
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 codeJ0697
DescriptorInjection, sterile cefuroxime sodium, per 750 mg
Billing unit750 MG
Payment limit / unit$2.044
Est. ASP / unit$1.928 est.
Mapped NDCs6
Data periodQ3 2026
Last updated2026-08-20
💊 About Cefuroxime DRUG GUIDE
Cefuroxime Axetil tablets treat several common bacterial infections in adults and children, including strep throat, ear infections (in children who can swallow tablets), sinus infections, acute flare-ups of chronic bronchitis, uncomplicated skin infections, urinary tract infections, uncomplicated gonorrhea, and early Lyme disease.The injectable forms — Cefuroxime and Cefuroxime sodium — are used in hospital or clinical settings to treat more serious infections, including pneumonia and other lower respiratory tract infections, urinary tract infections, skin and skin-structure infections, septicemia (blood infection), meningitis (infection of the brain and spinal cord lining), gonorrhea, and bone and joint infections.
The injectable forms are also used to help prevent infections in certain surgical procedures.
Clinical overview from our editorial drug guide for Cefuroxime. 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
$2.044
Est. ASP / unit
$1.928 est.
Est. after 2% sequester
$2.003
HCPCS dosage
750 MG
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, sterile cefuroxime sodium, per 750 mg
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 date1997-01-01
Date added1990-01-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J0697 = 750 mg. 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 J0697 WITH EST. MEDICARE PAY
6 NDCs map to J0697. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($2.044/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 00143-9567-25 | Cefuroxime 1.5 g/1 INJECTION, POWDER, FOR SOLUTION | Hikma | 25 VIAL in 1 CARTON (0143-9567-25) / 1 IN... | 1.5 g/1 | 50 | $102.20 | — | ● Active | CMS ASP |
| 00143-9568-25 | Cefuroxime 750 mg/1 INJECTION, POWDER, FOR SOLUTION | Hikma | 25 VIAL in 1 CARTON (0143-9568-25) / 1 IN... | 750 mg/1 | 25 | $51.10 | — | ● Active | CMS ASP |
| 00143-9977-22 | Cefuroxime 1.5 g/1 INJECTION, POWDER, FOR SOLUTION | Hikma | 25 VIAL in 1 CARTON (0143-9977-22) / 1 IN... | 1.5 g/1 | 50 | $102.20 | — | ● Active | CMS ASP |
| 00143-9979-22 | Cefuroxime 750 mg/1 INJECTION, POWDER, FOR SOLUTION | Hikma | 25 VIAL in 1 CARTON (0143-9979-22) / 1 IN... | 750 mg/1 | 25 | $51.10 | — | ● Active | CMS ASP |
| 25021-0118-10 | Cefuroxime sodium 750 mg/1 INJECTION, POWDER, FOR SOLUTION | Sagent | 25 VIAL in 1 CARTON (25021-118-10) / 1 IN... | 750 mg/1 | 25 | $51.10 | — | ● Active | CMS ASP |
| 25021-0119-20 | Cefuroxime sodium 1.5 g/20mL INJECTION, POWDER, FOR SOLUTION | Sagent | 25 VIAL in 1 CARTON (25021-119-20) / 20 m... | 1.5 g/20mL | 50 | $102.20 | — | ● Active | CMS ASP |
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
$269.35
Claims
109
Beneficiaries
92
Spend / beneficiary
$2.93
Spend / claim
$2.47
Trend by period
Where J0697 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #799 of 824
#794
PHENYLEPHRINE HCL-0.... J2371
$334.54
#795
CALCIUM GLUCONATE-NA... J0613
$319.51
#796
FLUCONAZOLE-NACL J1450
$308.26
#797
METHADONE HCL J1230
$278.72
#798
LABETALOL HCL J1920
$273.36
#799
CEFUROXIME SODIUM J0697
$269.35
#800
BENTYL* J0500
$265.01
#801
CONRAY Q9961
$251.21
#802
GLYCOPYRROLATE(J1596... J1596
$240.57
#803
COMBOGESIC IV J0138
$209.95
#804
MORPHINE SULFATE(J22... J2272
$209.58
Total claims — #621 of 824
#616
IFEX* J9208
115
#617
NOVOSEVEN RT J7189
114
#618
FLUDARABINE PHOSPHAT... J9185
113
#619
MARGENZA J9353
112
#620
SIMULECT J0480
109
#621
CEFUROXIME SODIUM J0697
109
#622
HYLENEX J3473
109
#623
COCOON MEMBRANE, PER... Q4264
109
#624
BYOOVIZ Q5124
109
#625
ACYCLOVIR SODIUM J0133
108
#626
ORBACTIV J2407
108
Top Medicare Part B drugs by the selected metric. Click any drug to open its J-code page. Source: CMS Medicare Quarterly Part B Spending by Drug.
Full breakdown by period (2)
| Period | Total spend | Beneficiaries | Claims | $/beneficiary | $/claim |
|---|---|---|---|---|---|
| 2026 (Q1) | $269.35 | 92 | 109 | $2.93 | $2.47 |
| 2025 (Q1-Q4) | $741.16 | 220 | 334 | $3.37 | $2.22 |
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
$606.86
Medicare paid
$527.38
Submitted services
459
Denial rate
32.7%
Allowed / service
$1.96
Submitted charges
$9.6K
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 J0697 is utilized CMS · BY PROVIDER · 2024
Medicare Part B services for this code by the rendering provider's state — 137 services across 2 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.
🗃️ 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
6 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.
❓ J0697 billing FAQ
What is HCPCS code J0697?
J0697 is a HCPCS Level II J-code used to bill Injection, sterile cefuroxime sodium, per 750 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J0697?
One unit of J0697 represents 750 MG. Report the number of units equal to the dose administered divided by 750 MG.
How many units of J0697 should I bill?
Divide the dose administered by the code's unit size (750 MG) 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 J0697?
The Medicare Part B payment limit is $2.044 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $2.003 per unit. Payment limits are revised quarterly.
Which NDCs bill under J0697?
6 NDCs currently map to J0697 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 J0697 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.