`J0692` Cefepime hcl for injection

Injection, cefepime hydrochloride, 500 mg

Medicare coverage: Carrier judgment
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 12 units per day (clinical), rationale: Prescribing Information
Outpatient hospital: max 12 units per day (clinical), rationale: Prescribing Information
DME supplier: max 12 units per day (clinical), rationale: Prescribing Information

Medicare pricing for J0692

Medicare Part B drug payment limit (ASP, October 2026)

J0692 payment limit: $1.292 per 500 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.

NDCs that bill under J0692 (CMS ASP NDC-HCPCS crosswalk, October 2026)

60505-6144-04 Cefepime, Apotex Corp: 20 billing units per package (10 VIAL, SINGLE-DOSE in 1 CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, SINGLE-DOSE)
60505-6145-04 Cefepime, Apotex Corp: 40 billing units per package (10 VIAL, SINGLE-DOSE in 1 CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, SINGLE-DOSE)
60505-6146-00 Cefepime, Apotex Corp: 2 billing units per package (1 VIAL, SINGLE-DOSE in 1 CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, SINGLE-DOSE)
60505-6146-04 Cefepime, Apotex Corp: 20 billing units per package (10 VIAL, SINGLE-DOSE in 1 CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, SINGLE-DOSE)
60505-6147-00 Cefepime, Apotex Corp: 4 billing units per package (1 VIAL, SINGLE-DOSE in 1 CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, SINGLE-DOSE)
60505-6147-04 Cefepime, Apotex Corp: 40 billing units per package (10 VIAL, SINGLE-DOSE in 1 CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, SINGLE-DOSE)
60505-6245-04 Cefepime, Apotex Corp: 20 billing units per package (10 VIAL, SINGLE-DOSE in 1 CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, SINGLE-DOSE)
60505-6246-04 Cefepime, Apotex Corp: 40 billing units per package (10 VIAL, SINGLE-DOSE in 1 CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, SINGLE-DOSE)
00143-9382-10 Cefepime, Hikma Pharmaceuticals USA Inc.: 20 billing units per package (10 VIAL in 1 CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL)
00143-9383-10 Cefepime, Hikma Pharmaceuticals USA Inc.: 40 billing units per package (10 VIAL in 1 CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL)
00409-9566-10 Cefepime, Pfizer Inc: 20 billing units per package (10 VIAL in 1 CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL)
00409-9735-10 Cefepime, Pfizer Inc: 40 billing units per package (10 VIAL in 1 CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL)
66794-0209-41 Cefepime, Piramal Critical Care Inc: 20 billing units per package
25021-0121-20 Cefepime, Sagent Pharmaceuticals: 20 billing units per package (10 VIAL in 1 CARTON / 20 mL in 1 VIAL)
25021-0121-66 Cefepime, Sagent Pharmaceuticals: 20 billing units per package
25021-0122-50 Cefepime, Sagent Pharmaceuticals: 40 billing units per package (10 VIAL in 1 CARTON / 20 mL in 1 VIAL)
25021-0122-67 Cefepime, Sagent Pharmaceuticals: 40 billing units per package
44567-0130-10 Cefepime, WG Critical Care, LLC: 20 billing units per package (10 VIAL in 1 CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL)
44567-0131-10 Cefepime, WG Critical Care, LLC: 40 billing units per package (10 VIAL in 1 CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL)
44567-0240-10 Cefepime, WG Critical Care, LLC: 20 billing units per package (10 VIAL in 1 CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL)
44567-0241-10 Cefepime, WG Critical Care, LLC: 40 billing units per package (10 VIAL in 1 CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL)
63323-0326-20 Maxipime, FreseniUS Kabi USA, LLC: 20 billing units per package (10 VIAL in 1 CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL)
63323-0340-20 Maxipime, FreseniUS Kabi USA, LLC: 40 billing units per package (10 VIAL in 1 CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL)

Physician Fee Schedule (CY 2026, RVU26D)

Status E: excluded from the PFS by regulation.

Payer policies and prior authorization for J0692

Payer coverage policies that name J0692

J0692 appears in 1 coverage policy from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Injectable Medications (0020)	listed, no stance (range J0278-J2543)	Mar 5, 2026	payer document

Medicaid fee-for-service

AZ: $1.30 (outpatient_hospital), effective Jul 1, 2026
FL: $12.00 (physician_administered_drugs), effective Jan 1, 2026
IL: $1.27 (practitioner), effective Apr 1, 2026
IN: $1.07 (professional, Advanced Practice Nurse (85%), non-facility), effective Jul 1, 2022
KS: $1.29 (default), effective Oct 1, 2026
KY: $0.00 (asc), effective Jan 1, 2026
LA: $1.30 (professional), effective Jul 1, 2026
MS: $1.27 (comprehensive), effective Jul 1, 2026
NE: $1.29 (injectables), effective Jul 1, 2026
OH: $1.30 (provider_administered_drugs), effective Jul 1, 2026
OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026
TX: $0.87 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Sep 1, 2026
VA: $1.29 (medical), effective Jul 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $1.30 (kidneycenters), effective Jul 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

J0692 Cefepime hcl for injection