`J0697` Sterile cefuroxime injection

Injection, sterile cefuroxime sodium, per 750 mg

Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 4 units per day (clinical), rationale: Prescribing Information
Outpatient hospital: max 12 units per day (clinical), rationale: Clinical: Data
DME supplier: max 0 units per day (clinical), rationale: CMS Policy

Medicare pricing for J0697

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

J0697 payment limit: $2.106 per 750 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.

NDCs that bill under J0697 (CMS ASP NDC-HCPCS crosswalk, October 2026)

00143-9567-25 Cefuroxime Sodium, Hikma Pharmaceuticals USA Inc.: 50 billing units per package (25 VIAL in 1 CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL)
00143-9568-25 Cefuroxime Sodium, Hikma Pharmaceuticals USA Inc.: 25 billing units per package (25 VIAL in 1 CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL)
25021-0118-10 Cefuroxime Sodium, Sagent Pharmaceuticals: 25 billing units per package (25 VIAL in 1 CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL)
25021-0119-20 Cefuroxime Sodium, Sagent Pharmaceuticals: 50 billing units per package (25 VIAL in 1 CARTON / 20 mL in 1 VIAL)
00143-9977-22 Zinacef, Hikma Pharmaceuticals USA Inc.: 50 billing units per package (25 VIAL in 1 CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL)
00143-9979-22 Zinacef, Hikma Pharmaceuticals USA Inc.: 25 billing units per package (25 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 J0697

Payer coverage policies that name J0697

J0697 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: $2.04 (outpatient_hospital), effective Jul 1, 2026
FL: $4.00 (physician_administered_drugs), effective Jan 1, 2026
IL: $7.97 (practitioner), effective Apr 1, 2026
IN: $1.96 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2011
KS: $2.11 (default), effective Oct 1, 2026
KY: $0.00 (asc), effective Jan 1, 2026
LA: $2.04 (professional), effective Jul 1, 2026
MS: $1.99 (comprehensive), effective Jul 1, 2026
NE: $2.04 (injectables), effective Jul 1, 2026
OH: $1.99 (provider_administered_drugs), effective Jul 1, 2026
OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026
TX: $2.05 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Sep 1, 2026
VA: $2.04 (medical), effective Jul 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $2.04 (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.

J0697 Sterile cefuroxime injection