`J0770` Colistimethate sodium inj

Injection, colistimethate sodium, up to 150 mg

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

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 5 units per day (clinical), rationale: Prescribing Information
Outpatient hospital: max 5 units per day (clinical), rationale: Prescribing Information
DME supplier: max 0 units per day (clinical), rationale: CMS Policy

Medicare pricing for J0770

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

J0770 payment limit: $18.051 per 150 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.

NDCs that bill under J0770 (CMS ASP NDC-HCPCS crosswalk, October 2026)

42023-0107-01 Colistimethate Sodium, Endo USA, Inc.: 1 billing unit per package (1 VIAL in 1 CARTON / 2 mL in 1 VIAL)
42023-0131-06 Colistimethate Sodium, Endo USA, Inc.: 6 billing units per package
63323-0393-06 Colistimethate Sodium, FreseniUS Kabi USA, LLC: 1 billing unit per package (1 VIAL in 1 BOX / 2 mL in 1 VIAL)
23155-0193-31 Colistimethate Sodium, Heritage Pharmaceuticals Inc.: 1 billing unit per package (1 VIAL, GLASS in 1 CARTON / 4 mL in 1 VIAL, GLASS)
23155-0193-41 Colistimethate Sodium, Heritage Pharmaceuticals Inc.: 12 billing units per package (12 VIAL, GLASS in 1 CARTON / 4 mL in 1 VIAL, GLASS)
00143-9443-01 Colistimethate Sodium, Hikma Pharmaceuticals Usa Inc.: 1 billing unit per package (1 VIAL, GLASS in 1 CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, GLASS)
00143-9443-12 Colistimethate Sodium, Hikma Pharmaceuticals Usa Inc.: 12 billing units per package (12 VIAL, GLASS in 1 CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, GLASS)
70594-0023-01 Colistimethate Sodium, Xellia Pharmaceuticals USA, LLC.: 1 billing unit per package (1 VIAL, GLASS in 1 VIAL / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, GLASS)
70594-0023-04 Colistimethate Sodium, Xellia Pharmaceuticals USA, LLC.: 12 billing units per package (12 VIAL, GLASS in 1 CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, GLASS)
70594-0023-09 Colistimethate Sodium, Xellia Pharmaceuticals USA, LLC.: 1 billing unit per package (1 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 J0770

Payer coverage policies that name J0770

J0770 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: $14.49 (outpatient_hospital), effective Jul 1, 2026
FL: $5.00 (physician_administered_drugs), effective Jan 1, 2026
IL: $13.88 (practitioner), effective Apr 1, 2026
IN: $9.24 (professional, Advanced Practice Nurse (85%), non-facility), effective Apr 1, 2022
KS: $18.05 (default), effective Oct 1, 2026
KY: $0.00 (asc), effective Jan 1, 2026
LA: $14.49 (professional), effective Jul 1, 2026
MS: $14.27 (comprehensive), effective Jul 1, 2026
NE: $14.49 (injectables), effective Jul 1, 2026
OH: $14.49 (provider_administered_drugs), effective Jul 1, 2026
OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026
TX: $12.08 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Sep 1, 2026
VA: $14.49 (medical), effective Jul 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $14.49 (professional_administered_drugs), 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.

J0770 Colistimethate sodium inj