HCPCS Level II › J codes J3000 Streptomycin injectionInjection, streptomycin, up to 1 gm
Medicare coverage: Special coverage instructions apply Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 2 units per day (clinical), rationale: Prescribing Information Outpatient hospital: max 2 units per day (clinical), rationale: Prescribing Information DME supplier: max 0 units per day (clinical), rationale: CMS Policy Medicare pricing for J3000 Medicare Part B drug payment limit (ASP, October 2026) J3000 payment limit: $16.407 per 1 GM, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.
NDCs that bill under J3000 (CMS ASP NDC-HCPCS crosswalk, October 2026) 39822-0706-02 Streptomycin Sulfate, XGen Pharmaceuticals DJB, Inc.: 10 billing units per package (10 VIAL in 1 BOX / 1 INJECTION, POWDER, LYOPHILIZED, 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 J3000 Payer coverage policies that name J3000 J3000 appears in 2 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Injectable Medications (0020) listed, no stance (range J2550-J3520) Mar 5, 2026 payer document Aetna Tinnitus Treatments (0406) listed, no stance Jul 10, 2026 payer document
Medicaid fee-for-service AZ: $26.88 (outpatient_hospital), effective Jul 1, 2026 FL: $2.00 (physician_administered_drugs), effective Jan 1, 2026 IL: $39.17 (practitioner), effective Apr 1, 2026 IN: $7.36 (professional, Advanced Practice Nurse (85%), non-facility), effective Jul 1, 2024 KY: $0.00 (asc), effective Jan 1, 2026 LA: $26.88 (professional), effective Jul 1, 2026 MS: $40.26 (comprehensive), effective Jul 1, 2026 NE: $26.88 (injectables), effective Jul 1, 2026 OH: $26.88 (provider_administered_drugs), effective Jul 1, 2026 OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026 TX: $33.88 (healthy_texas_women, Clinic/Group Practice, non-facility), effective Sep 1, 2026 VA: $26.88 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $26.88 (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.