| HCPCS Code: |
J0295 |
| Long Description: |
Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm |
| Short Description: |
Ampicillin sodium per 1.5 gm |
| Pricing Indicator 1: |
51 (Drugs) |
| Multiple Pricing Code: |
A (Not applicable as HCPCS priced under one methodology) |
| MCM Reference Section Number 1: |
2049 |
| Statute Number: |
|
| Coverage Code: |
D (Special coverage instructions apply) |
| ASC Payment Group Code: |
|
| Processing Note Number: |
|
| Berenson-Eggers Type of Service (BETOS) Code: |
O1E (Other drugs) |
| Type of Service Code 1: |
1 (Medical care) |
| Type of Service Code 2: |
P (Lump sum purchase of DME, prosthetics, orthotics) |
| Anesthesia Base Unit Quality: |
0 |
| Code Added: |
01-01-1995 |
| Action Effective Date: |
01-01-1997 |
| Action Code: |
N (No maintenance for this code) |
