{"id":177348,"date":"2026-08-13T06:57:28","date_gmt":"2026-08-13T06:57:28","guid":{"rendered":"https:\/\/pabau.com\/?p=177348"},"modified":"2026-08-13T10:28:52","modified_gmt":"2026-08-13T10:28:52","slug":"hcpcs-code-j1364","status":"publish","type":"post","link":"https:\/\/pabau.com\/nl\/procedure-codes\/hcpcs-code-j1364\/","title":{"rendered":"HCPCS Code J1364: erythromycin lactobionate billing guide"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"HCPCS Code J1364: erythromycin lactobionate billing guide\",\"description\":\"HCPCS Code J1364 covers injection of erythromycin lactobionate (IV antibiotic) per 500 mg. Reference guide for billing, NDC crosswalk, Medicare reimbursement, and documentation.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-j1364\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-08-10\",\"dateModified\":\"2026-08-13\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>HCPCS Code J1364 is the Level II J-code for injection of erythromycin lactobionate, billed per 500 mg administered.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>J1364 is covered under Medicare Part B as a physician-administered injectable antibiotic, and NDC reporting is required on Medicaid claims.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Billing errors most often stem from incorrect unit calculation, a missing NDC, or thin medical necessity documentation.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Practice management software like Pabau helps infusion practices submit J-code claims and track their status after submission.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-hcpcs-code-j1364-definition-and-code-details\" class=\"wp-block-heading\">HCPCS Code J1364: definition and code details<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">HCPCS Code J1364 covers the injection of erythromycin lactobionate at a billing unit of per 500 mg. Most billing teams reach this code while confirming the right J-code for an IV antibiotic. It is billed from physician offices, outpatient infusion centers, and hospital-based infusion suites. Unit structure is where most errors start. Each 500 mg administered equals one unit billed.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Erythromycin lactobionate is the IV-only formulation of erythromycin, a macrolide antibiotic used when oral dosing is not feasible. For <a href=\"https:\/\/pabau.com\/industry\/iv-therapy-emr-software\/\">IV therapy practice management<\/a>, accurate J-code assignment starts with confirming the administered dose. Map that dose to the correct billing unit before the claim goes out.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Attribute<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Value<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">HCPCS code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">J1364<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Full descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Injection, erythromycin lactobionate, per 500 mg<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code category<\/td>\n<td style=\"padding:12px 16px;color:#374151\">HCPCS Level II, J-code (J0000-J9999)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Type of service<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Injection (physician-administered drug)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Billing unit<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Per 500 mg administered<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Route of administration<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Intravenous (IV)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Medicare status<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Covered under Medicare Part B (physician-administered drugs)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Maintained by<\/td>\n<td style=\"padding:12px 16px;color:#374151\"><a href=\"https:\/\/www.cms.gov\/medicare\/coding-billing\/healthcare-common-procedure-system\" target=\"_blank\" rel=\"nofollow noopener\">CMS (Centers for Medicare and Medicaid Services)<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h2 id=\"h-clinical-use-and-indications-for-erythromycin-lactobionate\" class=\"wp-block-heading\">Clinical use and indications for erythromycin lactobionate<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Erythromycin lactobionate is used when patients cannot tolerate oral antibiotics or need rapid serum levels. It is typically given in hospital infusion suites, physician offices with infusion capability, and outpatient infusion centers. Confirming <a href=\"https:\/\/pabau.com\/blog\/who-can-administer-iv-vitamin-therapy\/\">who can administer IV therapy<\/a> in each setting matters before you bill J1364.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Clinical indications include moderate-to-severe bacterial infections where erythromycin is the appropriate choice. Practices running an infusion program need administration protocols and documentation standards that hold up under audit. Purpose-built <a href=\"https:\/\/pabau.com\/industry\/lp\/infusion-center-software\/\">infusion center software<\/a> keeps both in one record.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Legionella pneumophila (Legionnaires&#8217; disease):<\/strong> IV erythromycin is a first-line or alternative agent for severe cases.<\/li>\n\n\n\n<li><strong>Atypical pneumonia:<\/strong> Mycoplasma pneumoniae and Chlamydophila pneumoniae infections where IV therapy is indicated.<\/li>\n\n\n\n<li><strong>Pertussis (whooping cough):<\/strong> IV erythromycin for hospitalized patients unable to take oral therapy.<\/li>\n\n\n\n<li><strong>Skin and soft tissue infections:<\/strong> caused by susceptible organisms in patients who need IV treatment.<\/li>\n\n\n\n<li><strong>Pelvic inflammatory disease (PID):<\/strong> as an alternative agent in multi-drug IV regimens.<\/li>\n\n\n\n<li><strong>Gastroparesis:<\/strong> IV erythromycin used off-label as a prokinetic agent to stimulate gastric motility.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">That last indication matters for billing, because prokinetic use places J1364 outside a straightforward antibiotic claim. Billing staff need a diagnosis pairing that reflects the documented clinical intent. Infection treatment and prokinetic therapy are not interchangeable on the claim.<\/p>\n\n\n\n<h2 id=\"h-icd-10-diagnosis-codes-paired-with-j1364\" class=\"wp-block-heading\">ICD-10 diagnosis codes paired with J1364<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Every J1364 claim requires a linked ICD-10 diagnosis code that establishes medical necessity. The diagnosis must be documented in the patient&#8217;s record and match what is submitted on the claim. Payers audit the J-code-to-diagnosis pairing, and mismatches are a leading cause of denial.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">ICD-10 code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Clinical context<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A48.1<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Legionnaires&#8217; disease<\/td>\n<td style=\"padding:12px 16px;color:#374151\">IV erythromycin is a primary treatment option for severe cases<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">J15.7<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Pneumonia due to Mycoplasma pneumoniae<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Atypical pneumonia, where macrolides are first-line<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A37.01<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Whooping cough due to Bordetella pertussis with pneumonia<\/td>\n<td style=\"padding:12px 16px;color:#374151\">IV route for hospitalized patients with severe pertussis<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">K31.84<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Gastroparesis<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Off-label prokinetic use, so confirm payer coverage first<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">N73.0<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Acute parametritis and pelvic cellulitis<\/td>\n<td style=\"padding:12px 16px;color:#374151\">PID treatment, typically part of a multi-drug IV regimen<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">L03.90<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Cellulitis, unspecified<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Skin and soft tissue infections needing IV antibiotics<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">For gastroparesis use, verify individual payer coverage policies before billing J1364. Some commercial payers and Medicare contractors apply medical necessity criteria specific to the prokinetic indication. Document the clinical rationale explicitly in the patient record.<\/p>\n\n\n\n<h2 id=\"h-ndc-to-hcpcs-j1364-crosswalk\" class=\"wp-block-heading\">NDC to HCPCS J1364 crosswalk<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">National Drug Code (NDC) reporting is required on Medicaid claims for drug products, and it is strongly recommended on Medicare Part B claims. The NDC maps the specific product dispensed back to the HCPCS J-code on the claim. Pull the NDC from the product label or pharmacy record at the time of administration, never from memory.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">NDC number<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Labeler \/ manufacturer<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Product name<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Package size<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Billing units per vial<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">00409-6482-01<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Hospira (Pfizer)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Erythrocin Lactobionate-IV<\/td>\n<td style=\"padding:12px 16px;color:#374151\">500 mg \/ 10 mL vial, tray of 10<\/td>\n<td style=\"padding:12px 16px;color:#374151\">1 unit (per 500 mg)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">68083-513-10<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Gland Pharma<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Erythromycin lactobionate for injection<\/td>\n<td style=\"padding:12px 16px;color:#374151\">500 mg single-dose vial, carton of 10<\/td>\n<td style=\"padding:12px 16px;color:#374151\">1 unit (per 500 mg)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">72485-701-10<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Armas Pharmaceuticals<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Erythromycin lactobionate for injection<\/td>\n<td style=\"padding:12px 16px;color:#374151\">500 mg single-dose vial, carton of 10<\/td>\n<td style=\"padding:12px 16px;color:#374151\">1 unit (per 500 mg)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Verify current NDC via the FDA NDC Directory<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Any labeler<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Erythromycin lactobionate (generic)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Varies by labeler and lot<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Calculate from the administered dose<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Confirm every NDC against the current <a href=\"https:\/\/www.fda.gov\/drugs\/drug-approvals-and-databases\/national-drug-code-directory\" target=\"_blank\" rel=\"nofollow noopener\">FDA NDC Directory<\/a> before submission. NDC numbers change when a labeler updates packaging or a product is discontinued. Submitting an outdated NDC will trigger a claim edit.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">On Medicaid claims, report the NDC in the 11-digit format using 5-4-2 segments. Pair it with the quantity and the unit of measure qualifier in the appropriate claim field. Use F2 for international units, ML for milliliters, GR for grams, or UN for units. State Medicaid programs vary here, so confirm the format with each state agency.<\/p>\n\n\n\n<h2 id=\"h-medicare-reimbursement-for-j1364\" class=\"wp-block-heading\">Medicare reimbursement for J1364<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Under Medicare Part B, physician-administered injectable drugs including J1364 are generally paid using the Average Sales Price (ASP) methodology. The standard rate is ASP plus 6% in non-facility settings such as physician offices and outpatient infusion centers. Hospital outpatient departments are paid under the Outpatient Prospective Payment System (OPPS) instead.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">CMS updates ASP pricing quarterly. Erythromycin lactobionate has low market volume next to widely used biologics, so its rate can move more noticeably between quarters. Check the current quarter in the <a href=\"https:\/\/www.cms.gov\/medicare\/payment\/part-b-drugs\/asp-pricing-files\" target=\"_blank\" rel=\"nofollow noopener\">CMS ASP drug pricing files<\/a> before you build a fee schedule. The Physician Fee Schedule lookup is the wrong tool here, because it does not carry drug payment limits. <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">Claims management software<\/a> that reflects current payer rates reduces the risk of under-billing.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-j1364\/automate-claims-through-healthcode.webp\" alt=\"Pabau claims management dashboard showing submitted claims and their status\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&#8217;s claims management dashboard shows every submitted J-code claim and its current status, so denials surface within days rather than at month end.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Setting<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Payment methodology<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Notes<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Physician office \/ non-facility<\/td>\n<td style=\"padding:12px 16px;color:#374151\">ASP + 6%<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Most common setting for outpatient IV antibiotic administration<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Hospital outpatient department<\/td>\n<td style=\"padding:12px 16px;color:#374151\">OPPS (Ambulatory Payment Classification)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Drug packaged into the APC payment in most cases<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Critical access hospital (CAH)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Cost-based reimbursement<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Different methodology, so verify with your MAC<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Medicaid<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Varies by state<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Confirm the state fee schedule, and report the NDC<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Practices running infusion alongside other services get the most from an <a href=\"https:\/\/pabau.com\/blog\/best-emr-for-iv-therapy\/\">EMR built for IV therapy<\/a>. The administration record and the claim then draw on the same data. When the administered dose is charted electronically, the coder reads the dose from the note instead of chasing a paper log.<\/p>\n\n\n\n<h2 id=\"h-buy-and-bill-process-for-erythromycin-lactobionate\" class=\"wp-block-heading\">Buy-and-bill process for erythromycin lactobionate<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Buy-and-bill applies when the practice purchases the drug directly, administers it, and then bills the payer for both the drug and its administration. For J1364 that means acquiring erythromycin lactobionate from a wholesaler and submitting the J-code with the matching administration CPT code. Practices <a href=\"https:\/\/pabau.com\/blog\/how-to-open-an-iv-therapy-clinic\/\">opening an IV therapy practice<\/a> should map this workflow before the first patient.<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Acquisition:<\/strong> Purchase erythromycin lactobionate from an authorized drug wholesaler. Record the lot number, NDC, and acquisition cost at purchase.<\/li>\n\n\n\n<li><strong>Verification:<\/strong> Confirm the patient&#8217;s coverage for J1364 before administration. For Medicare, check the current ASP rate. For Medicaid, verify state coverage and NDC requirements.<\/li>\n\n\n\n<li><strong>Administration:<\/strong> A qualified clinician gives the IV drug. Document the dose in milligrams, the route, start and stop times, and who administered it.<\/li>\n\n\n\n<li><strong>Claim preparation:<\/strong> Assign J1364 with the correct units, meaning total milligrams divided by 500. Report the NDC in 11-digit format, link the ICD-10 code, and add the administration CPT code.<\/li>\n\n\n\n<li><strong>Submission:<\/strong> Submit on the CMS-1500 for professional claims or the UB-04 for institutional claims. Retain the documentation for at least seven years to support a payer audit.<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\">Mobile programs add another variable. The <a href=\"https:\/\/pabau.com\/blog\/mobile-iv-therapy-business\/\">billing workflow for mobile IV therapy<\/a> turns on place-of-service coding, because the claim must reflect where the infusion actually happened. That single field changes the payment rate applied.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Connecting the clinical record to the billing system through <a href=\"https:\/\/pabau.com\/blog\/ehr-integration\/\">EHR integration<\/a> cuts the transcription errors that creep in between the note and the submitted claim. The unit count then comes from the charted dose rather than a coder&#8217;s arithmetic.<\/p>\n\n\n\n<h2 id=\"h-documentation-requirements-for-billing-j1364\" class=\"wp-block-heading\">Documentation requirements for billing J1364<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Incomplete documentation is the most common reason J1364 claims fail on audit. CMS and commercial payers expect the medical record to support every element of the claim on its own. That record has to exist before the claim goes out, not be reconstructed afterward.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pabau.com\/blog\/hipaa-compliance-software\/\">HIPAA-compliant documentation practices<\/a> are both a regulatory requirement and the foundation for surviving an audit. Structured <a href=\"https:\/\/pabau.com\/blog\/medical-forms-at-your-healthcare-practice\/\">medical forms<\/a> that capture every billing element at the point of care remove the need to chase charts later.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Diagnosis:<\/strong> the ICD-10 code with supporting documentation, such as history, exam, labs, and cultures, establishing medical necessity for IV erythromycin.<\/li>\n\n\n\n<li><strong>Drug name and strength:<\/strong> the full drug name and the administered dose in milligrams, not just &#8220;antibiotic given.&#8221;<\/li>\n\n\n\n<li><strong>Route of administration:<\/strong> explicitly documented as intravenous.<\/li>\n\n\n\n<li><strong>NDC number:<\/strong> the 11-digit NDC from the label of the specific product administered.<\/li>\n\n\n\n<li><strong>Lot number and expiration date:<\/strong> required for traceability and recommended for all injectable drugs.<\/li>\n\n\n\n<li><strong>Date and time of service:<\/strong> including infusion start and stop times.<\/li>\n\n\n\n<li><strong>Administering clinician:<\/strong> name and credentials of the provider who gave the infusion.<\/li>\n\n\n\n<li><strong>Ordering provider:<\/strong> name and NPI of the physician who ordered the drug.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">The prokinetic indication needs more on the chart. Include the K31.84 diagnosis, the rationale for choosing IV erythromycin over standard prokinetic agents, and any prior treatment failure or contraindication. Some payers require prior authorization for off-label use.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Prompting clinicians to complete every required field at administration time is what stops audit failures. <a href=\"https:\/\/pabau.com\/features\/patient-intake-software\/\">Digital intake and treatment forms<\/a> can make those fields mandatory before the note is signed.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-j1364\/customizable-consent-and-intake-forms.webp\" alt=\"Customizable consent and intake form builder in Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&#8217;s form builder lets you make the dose, route, and lot number required fields, so a J1364 note cannot be signed while they are blank.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Audit your J1364 claims quarterly. Pull ten claims and check each one for the 11-digit NDC, the correct unit count, a linked ICD-10 code, and a named administering clinician. Catching a systematic error across ten claims costs far less than finding it during a payer audit.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-coding-tips-and-common-billing-errors-for-j1364\" class=\"wp-block-heading\">Coding tips and common billing errors for J1364<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Most J1364 errors are preventable, and they cluster in three places. Unit calculation, NDC reporting, and administration code pairing account for the bulk of denials. Each one has a straightforward fix once the team knows what to look for.<\/p>\n\n\n\n<h3 id=\"h-unit-calculation-errors\" class=\"wp-block-heading\">Unit calculation errors<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">J1364 is billed per 500 mg. A patient who receives 1,000 mg needs 2 units billed, and 500 mg is 1 unit. A 250 mg dose works out at 0.5 units, though some payers require rounding to a whole unit. Confirm the rounding policy with each payer before billing a fractional dose.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The most common error is billing 1 unit regardless of the dose given. At a typical dose of 500 mg to 1,000 mg every six hours, a single infusion episode can legitimately require 1 to 2 units. Check the administered dose against the physician order before assigning units.<\/p>\n\n\n\n<h3 id=\"h-missing-or-incorrect-ndc\" class=\"wp-block-heading\">Missing or incorrect NDC<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Medicaid claims submitted without an NDC reject outright in most states. Medicare Part B claims can process without one, but they may be flagged for post-payment audit. The NDC must be the 11-digit code from the product actually administered, in 5-4-2 segments, for example 00409-6482-01.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Using a 10-digit NDC is an audit risk, as is reporting the NDC of a product other than the one given. Capture the NDC from the label at administration and record it in the note immediately. Where a practice stocks both the branded vial and a generic, the NDC on the claim has to follow the vial.<\/p>\n\n\n\n<h3 id=\"h-administration-code-pairing\" class=\"wp-block-heading\">Administration code pairing<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">J1364 covers the drug only, so the infusion itself is billed separately. Use CPT 96374 for an IV push of a single or initial drug. Use CPT 96365 for an infusion up to one hour, then CPT 96366 for each additional hour. Billing J1364 with no administration code leaves revenue behind and can trip a claim edit at payers that expect both.<\/p>\n\n\n\n<h2 id=\"h-related-hcpcs-j-codes\" class=\"wp-block-heading\">Related HCPCS J-codes<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Verifying the code before billing prevents misassignment between adjacent antibiotic and injectable codes. The table below covers the codes most often confused with J1364, along with those that show up in the same infusion billing context. Other single-drug J-codes such as <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-j0153\/\">J0153<\/a> and <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-j0600\/\">J0600<\/a> follow the same unit logic.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">HCPCS code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Typical use<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Key difference from J1364<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">J1364<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Injection, erythromycin lactobionate, per 500 mg<\/td>\n<td style=\"padding:12px 16px;color:#374151\">IV macrolide antibiotic, and off-label prokinetic<\/td>\n<td style=\"padding:12px 16px;color:#374151\">This code<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">J1360<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Injection, dihydroergotamine mesylate, per 1 mg<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Migraine treatment<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Different drug, used for vascular headache<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">J1370<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Injection, ethanolamine oleate, 100 mg<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Sclerosing agent for esophageal varices<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A sclerosant, not an antibiotic<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">J3490<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unclassified drug<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Drugs with no specific J-code assignment<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A catch-all code that needs extra documentation<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">J0285<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Injection, amphotericin B, 50 mg<\/td>\n<td style=\"padding:12px 16px;color:#374151\">IV antifungal therapy<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A different drug class, and a different unit size<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">J3490 is the distinction that costs practices money. Erythromycin lactobionate has its own code, so submitting it as an unclassified drug is an error. Some payers pay J3490 claims, but they invite scrutiny and require the drug name and dose written on the claim form. Always use the specific code where one exists.<\/p>\n\n\n\n<h2 id=\"h-how-pabau-keeps-j-code-claims-moving\" class=\"wp-block-heading\">How Pabau keeps J-code claims moving<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">In most infusion practices the J1364 claim starts life in three places at once. The dose sits in the clinical note, while the NDC sits on a vial log or in pharmacy records. The claim itself is keyed into a separate billing system. Every hand-off is a chance for the unit count or the NDC to drift.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practice management software like Pabau keeps the administration note, the diagnosis, and the claim in one patient record. Your team still decides the code, the units, and the NDC that belong on the claim. Pabau then submits it and tracks its status, so a rejection surfaces while the encounter is still fresh.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">That matters most for drugs like erythromycin lactobionate, where volume is low and each claim carries real value. Our <a href=\"https:\/\/pabau.com\/blog\/claims-management-software-pabau-vs-waystar\/\">comparison of claims tools<\/a> covers how the submission and tracking workflow differs between platforms.<\/p>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Accurate J-code billing starts with the right workflow                <\/h3>\n\n                <p class=\"description\">\n                    Pabau keeps your administration notes and your billing in one record, then helps you submit J-code claims and track their status after submission. Rejections surface early, so fewer of them turn into write-offs.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau claims management dashboard\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">J1364 is a simple code with three expensive failure points. Get the unit math, the NDC, and the medical necessity documentation right and the claim pays without argument. Miss one of them and the money comes back months later, with a request for records attached.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The fix is structural rather than educational. Capture the dose, the lot, and the NDC at the moment of administration, and the coder never has to reconstruct the encounter. Knowing the code is the easy part.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If your practice bills physician-administered drugs regularly, that discipline is worth building into the software rather than the checklist. <a href=\"https:\/\/pabau.com\/book-demo\/\">Book a demo<\/a> to see how Pabau connects infusion records to claim submission and status tracking.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Billing another single-drug J-code?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-j0153\/\">J0153<\/a> walks through unit calculation and documentation for another Part B injectable.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Need the same detail for a different drug?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-j0600\/\">J0600<\/a> covers coverage rules, units, and the NDC reporting payers expect.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Comparing claims tools?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/claims-management-software-pabau-vs-waystar\/\">Pabau vs Waystar for claims management<\/a> sets out how submission and status tracking differ.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Need a cleaner record of what was given?<\/strong> <a href=\"https:\/\/pabau.com\/templates\/medication-log\/\">Medication log template<\/a> captures dose, route, and lot number in the format an auditor asks for.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Running a dedicated infusion service?<\/strong> <a href=\"https:\/\/pabau.com\/industry\/lp\/infusion-center-software\/\">Infusion center software<\/a> explains the scheduling and documentation features these programs rely on.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1786604017988\"><h3 class=\"schema-faq-question\">What is HCPCS Code J1364 used for?<\/h3> <p class=\"schema-faq-answer\">HCPCS Code J1364 is the Level II billing code for injection of erythromycin lactobionate, billed per 500 mg administered. Physician offices and outpatient infusion centers use it to bill Medicare, Medicaid, and commercial payers for intravenous erythromycin.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786604017989\"><h3 class=\"schema-faq-question\">What is the correct unit for billing J1364?<\/h3> <p class=\"schema-faq-answer\">J1364 is billed per 500 mg. A dose of 1,000 mg equals 2 units, and a dose of 500 mg equals 1 unit. Divide the total administered dose in milligrams by 500, then confirm the rounding policy for fractional doses with each payer.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786604017990\"><h3 class=\"schema-faq-question\">Does Medicare cover J1364?<\/h3> <p class=\"schema-faq-answer\">Medicare Part B generally covers J1364 as a physician-administered injectable antibiotic, paid at ASP plus 6% in non-facility settings. Coverage depends on documented medical necessity and remains subject to payer policy and local coverage determinations.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786604017992\"><h3 class=\"schema-faq-question\">What NDC codes map to HCPCS J1364?<\/h3> <p class=\"schema-faq-answer\">Products mapped to J1364 include Hospira&#8217;s Erythrocin Lactobionate-IV 500 mg vial, NDC 00409-6482-01. Generic 500 mg vials come from labelers such as Gland Pharma and Armas Pharmaceuticals. NDC numbers change with packaging, so pull the number from the label at administration and verify it in the FDA NDC Directory.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786604017993\"><h3 class=\"schema-faq-question\">What documentation is required to bill J1364?<\/h3> <p class=\"schema-faq-answer\">You need the ICD-10 diagnosis code establishing medical necessity, plus the drug name and the administered dose in milligrams. The record must also show the IV route, the 11-digit NDC, and the infusion start and stop times. Name the administering clinician and their credentials.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>HCPCS Code J1364: definition and code details HCPCS Code J1364 covers the injection of erythromycin lactobionate at a billing unit of per 500 mg. Most billing teams reach this code while confirming the right J-code for an IV antibiotic. It is billed from physician offices, outpatient infusion centers, and hospital-based infusion suites. Unit structure is [&hellip;]<\/p>\n","protected":false},"author":84,"featured_media":177347,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"77","_yoast_wpseo_content_score":"90","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1548],"tags":[1364,1582],"class_list":["post-177348","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-hcpcs","tag-billing","tag-hcpcs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.3 (Yoast SEO v28.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>HCPCS Code J1364: erythromycin lactobionate billing guide<\/title>\n<meta name=\"description\" content=\"J1364 covers erythromycin lactobionate per 500 mg. 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Verify NDC, ASP+6% payment, and unit math to prevent denials.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/pabau.com\/nl\/procedure-codes\/hcpcs-code-j1364\/\" \/>\n<meta property=\"og:site_name\" content=\"Pabau\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/Pabau\/\" \/>\n<meta property=\"article:published_time\" content=\"2026-08-13T06:57:28+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-08-13T10:28:52+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/08\/hcpcs-code-j1364.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"630\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Despina Petrushevska\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:site\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:label1\" content=\"Geschreven door\" \/>\n\t<meta name=\"twitter:data1\" content=\"Despina Petrushevska\" \/>\n\t<meta name=\"twitter:label2\" content=\"Geschatte leestijd\" \/>\n\t<meta name=\"twitter:data2\" content=\"13 minuten\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j1364\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j1364\\\/\"},\"author\":{\"name\":\"Despina Petrushevska\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/#\\\/schema\\\/person\\\/80e6d36732fad68140a849f3c351449b\"},\"headline\":\"HCPCS Code J1364: erythromycin lactobionate billing guide\",\"datePublished\":\"2026-08-13T06:57:28+00:00\",\"dateModified\":\"2026-08-13T10:28:52+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j1364\\\/\"},\"wordCount\":2575,\"publisher\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j1364\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/hcpcs-code-j1364.webp\",\"keywords\":[\"billing\",\"Hcpcs\"],\"articleSection\":[\"Billing Codes\",\"HCPCS\"],\"inLanguage\":\"nl-NL\"},{\"@type\":[\"WebPage\",\"FAQPage\"],\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j1364\\\/\",\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j1364\\\/\",\"name\":\"HCPCS Code J1364: erythromycin lactobionate billing guide\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j1364\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j1364\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/hcpcs-code-j1364.webp\",\"datePublished\":\"2026-08-13T06:57:28+00:00\",\"dateModified\":\"2026-08-13T10:28:52+00:00\",\"description\":\"J1364 covers erythromycin lactobionate per 500 mg. 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Physician offices and outpatient infusion centers use it to bill Medicare, Medicaid, and commercial payers for intravenous erythromycin.\",\"inLanguage\":\"nl-NL\"},\"inLanguage\":\"nl-NL\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j1364\\\/#faq-question-1786604017989\",\"position\":2,\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j1364\\\/#faq-question-1786604017989\",\"name\":\"What is the correct unit for billing J1364?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"J1364 is billed per 500 mg. A dose of 1,000 mg equals 2 units, and a dose of 500 mg equals 1 unit. Divide the total administered dose in milligrams by 500, then confirm the rounding policy for fractional doses with each payer.\",\"inLanguage\":\"nl-NL\"},\"inLanguage\":\"nl-NL\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j1364\\\/#faq-question-1786604017990\",\"position\":3,\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j1364\\\/#faq-question-1786604017990\",\"name\":\"Does Medicare cover J1364?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Medicare Part B generally covers J1364 as a physician-administered injectable antibiotic, paid at ASP plus 6% in non-facility settings. Coverage depends on documented medical necessity and remains subject to payer policy and local coverage determinations.\",\"inLanguage\":\"nl-NL\"},\"inLanguage\":\"nl-NL\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j1364\\\/#faq-question-1786604017992\",\"position\":4,\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-j1364\\\/#faq-question-1786604017992\",\"name\":\"What NDC codes map to HCPCS J1364?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Products mapped to J1364 include Hospira's Erythrocin Lactobionate-IV 500 mg vial, NDC 00409-6482-01. Generic 500 mg vials come from labelers such as Gland Pharma and Armas Pharmaceuticals. 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Divide the total administered dose in milligrams by 500, then confirm the rounding policy for fractional doses with each payer.","inLanguage":"nl-NL"},"inLanguage":"nl-NL"},{"@type":"Question","@id":"https:\/\/pabau.com\/nl\/procedure-codes\/hcpcs-code-j1364\/#faq-question-1786604017990","position":3,"url":"https:\/\/pabau.com\/nl\/procedure-codes\/hcpcs-code-j1364\/#faq-question-1786604017990","name":"Does Medicare cover J1364?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Medicare Part B generally covers J1364 as a physician-administered injectable antibiotic, paid at ASP plus 6% in non-facility settings. Coverage depends on documented medical necessity and remains subject to payer policy and local coverage determinations.","inLanguage":"nl-NL"},"inLanguage":"nl-NL"},{"@type":"Question","@id":"https:\/\/pabau.com\/nl\/procedure-codes\/hcpcs-code-j1364\/#faq-question-1786604017992","position":4,"url":"https:\/\/pabau.com\/nl\/procedure-codes\/hcpcs-code-j1364\/#faq-question-1786604017992","name":"What NDC codes map to HCPCS J1364?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Products mapped to J1364 include Hospira's Erythrocin Lactobionate-IV 500 mg vial, NDC 00409-6482-01. Generic 500 mg vials come from labelers such as Gland Pharma and Armas Pharmaceuticals. NDC numbers change with packaging, so pull the number from the label at administration and verify it in the FDA NDC Directory.","inLanguage":"nl-NL"},"inLanguage":"nl-NL"},{"@type":"Question","@id":"https:\/\/pabau.com\/nl\/procedure-codes\/hcpcs-code-j1364\/#faq-question-1786604017993","position":5,"url":"https:\/\/pabau.com\/nl\/procedure-codes\/hcpcs-code-j1364\/#faq-question-1786604017993","name":"What documentation is required to bill J1364?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"You need the ICD-10 diagnosis code establishing medical necessity, plus the drug name and the administered dose in milligrams. The record must also show the IV route, the 11-digit NDC, and the infusion start and stop times. 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