HCPCS code S0040 – Ticarcillin-clavulanate (Timentin) injection, 3.1 g

Key takeaways

HCPCS Code S0040 is injection, ticarcillin disodium and clavulanate potassium, 3.1 grams. That is the intravenous antibiotic sold as Timentin.

GlaxoSmithKline stopped making Timentin for the US market in 2015. No generic, import or compounding route replaced it.

The code is still listed in the CMS HCPCS Level II file, so it turns up on historical claims, payer files and audits.

When a practice gives a different antibiotic, the claim carries that drug’s own HCPCS code and NDC, never S0040.

Pabau’s claims management software builds each claim from the treatment record and tracks it from submission to remittance.

What HCPCS Code S0040 describes

HCPCS Code S0040 is the Level II code for injection, ticarcillin disodium and clavulanate potassium, 3.1 grams. Each 3.1-gram unit pairs 3 grams of ticarcillin with 100 mg of clavulanic acid. The product it was written for is Timentin, the GlaxoSmithKline brand of this intravenous antibiotic.

Ticarcillin is an extended-spectrum penicillin, and clavulanate is a beta-lactamase inhibitor that protects it from bacterial enzymes. S0040 sits in the S0012-S0197 range of temporary national drug codes, one series in our HCPCS code library.

CMS lists S-codes in the HCPCS file, but Medicare does not pay them. They exist for commercial insurers and some state Medicaid programs.

The descriptor in the current CMS HCPCS Level II release is unchanged from the original. A code that stays in the file only means CMS has not retired it. It says nothing about whether the drug can still be bought.

Is Timentin still available in the US?

No. GlaxoSmithKline announced on February 9, 2015 that it would stop making Timentin for the US market. The notice is posted on the FDA drug shortage pages. Drugs.com and Mayo Clinic now list both the brand and its generics as discontinued in the US.

No approved generic (ANDA) product took its place, and there is no import or compounding route for it. A US practice cannot buy or administer ticarcillin-clavulanate today. Any claim for S0040 with a recent date of service describes a drug the practice could not have stocked.

That changes what S0040 is useful for. Billers meet it when they work old claims, reconcile payer fee files, answer audit requests, or clean legacy codes out of a charge master. A new claim should never carry it. The chart below sorts an S0040 claim line by its payer and its date of service.

What to bill when another antibiotic is given

Bill the HCPCS code for the drug the patient received, with that product’s own NDC. The prescriber chooses the alternative antibiotic, and the code follows the drug. Reporting S0040 for a different product misstates the service on the claim.

The table shows common examples. They illustrate the coding step only and are not a recommendation on which drug to use.

Check the units against the new descriptor, because each code has its own billing unit. A 3.1-gram unit habit carried over from S0040 will miscount J2543 or J0295. Confirm the payer’s rules for the replacement code, including any prior authorization, before the date of service.

Payer coverage and fee schedule for S0040

CMS has never published a payment rate for S0040, so there is no Medicare fee schedule figure to look up. Commercial payers and some state Medicaid programs once set their own allowed amounts for it. Some payer files still carry that row, because S0040 remains a listed code.

Treat an S0040 allowed amount in a payer file as a historical entry. It is not a benchmark for revenue planning, and it does not mean the payer expects new claims. When the substitute drug carries a J-code, the payer’s rate for that J-code is the figure that matters.

Historical indications and ICD-10-CM pairings

Timentin was labeled for serious infections caused by susceptible bacteria. A reviewer checking an old S0040 claim should see a diagnosis that matches one of those labeled uses. The categories below are the usual ICD-10-CM homes for them.

These pairings are for audits and appeals on past dates of service. For a current patient, the diagnosis pairs with the code of the antibiotic that was given. The coding rules are unchanged: use the most specific code the record supports, and make sure the clinical note states the indication.

S0040 prior authorization and modifiers

No new prior authorization should be requested for S0040, because the drug cannot be supplied. If an open authorization for S0040 still sits in a payer portal, close it. Request a fresh authorization for the replacement drug, under its own code.

On a historical claim, modifiers follow the payer’s policy on the original date of service. The ones that appeared on S-series drug claims were few:

• JW: drug amount discarded, for the wasted part of a single-dose vial where the payer required waste reporting
• JZ: zero drug amount discarded, where the payer asked for it alongside JW rules
• KX: attests the medical policy’s requirements have been met, used only by payers whose drug policy called for it

A corrected historical claim keeps the modifiers that fit that date of service. Apply the same payer rules to the replacement drug’s code on any current claim.

Documentation for historical S0040 claims and audits

A payer reviewing a past S0040 claim checks the record against the claim line. Keep these elements together for every historical claim that carried the code:

• Physician order: a signed, dated order naming ticarcillin-clavulanate, the dose, the route and the frequency
• Medical necessity: clinical notes with the infection treated and the reason for this antibiotic
• Product record: the 11-digit NDC of the vial administered, in 5-4-2 format with the N4 qualifier
• Dose and date: the dose given in 3.1-gram units and the date of service
• Authorization: the prior authorization number and its date range, where the payer required one

For a current patient, record the substitute drug in the same way, with its own NDC and billing units. Keep records for at least seven years, or longer where state law or the payer contract requires it.

Common S0040 claim denials and how to resolve them

Denials on S0040 lines come from a short list of causes. Most appear when old claims are reworked or appealed. For a wider method, our guide to denial management in healthcare tracks patterns by code and payer.

The last row is the one to watch on recent dates of service. An S0040 line dated after the US discontinuation should be checked against the medication record before anyone defends it.

How Pabau keeps drug claims matched to the treatment record

Retired drugs linger in charge masters and billing templates long after the product leaves the shelf. A biller who picks a code from habit can send S0040 for an antibiotic the practice never stocked. The fix is a claim built from what the record says was given.

Pabau, the practice management platform we build, keeps the clinical record and the claim in one system. Its claims management software handles submission, eligibility checks, claim status and remittance posting in that same place. The billing team works from the treatment note, not a re-keyed summary.

Claims route out through the Claim.MD clearinghouse, and remittance advice comes back against the same patient record. A denial on a reworked legacy claim shows up the day it arrives, next to the note that explains it.

Bill the drug your record says was given

Pabau’s claims management software builds claims from the treatment record and tracks them through the Claim.MD clearinghouse to remittance. See how it keeps drug coding accurate.

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Conclusion

S0040 is a live code for a drug the US market no longer has. Leave it on historical claims, where it belongs, and keep it off current billing. When a patient needs an alternative to ticarcillin-clavulanate, the code and NDC follow the drug the prescriber chose.

The practical step is a charge-master check. Remove or flag S0040 so it cannot be picked by default, and point billers to the replacement codes. Book a demo to see how Pabau ties each drug claim to the treatment record behind it.

Continue your research

Want to understand how the billing workflow fits into broader practice operations? What is revenue cycle management explains the end-to-end process from eligibility through payment posting.

Looking for clean claim submission standards that apply to drug codes? Clean claim requirements details the data elements every commercial payer evaluates before adjudicating a drug code claim.

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