Summary & Overview
HCPCS C9443: Dalbavancin Injection, 10 mg
HCPCS Level II code C9443 denotes a 10 mg unit of dalbavancin administered by injection. Dalbavancin is a long-acting intravenous lipoglycopeptide antibiotic used to treat serious Gram-positive infections, and accurate coding of single-dose units is important for claims processing, inventory tracking, and cost analysis. Nationally, precise HCPCS coding for injectable antibiotics affects reimbursement workflows, prior authorization processes, and outpatient infusion billing.
Key payers reviewed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will gain a concise understanding of what C9443 represents clinically and operationally, the typical sites of service for dalbavancin administration, and which major payers are relevant in coverage discussions. The summary also orients readers to the types of benchmarks and policy issues commonly associated with high-cost parenteral antibiotics, such as unit pricing, claim adjudication, and billing best practices.
This publication provides benchmarks where available, notes policy updates affecting injectable antimicrobial reimbursement, and situates C9443 in clinical context for outpatient infusion and hospital outpatient settings. Data not available in the input will be identified as such in individual sections.
Billing Code Overview
HCPCS Level II code C9443 represents an injection of dalbavancin, 10 mg. This entry documents the drug product and unit-of-service for billing purposes when dalbavancin is administered.
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Service type: Drug administration (intravenous antibiotic infusion/injection)
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Typical site of service: Outpatient infusion center, hospital outpatient department, or clinic setting where parenteral antimicrobial therapy is delivered.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient for administration of C9443 (injection, dalbavancin, 10 mg) is an adult with a confirmed or suspected serious Gram-positive bacterial infection — commonly acute bacterial skin and skin structure infections (ABSSSI) such as cellulitis, wound infection, or complicated soft-tissue infection — who requires long-acting intravenous antibiotic therapy. The clinical workflow commonly follows: an emergency department or outpatient clinic evaluation identifies a patient with ABSSSI; empirical and/or culture-directed therapy is considered; the clinician determines that outpatient parenteral therapy with a long-acting agent is appropriate to avoid prolonged hospitalization or facilitate early discharge. The provider orders C9443 dosed to deliver the pharmacy-determined vial amount corresponding to the required milligram dose (dalbavancin supplied and billed per 10 mg unit). Pharmacy prepares the intravenous infusion (typically a 30-minute single or two-dose regimen per dalbavancin product labeling). Nursing documents the infusion start and stop times, monitors for infusion reactions, and records lot numbers and wound or systemic response. Follow-up visits or telehealth assessments evaluate clinical response, tolerability, laboratory surveillance if indicated (renal and hepatic function), and any necessary additional antimicrobial management. Billing uses the C9443 HCPCS unit count to reflect the total milligrams administered divided by 10 mg per unit, and claims may include applicable modifiers to indicate payment circumstances or services performed in the outpatient infusion setting.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separate E/M service on same day | When a distinct evaluation and management visit is provided on the same day as dalbavancin administration |
59 | Distinct procedural service | When a separately identifiable procedure unrelated to the infusion is performed the same day |
76 | Repeat procedure or service by same physician | When the dalbavancin infusion is repeated later the same day |
77 | Repeat procedure by another physician | When another physician repeats the infusion procedure the same day |
91 | Repeat clinical diagnostic laboratory test | When repeat lab testing is billed to monitor therapy effectiveness or safety |
Q5 | Service furnished under arrangement by this provider | When the administering facility bills for a service provided under arrangement |
XE | Separate encounter, distinct from other services | When the infusion represents a distinct encounter not bundled with other services |
XP | Separate practitioner, distinct from other practitioners | When a separate practitioner provides the infusion service distinct from other billed services |
XU | Unusual non-overlapping service | When the service is distinct and not overlapping with other billed services |
GP | Registered provider-engaged physical therapy (example taxonomy billing) | When applicable in outpatient therapy clinic contexts (note: used rarely with infusion billing) |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207Q00000X | Infectious Disease Physician | Frequently orders and manages dalbavancin for complicated Gram-positive infections |
208000000X | Emergency Medicine Physician | May initiate dalbavancin to facilitate ED discharge for ABSSSI |
363L00000X | Registered Nurse | Administers IV infusion in outpatient infusion center or clinic |
3336C0003X | Clinical Pharmacist | Prepares dose, performs stewardship oversight and dosing verification |
261QM0800X | Hematology/Oncology (infusion clinic context) | Infusion clinic providers who may administer antimicrobials in ambulatory infusion settings |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
L03.116 | Cellulitis of left lower limb | Localization of ABSSSI commonly treated with intravenous dalbavancin when severe or progressing |
L03.115 | Cellulitis of right lower limb | Common site-specific diagnosis prompting long-acting IV antibiotic therapy |
L02.611 | Cutaneous abscess of left lower limb | Abscess requiring IV therapy post-drainage or when systemic involvement present |
A41.9 | Sepsis, unspecified organism | Systemic infection where long-acting gram-positive coverage may be part of therapy when pathogen known |
B95.62 | Methicillin resistant Staphylococcus aureus infection as the cause of disease classified elsewhere | MRSA identified on culture supports use of dalbavancin for Gram-positive resistant organisms |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
96365 | Intravenous infusion, therapeutic, prophylactic, or diagnostic; initial, up to 1 hour | Used when dalbavancin infusion is billed for the initial infusion time period in outpatient or clinic settings |
96366 | Intravenous infusion, each additional hour | Used if infusion duration exceeds the initial hour billing increment |
99070 | Supplies and materials (e.g., gloves, gauze) | Used to bill separately for non-drug supplies associated with infusion when permitted |
36415 | Collection of venous blood by venipuncture | Performed for baseline or monitoring laboratory tests during dalbavancin therapy |
99212 | Office or other outpatient visit for the evaluation and management of an established patient, low complexity | Example level of E/M visit that may occur on the same day as infusion and billed with appropriate modifier |