Summary & Overview
HCPCS Level II J0875: Dalbavancin Injection, 5 mg
HCPCS Level II code J0875 denotes a 5 mg unit of dalbavancin injection, an intravenous antibiotic used in outpatient and hospital outpatient infusion settings. Nationally, accurate coding for high-cost parenteral antimicrobials such as dalbavancin affects billing consistency, payer coverage decisions, and utilization tracking for complex infectious disease management.
Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical context, typical sites of service, and the payer landscape addressed in this publication. The analysis highlights benchmarks for utilization and reimbursement patterns, recent policy updates that affect coverage and billing for long-acting intravenous antibiotics, and practical coding considerations tied to unitization of dosage billing.
This publication provides national-level insights useful to billing managers, pharmacy directors, and revenue cycle teams seeking clarity on coding conventions for dalbavancin. It summarizes common payer positions, outlines what benchmarks and policy changes to expect, and situates J0875 within the broader set of parenteral antimicrobial billing practices. Data limitations and unavailable input fields are noted where applicable.
Billing Code Overview
HCPCS Level II code J0875 describes an injection of dalbavancin, 5 mg. This HCPCS Level II code represents a single unit of the intravenous antibiotic dalbavancin, typically administered as a measured milligram dose for the treatment of certain bacterial infections.
Service Type: Parenteral administration — therapeutic drug injection
Typical Site of Service: Outpatient infusion center, clinic, or hospital outpatient department
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting with a confirmed or suspected Gram-positive bacterial skin and soft tissue infection (for example, cellulitis or wound infection) or a bloodstream infection requiring long-acting intravenous antibiotic therapy. The patient often has one or more comorbidities (e.g., diabetes mellitus, peripheral vascular disease) that complicate outpatient oral therapy adherence or absorption. Prior to administration, an infectious disease clinician or hospitalist documents indication, reviews allergies, checks baseline labs (renal and hepatic function), and obtains relevant cultures. Dalbavancin is supplied as an intravenous infusion; usual dosing regimens include a single-dose or two-dose strategy. The infusion is administered in an outpatient infusion center, hospital inpatient unit, or ambulatory clinic by a registered nurse with appropriate IV access and monitoring. Observation for infusion-related reactions occurs during and for a brief period after administration. Medication administration is documented in the medical record, and billing uses the HCPCS Level II code J0875 reported per 5 mg unit with appropriate diagnosis linkage and applicable modifier(s).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard billing | Use when no modifier applies and service is billed as usual. |