Summary & Overview
HCPCS J0877: Daptomycin (Hospira) Injection, 1 mg
HCPCS Level II code J0877 designates a 1 mg injectable unit of daptomycin produced by Hospira and flagged as not therapeutically equivalent to J0878. As a parenteral antibiotic for serious Gram-positive infections, this code is used in acute care settings where intravenous antimicrobial therapy is administered. Nationally, accurate coding of specific branded injectable agents matters for clinical documentation, formulary alignment, and payer coverage determinations.
Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical role, typical sites of service, and the payer landscape relevant to reimbursement and coverage practices. The publication also outlines common billing modifiers and considerations for service-line reporting, as well as gaps where input data was not provided.
This analysis provides clinicians, billing professionals, and policy staff with a concise reference to support correct HCPCS Level II reporting of branded daptomycin product use, clarity on expected service contexts, and the payer mix most likely to be involved in coverage decisions.
Billing Code Overview
HCPCS Level II code J0877 represents an injection of daptomycin (Hospira) supplied in a dosage unit of 1 mg and is noted as not therapeutically equivalent to J0878. This HCPCS Level II code describes a single-drug injectable antibiotic product used for systemic treatment of serious Gram-positive infections.
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Service type: Injectable antimicrobial therapy
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Typical site of service: Hospital inpatient, hospital outpatient, and other acute care settings where parenteral antibiotics are administered
Clinical & Coding Specifications
Clinical Context
A hospitalized adult patient with a severe gram-positive bloodstream infection or complicated skin and soft tissue infection receives intravenous daptomycin (brand: Hospira) as targeted therapy after culture and susceptibility results indicate methicillin-resistant Staphylococcus aureus (MRSA) or other susceptible organisms. The antimicrobial stewardship team documents indication, dose, and duration in the medical record. Pharmacy compounds and dispenses J0877 per milligram; nursing administers the intravenous infusion, monitors for infusion reactions, serum creatine kinase (CK) levels, and documents administration time and lot number. Common workflow steps include physician order entry with indication and weight-based dose, pharmacist verification and billing using J0877 units, bedside administration by nursing, and follow-up infectious disease consultation to assess response and need for therapy modification.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug discarded/unused portion | When part of a single-use vial is discarded and payor requires reporting of wasted medication |
JZ | No drug administered, no wastage | When ordered but not administered and no drug was prepared |
QX | Commercially supplied sterile preparation - personal/office | When the drug is provided under a qualified clinical trial arrangement using a commercial supplier modifier (trial billing context) |
QY | Clinical trial drug provided by clinical study sponsor | When the medication is supplied by the study sponsor under a clinical research protocol |
CQ | Intravenous infusion, billed with J-code modifier for concentration differences | When the product differs in concentration or product source requiring clarifying modifier (site-specific billing policies may require) |
62 | Two surgeons/paired providers | When two physicians with different specialties perform distinct concurrent services related to complex infectious disease procedures (rare for antibiotic administration) |
78 | Unplanned return to the operating room by the same physician following initial procedure | When a postoperative infection requires re-intervention and additional intraoperative antibiotic administration occurs |
80 | Assistant surgeon | When an assistant surgeon is involved in a procedure where intraoperative intravascular daptomycin is administered |
59 | Distinct procedural service | When daptomycin administration is reported on the same day as another injectable procedure that is separate and distinct |
52 | Reduced services | When the full service of drug administration is reduced due to unforeseen clinical factors |
53 | Discontinued procedure | When administration is initiated but halted for patient safety reasons |
22 | Increased procedural services | When administration requires substantially greater resources or time than typical |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207R00000X | Infectious Disease Specialist | Primary prescribers and consultants for complex bacteremia and endocarditis management |
207L00000X | Critical Care Medicine | Manages critically ill patients receiving IV antimicrobials in ICU settings |
163W00000X | Clinical Pharmacist | Pharmacists who verify dosing, prepare infusion, and manage stewardship documentation |
362X00000X | Registered Nurse | Administers IV medication, monitors infusion and documents administration |
207K00000X | Internal Medicine | Hospitalists who frequently initiate and manage antibiotic therapy |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
A41.9 | Sepsis, unspecified organism | Severe bloodstream infections where IV daptomycin may be used for coverage of gram-positive pathogens |
A49.01 | Methicillin resistant Staphylococcus aureus infection of unspecified site | MRSA infections commonly treated with daptomycin when indicated |
L03.90 | Cellulitis, unspecified | Complicated skin and soft tissue infections that may require IV daptomycin |
I33.0 | Acute and subacute infective endocarditis | Daptomycin can be used as part of therapy for right-sided or complicated endocarditis due to susceptible organisms |
G00.9 | Bacterial meningitis, unspecified | In select cases with susceptible organisms and when daptomycin penetration and stewardship considerations apply |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
96365 | Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour | Often used when daptomycin infusion is administered as the first hour infusion in an outpatient infusion center or observation setting |
96366 | Intravenous infusion, each additional hour (list separately in addition to code for primary infusion) | Used when the daptomycin infusion duration extends beyond the initial hour and additional timed infusion billing is required |
96372 | Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular | Billed when a separate injectable medication is given in the same encounter alongside IV daptomycin (e.g., supportive medications) |
36415 | Collection of venous blood by venipuncture | Used for laboratory monitoring such as baseline and follow-up serum creatine kinase and renal function while on daptomycin |
99223 | Initial hospital care, typically 70 minutes or more | Used for inpatient consult or admission evaluation when initiating IV daptomycin for severe infections |