Summary & Overview
HCPCS Level II J0878: Daptomycin Injection, 1 mg
HCPCS Level II code J0878 denotes the per-milligram billing unit for daptomycin injection (1 mg). Daptomycin is a parenteral antibiotic used for serious gram-positive infections, and accurate per-milligram reporting affects hospital and outpatient infusion billing and inventory management. Nationally, consistent use of this HCPCS Level II code supports standardized claims processing, drug utilization tracking, and payment reconciliation across payers.
Key payers in the coverage landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how J0878 is applied in clinical settings, typical sites of service where daptomycin is administered, and payer coverage context. The publication provides benchmark-oriented content covering unitization practices, claim line reporting considerations, and common modifier usage (listed separately), as well as clinical context that explains why per-milligram coding matters for high-cost parenteral antibiotics.
Where specific data points or payer-specific rates are not provided in the input, the text indicates "Data not available in the input." The report is intended for coding, billing, and revenue cycle professionals, pharmacists, and policy analysts seeking a national perspective on reporting and handling of per-milligram injectable antimicrobial claims.
Billing Code Overview
HCPCS Level II code J0878 represents injection, daptomycin, 1 mg. This code is used to report administration of the antibiotic daptomycin measured per milligram.
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Service type: Intravenous antimicrobial administration (parenteral injection/infusion)
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Typical site of service: Hospital inpatient, hospital outpatient, emergency department, infusion center, and other outpatient clinical settings where parenteral antibiotics are administered.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult admitted to an inpatient ward or seen in an outpatient infusion center with a serious gram-positive bacterial infection requiring intravenous daptomycin therapy. For example, a 68-year-old male with a prosthetic joint infection and persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia after initial therapy may be started on daptomycin. The clinical workflow includes order entry by the attending infectious disease physician, pharmacy verification of dosing (commonly weight-based, e.g., 6 mg/kg daily), preparation of the appropriate daptomycin vial(s) by the pharmacy, administration via peripheral or central intravenous line by a registered nurse, monitoring of creatine phosphokinase (CPK) and renal function prior to and during therapy, and documentation of dose, lot number, units billed, and site of service. Billing uses J0878 reported per milligram (1 mg units) with quantity reflecting total milligrams administered for the encounter. Typical sites of service include the inpatient hospital floor, observation unit, outpatient infusion center, emergency department when administered as part of a visit, or skilled nursing facility when provided as part of parenteral antibiotic therapy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug wasted/ discarded | Use when a portion of single-use vial drug is discarded and payer requires reporting of wastage per local policy. |