Summary & Overview
HCPCS J3095: Telavancin Injection, 10 mg
HCPCS Level II code J3095 identifies telavancin, an intravenously administered antibiotic supplied in 10 mg units. As a labeled therapy for certain severe Gram-positive infections, this code is used when telavancin is furnished in clinical settings that provide parenteral drug therapy. Nationally, drug J-codes like J3095 are central to facility billing, hospital pharmacy charge capture, and payer coverage determinations for high-cost injectable antimicrobials.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical purpose and service context, an outline of which payers commonly cover the product, and the types of benchmarks and policy areas typically examined for injectable drug codes — such as coverage policies, unitization and billing practices, and site-of-service considerations. The publication highlights where readers can expect to find payer-specific coverage rules, prior authorization trends, and reimbursement policy notes for injectable antibiotics, and it summarizes what to look for in claims and charge data when assessing utilization of J3095.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and detailed payer-specific policy language.
Billing Code Overview
HCPCS Level II code J3095 describes the medication telavancin delivered by injection, in a unit of 10 mg. This code represents a parenteral antibiotic administration product used for treatment of serious Gram-positive bacterial infections where telavancin is clinically indicated.
Service type: Injectable drug administration / drug supply
Typical site of service: Hospital inpatient, hospital outpatient department, or other facility settings where intravenous antibiotics are administered
Clinical & Coding Specifications
Clinical Context
A 68-year-old hospitalized patient with a documented Gram-positive complicated skin and soft tissue infection (such as methicillin-resistant Staphylococcus aureus) and significant comorbidities (chronic kidney disease stage 3 and diabetes mellitus) requires intravenous antibacterial therapy. The inpatient infectious diseases team evaluates the patient and determines telavancin is appropriate based on pathogen susceptibility, prior antibiotic exposure, and clinical severity. The medication J3095 (Injection, telavancin, 10 mg) is prepared by pharmacy and administered by a registered nurse via peripheral IV or central line in the inpatient acute care setting. Documentation includes indication, dose (calculated per weight and renal function), infusion rate, lot number, vial waste if any, and administration modifiers such as JW for discarded drug when applicable. Monitoring includes vital signs, renal function tests, and assessment for infusion-related reactions; dose adjustments are made for renal impairment. The clinical workflow typically involves order entry by the prescribing physician, pharmacy verification and compounding, bedside administration by nursing with MAR documentation, and billing using J3095 with appropriate units to reflect the total milligrams administered.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW |