J0875 HCPCS Code Guide: Dalbavancin Billing, Units, and Reimbursement

The dalbavancin for injection, 5 mg/unit, is reported in the J0875 HCPCS code. The dose, number of vials used, dose wastage and payment systems must all be documented correctly for accurate billing. This was the first time dalbavancin was reported with a temporary HCPCS code, and CMS set up this code as permanent code for dalbavancin.

Dalbavancin is a type of antibiotic that is given intravenously (into the vein) for treatment of some severe bacterial infections. It may be administered as a single 1,500 mg or as two doses depending on the clinical situation and renal function of the patient.

The biggest problem for the coder and billers is determining the number of units based on the administered dose. Documentation should also back up the drug product, dosage, medical necessity and any excess quantity that’s reported separately. This guide outlines what billing units are in J0875, dosage calculation, wastage, modifiers, NDC identification, reimbursement, documentation and common claim errors.

What Is the J0875 HCPCS Code?

J0875 is the HCPCS Level II code for injection, dalbavancin, 5 mg. The CMS made this code the permanent code for reporting dalbavancin.

Billing is based on the amount of dalbavancin administered. The milligram dosage should therefore be used to determine units, not the number of vials. This code is used to identify the drug. Each administration service that is reportable separately should be assessed by the CPT and Payer requirements.

What Drug Does J0875 Represent?

This code is a code for an antibiotic, dalbavancin, used intravenously (intravenous infusion means that the drug is given into a vein). The dosage unit of the code listed on CMS is 5 mg.

The current labeling for dalbavancin does not mention that it is an intravenously administered product that is supplied as lyophilized 500 mg powder per vial. Medication should be re-constituted and diluted prior to administration.

This is relevant to claim preparation. The vial has 500mg and one billing unit is just 5mg.

So, 100 units are given with a single 500 mg vial.

How Many Milligrams Equal One J0875 Unit?

One J0875 unit represents 5 mg of dalbavancin. The number of units reported should reflect the documented amount administered.

The basic calculation is:

units = administered dalbavancin in mg ÷ 5 mg

For example:

500 mg ÷ 5 mg = 100 units

A 1,000 mg dose would equal:

1,000 mg ÷ 5 mg = 200 units

A 1,500 mg dose would equal:

1,500 mg ÷ 5 mg = 300 units

The medical record should support the actual administered amount before units are submitted.

How Are J0875 Billing Units Calculated?

J0875 unit calculation starts with the documented dalbavancin dose. The total milligrams administered are divided by 5 because each HCPCS unit represents 5 mg.

The calculation should be based on the prescribed and administered dose. Vial count alone does not establish the billable units. When a dose creates unused medication, the billing team should separately evaluate whether the discarded amount qualifies for reporting under applicable payer rules.

What Are the Standard Dalbavancin Doses?

There are different adult dosage recommendations for renal function in the current prescribing information. The recommended single dose for adults with a creatinine clearance of ≥ 30 mL/min or those undergoing regular hemodialysis is 1,500 mg.

The label also indicates that this population is given 1000 mg twice, with 1000 mg given 1 week later. The recommended single dose for adults with a creatinine clearance less than 30 mL/min and who are not on regular hemodialysis is 1,125 mg. This is given as 750 mg two doses at a week interval.

The recent label reads: Dalbavancin is to be infused intravenously for 30 minutes. Coders should not determine the patient’s clinical dose independently. The documented administered dose should drive the HCPCS unit calculation.

J0875 Billing and Coding Guidelines

Accurate billing begins by confirming that dalbavancin was actually administered. The medication record should support the drug name, dosage, route, and date of service. The claim should then report the appropriate number of units. The number of vials used should be reviewed separately because vial quantity and billable units are not always identical.

Important billing checks include:

• Confirm dalbavancin was administered.
• Verify the documented milligram dose.
• Calculate units using 5 mg per unit.
• Confirm the product and NDC.
• Review the patient’s diagnosis.
• Confirm medical necessity.
• Check payer coverage requirements.
• Review discarded medication documentation.
• Evaluate JW or JZ requirements.
• Verify current reimbursement information.
• Report applicable administration services separately.

A complete medication record makes unit calculation easier. It also gives the payer clear support for the quantity billed.

Does J0875 Include the Infusion Administration?

J0875 reports the dalbavancin drug, not the professional administration service. An appropriate infusion administration CPT code may be reported separately when the service meets applicable coding requirements. The current prescribing information states that dalbavancin is administered by intravenous infusion over 30 minutes.

The administration code should be selected based on the documented service and current CPT guidance. Coders should not assume that this code itself includes the infusion service. The medical record should clearly identify the administration performed. This includes the route, start and stop information when required, and other details supporting the reported service.

What Modifiers Apply to J0875?

This code does not automatically require a modifier. Modifier selection depends on the claim circumstances and applicable payer rules. The JW and JZ modifiers are especially relevant when Medicare’s discarded drug policy applies to an eligible single-dose container. CMS specifically includes this code among the HCPCS codes covered by its JW and JZ policy.

JW and JZ should not be added simply because this is a drug code. The applicable container, wastage, Medicare requirements, and claim circumstances should first be confirmed.

J0875 Drug Wastage and Single-Dose Vials

Dalbavancin is available as single dose vials of 500 mg. Prescribed information for the current product states that leftover solution after reconstitution should be disposed of. Because this code is reported per 5 mg, the vial size can create substantial differences between the amount available and the amount administered.

For example, a 375 mg dose requires less than one 500 mg vial. The unused amount may therefore require evaluation under applicable discarded-drug reporting rules. A 500 mg dose uses the full labeled vial amount. In that situation, there is no unused medication from that vial to report as discarded.

The medical record should clearly document the administered amount and any discarded amount. CMS policy should then be reviewed to determine whether JW or JZ reporting applies.

J0875 NDC and Drug Identification

During treatment, a specific dalbavancin product will be used and identified by the National Drug Code (NDC). The information on the NDC may be used to assist with mapping the billed HCPCS code to the actual medication administered.

The current label states that dalbavancin is a lyophilized powder, supplied for reconstitution, 500 mg. If a payer needs NDC reporting, then the NDC must be provided by the actual product administered.  CMS also publishes NDC-HCPCS crosswalk information with its Part B drug pricing files.

What Documentation Supports J0875 Billing?

J0875 documentation should establish the medication administered and the amount billed. The record should also support the clinical reason for treatment.

Important documentation may include:

Complete documentation should be available before claim submission. Missing dosage information can make accurate unit reporting difficult.

J0875 Medical Necessity and Coverage

J0875 is used to report dalbavancin, but correct HCPCS selection alone does not establish medical necessity. The patient’s diagnosis and treatment must meet applicable coverage requirements. The current dalbavancin labeling identifies its use for acute bacterial skin and skin structure infections caused by designated susceptible microorganisms.

Payers may apply additional coverage criteria. Medicare contractors and commercial insurers can have different documentation or authorization requirements. Billing teams should therefore verify the diagnosis, coverage policy, authorization status, and treatment documentation before submitting the claim. A claim supported by the correct drug code can still be denied if medical necessity or coverage requirements are not satisfied.

J0875 Medicare Reimbursement

This code reimbursement can change according to the applicable Medicare payment methodology and date of service. CMS publishes Medicare Part B drug payment limits through its quarterly payment files. For 2026, CMS lists January, April, July, and October Part B payment files. The October 2026 file is identified as a preliminary file dated September 8, 2026.

CMS explains that most separately payable Part B drugs and biologicals use a payment limit based on ASP plus 6 percent, although payment methodologies can differ for particular products. Therefore, an older J0875 reimbursement amount should not automatically be used for a current claim. Billing teams should verify the applicable CMS file for the date of service. Commercial payer reimbursement may differ substantially from Medicare. Contracted rates and payer-specific policies should be reviewed separately.

Does J0875 Have an RVU?

This code represents a drug rather than a typical physician service. It should therefore not be analyzed like an E/M or procedural CPT code using physician work RVUs. The reimbursement analysis for this code focuses primarily on drug payment methodology. The separately reported infusion administration service can have its own CPT reimbursement and RVU considerations. Keeping the medication and administration components separate helps prevent incorrect reimbursement calculations. It also makes claim auditing more straightforward.

J0875 Billing Example

Suppose that a documented 1500mg dose of dalbavancin is given to an adult patient.

As one J0875 unit is equal to 5mg, the calculation is:

1,500 mg ÷ 5 mg = 300 J0875 units

The patient is then given 300 J0875 units for the 1,500 mg dose given.

The current labelling shows that it is used in adults with a creatinine clearance of at least 30 mL/min (including regular hemodialysis patients). Now consider a patient receiving 1,125 mg because of the labeled renal impairment dosing regimen.

The calculation becomes:

1,125 mg ÷ 5 mg = 225 J0875 units

The claim should reflect the documented administered dose. Any unused medication should be evaluated separately under the applicable wastage rules.

Common J0875 Billing Errors

J0875 claims can be affected by incorrect unit calculations, product information, or incomplete documentation.

Common errors include:

• Reporting the wrong drug code.
• Confusing vial quantity with billable units.
• Forgetting that one unit represents 5 mg.
• Reporting unsupported administered quantities.
• Using an incorrect NDC.
• Failing to document discarded medication.
• Misusing JW or JZ.
• Ignoring payer-specific coverage requirements.
• Reporting unsupported infusion services.
• Using outdated reimbursement information.
• Failing to verify renal dosing documentation.
• Failing to include adequate documentation for medical necessity.

Avoidable denials or discrepancies in payments may occur because of these errors. Many problems can be discovered prior to submission with a pre-billing review.

How to Audit J0875 Claims?

The clinical record should be compared to the claim in an audit of this code. The reviewer should ensure that all the information about the medicine, the dosage, the units and the product is consistent.

These are the steps in a practical audit:

1. Verify dalbavancin given.
2. Check the recorded milligram dose.
3. Recalculate the units.
4. Compare the NDC with the actual product.
5. Review the vial quantity.
6. Check discarded medication documentation.
7. Evaluate JW or JZ usage.
8. Confirm the diagnosis supports medical necessity.
9. Review the infusion documentation.
10. Compare payment with the applicable payer rate.

The audit should also confirm that the reported units represent the administered drug rather than simply the total amount purchased.

Key Takeaways for J0875 Billing

The J0875 HCPCS code represents dalbavancin injection, 5 mg. CMS established the code specifically for dalbavancin reporting, making accurate dose-based unit calculation essential. There are 5 mg in each unit. Therefore, a 1,500 mg dose equals 300 units, while a 1,125 mg dose equals 225 units.

When administering and discarding dosages, keep in mind the size of the vial used because Dalbavancin comes in 500 mg vials. The current labeling also offers a variety of dosing regimens for adults according to renal function. JW and JZ requirements should be evaluated when applicable to Medicare drug wastage reporting. CMS specifically lists this code among the HCPCS codes covered by its discarded-drug policy.

When billing for reimbursement, you should refer to the latest Medicare Part B payment files and not historical rates. These files are updated quarterly by CMS and may be based on varying methodologies by commercial payers.

Matching the drug, dose, units, NDC, documentation, wastage, diagnosis and payer requirements are the keys to accurate billing. By reviewing claims carefully, denials can be minimized and accuracy in reimbursements improved.

Frequently Asked Questions