J0875 HCPCS code: Injection, dalbavancin, 5 mg
J0875 is the HCPCS Level II code for injection, dalbavancin, 5 mg. In 2024 Medicare paid an average of $11.99 per service for J0875 across 1,396,625 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 300 per day on outpatient hospital claims. Medicare volume rose 6% from 2022 to 2024 (1,323,335 to 1,396,625 services). In 2024, about 554 clinicians billed Medicare for J0875 for 2,767 beneficiaries; Texas, Illinois, Florida accounted for 43% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2016-01-01 |
| Last action effective | 2016-01-01 |
Who bills J0875 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 554 |
| Medicare beneficiaries | 2,767 |
| States with claims | 27 |
| Share of services in top 3 states (Texas, Illinois, Florida) | 43% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J0875, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 1,323,335 | 2,839 | $14.73 | $11.75 |
| 2023 | 1,473,958 | 2,924 | $14.67 | $11.68 |
| 2024 | 1,396,625 | 2,767 | $15.06 | $11.99 |
States with the most J0875 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 276,654 | $12.00 |
| Illinois | 181,645 | $12.08 |
| Florida | 140,236 | $11.87 |
| Alabama | 101,025 | $12.03 |
| Kansas | 98,100 | $12.10 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 300 | Prescribing Information |
| practitioner claims | 300 | Prescribing Information |
What changed for J0875
- 2016-01-01: J0875 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code J0875?
J0875 is the HCPCS Level II code for injection, dalbavancin, 5 mg. Short descriptor: "Injection, dalbavancin".
How much does Medicare pay for J0875?
In 2024, the average Medicare payment was $11.99 per service (average allowed $15.06).
Does Medicare cover J0875?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J0875 can be billed per day?
300 on outpatient hospital claims; 300 on practitioner claims (NCCI medically unlikely edits).
Related J08 codes
- J0800 — Injection, corticotropin, up to 40 units
- J0801 — Injection, corticotropin (acthar gel), up to 40 units
- J0802 — Injection, corticotropin (ani), up to 40 units
- J0833 — Injection, cosyntropin, not otherwise specified, 0.25 mg
- J0834 — Injection, cosyntropin, 0.25 mg
- J0840 — Injection, crotalidae polyvalent immune fab (ovine), up to 1 gram
- J0841 — Injection, crotalidae immune f(ab')2 (equine), 120 mg
- J0850 — Injection, cytomegalovirus immune globulin intravenous (human), per vial
- J0870 — Injection, imetelstat, 1 mg
- J0872 — Injection, daptomycin (xellia), unrefrigerated, not therapeutically equivalent to j0878 or j0873, 1 mg
- J0873 — Injection, daptomycin (xellia), not therapeutically equivalent to j0878 or j0872, 1 mg
- J0874 — Injection, daptomycin (baxter), not therapeutically equivalent to j0878, 1 mg
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Next steps
- Run a reimbursement report for a device billed under J0875
- Watch J0875 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0875
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.