J0875
J0875 – Injection, dalbavancin, 5 mg · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 5 NDCs crosswalked per 5 MG $11.293/unit ASP+6%
📋 J0875 summary
J0875 is a HCPCS Level II J-code used to bill dalbavancin, 5 mg, billed per 5 MG. The number of billing units to report depends on the dose administered and the NDC/package billed — use the calculator below.
Brand names associated with J0875: Dalbavancin, Dalvance, Dalbavancin Hydrochloride
Code J0875
Billing unit 5 MG Payment limit $11.293/unit NDC-Crosswalk 5
Quarter Q3 2026
RxCUI Atlas Trace the drug concept →
⚠ An NDC↔HCPCS crosswalk and a published payment limit do not guarantee payer coverage or payment. Always verify the current payer policy and claim format before billing.
🗂️ Key billing facts
HCPCS codeJ0875
DescriptorInjection, dalbavancin, 5 mg
Billing unit5 MG
Payment limit / unit$11.293
Est. ASP / unit$10.654 est.
Mapped NDCs5
Data periodQ3 2026
Last updated2026-08-20
💊 About Dalbavancin Injection DRUG GUIDE
Dalvance (dalbavancin) injection is approved to treat acute bacterial skin and skin structure infections (ABSSSI) in adults and children from birth through age 17.
These are serious bacterial skin infections that require treatment with an antibacterial given by IV.It works against specific Gram-positive bacteria, including Staphylococcus aureus (both methicillin-susceptible and methicillin-resistant strains, known as MRSA), several Streptococcus species, and vancomycin-susceptible Enterococcus faecalis.
It should only be used when one of these susceptible bacteria is proven or strongly suspected to be causing the infection.
Clinical overview from our editorial drug guide for Dalbavancin Injection. For billing reference, see the sections above.
🧾 Billing & reimbursement HCPCS · CMS · EFF. Q3 2026
📅 Payment limits effective Q3 2026 — from the CMS Medicare Part B Payment Limit File (revised quarterly).
Medicare payment limit / unit
$11.293
Est. ASP / unit
$10.654 est.
Est. after 2% sequester
$11.067
HCPCS dosage
5 MG
The CMS payment limit is the Medicare Part B drug allowance (ASP + 6%, statutory). After the 2% federal sequester the effective payment is ≈ ASP + 4.3%; estimated ASP = payment limit ÷ 1.06. Source: CMS Medicare Part B Payment Limit File (quarterly), Q3 2026.
Full HCPCS code details (official CMS record)
Long descriptionInjection, dalbavancin, 5 mg
CoverageC — Carrier/MAC judgment
Pricing indicator51 — Drug — priced under the ASP methodology
Type of service1 — Medical care
BETOS-2O1E
ASC payment groupYY
Action codeN — No maintenance this year
Effective date2016-01-01
Date added2016-01-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J0875 = 5 mg. Enter a regimen to convert dose → billing units and project a full course.
Billing units = dose ÷ HCPCS unit size. Most payers require whole units — round per the payer's policy. “Est. Medicare pay” uses the current payment limit. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (JZ when none is discarded) where allowed. Always verify payer-specific rounding before billing.
🔁 NDCs that bill under J0875 WITH EST. MEDICARE PAY
5 NDCs map to J0875. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($11.293/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 00480-3325-01 | Dalbavancin 500 mg/25mL INJECTION, POWDER, FOR SOLUTION | Teva | 1 VIAL in 1 CARTON (0480-3325-01) / 25 mL... | 500 mg/25mL | 100 | $1,129.30 | — | ● Active | CMS ASP |
| 57970-0100-01 | DALVANCE Dalbavancin 500 mg/25mL INJECTION, POWDER, FOR SOLUTION | Allergan, | 1 VIAL in 1 PACKAGE (57970-100-01) / 25 m... | 500 mg/25mL | 100 | $1,129.30 | — | ● Active | CMS ASP |
| 65219-0120-12 | DALBAVANCIN HYDROCHLORIDE 500 mg/25mL INJECTION, POWDER, FOR SOLUTION | Fresenius | 1 VIAL in 1 PACKAGE (65219-120-12) / 25 m... | 500 mg/25mL | 100 | $1,129.30 | — | ● Active | CMS ASP |
| 71288-0034-50 | Dalbavancin 500 mg/25mL INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION | Meitheal | 1 VIAL, SINGLE-DOSE in 1 CARTON (71288-034... | 500 mg/25mL | 100 | $1,129.30 | — | ● Active | CMS ASP |
| 81298-2390-01 | Dalbavancin 500 mg/1 INJECTION, POWDER, FOR SOLUTION | Long | 1 VIAL in 1 CARTON (81298-2390-1) / 1 INJ... | 500 mg/1 | 100 | $1,129.30 | — | ● Active | CMS ASP |
NDC→HCPCS mappings come from the CMS ASP NDC-HCPCS crosswalk; additional DME MAC / DMEPOS mappings come from PDAC and are labeled separately. NADAC from CMS (weekly). “Status” reflects the product's marketing / obsolete flag in the NDC directory. Presence or absence here does not determine Medicare coverage. Linked NDCs open the full product page.
📊 Medicare utilization & spend CMS · PART B · 2026 (Q1)
Period
Total Part B spend
$17.7M
Claims
4,418
Beneficiaries
2,659
Spend / beneficiary
$6,657.52
Spend / claim
$4,006.87
Trend by period
Where J0875 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #132 of 824
#127
COLUMVI J9286
$20.19M
#128
IHEEZO J2403
$19.59M
#129
NEXVIAZYME J0219
$18.44M
#130
AMCHOPLAST, PER SQ C... Q4316
$18.44M
#131
EMPLICITI J9176
$17.91M
#132
DALBAVANCIN HCL* J0875
$17.7M
#133
ELREXFIO J1323
$16.82M
#134
ALYMSYS Q5126
$16.72M
#135
IDELVION J7202
$16.67M
#136
NIKTIMVO J9038
$16.36M
#137
RYSTIGGO J9333
$16.15M
Total claims — #231 of 824
#226
TYSABRI J2323
4,821
#227
DOXIL* Q2050
4,593
#228
AMVUTTRA J0225
4,551
#229
OCREVUS J2350
4,531
#230
BENDEKA J9034
4,474
#231
DALBAVANCIN HCL* J0875
4,418
#232
FYLNETRA Q5130
4,408
#233
CEFAZOLIN SODIUM-DEX... J0690
4,394
#234
ADRIAMYCIN* J9000
4,382
#235
CARNITOR* J1955
4,361
#236
SAPHNELO J0491
4,352
Top Medicare Part B drugs by the selected metric. Click any drug to open its J-code page. Source: CMS Medicare Quarterly Part B Spending by Drug.
Full breakdown by period (2)
| Period | Total spend | Beneficiaries | Claims | $/beneficiary | $/claim |
|---|---|---|---|---|---|
| 2026 (Q1) | $17.7M | 2,659 | 4,418 | $6,657.52 | $4,006.87 |
| 2025 (Q1-Q4) | $69.85M | 8,818 | 18,573 | $7,921.03 | $3,760.71 |
Provider-administered (Part B) spend, calculated for the whole HCPCS code (CMS does not publish Medicare spend per individual NDC). Self-administered use is covered under Part D instead. A blank patient count means fewer than 11 people — CMS hides counts that small to protect privacy. Source: CMS Medicare Quarterly Part B Spending by Drug (data.cms.gov), updated quarterly.
📈 Medicare Part B claims detail CMS PSPS · 2024
Calendar-year 2024 Medicare Part B fee-for-service activity for this HCPCS code, summed across all carriers, localities and specialties (CMS Physician/Supplier Procedure Summary). A “service” is one billed line/unit — not one claim — so counts run higher than claim counts.
Allowed charges
$24.16M
Medicare paid
$18.79M
Submitted services
1,668,273
Denial rate
6.8%
Allowed / service
$15.54
Submitted charges
$64.68M
Source: CMS Physician/Supplier Procedure Summary (PSPS), CY2024 — Medicare Part B carrier + DME fee-for-service claims (excludes Medicare Advantage). Figures are for the whole HCPCS code, which may cover uses beyond this drug. ⚠ CMS hides any figure covering fewer than 11 patients (a privacy rule), so totals — especially denials and low-volume codes — run a little low.
🗺️ Where J0875 is utilized CMS · BY PROVIDER · 2024
Medicare Part B services for this code by the rendering provider's state — 833,120 services across 21 states & territories in 2024 (CMS reports include DC and U.S. territories). Switch to per 100k to compare states fairly regardless of population. Hover or tap a state for its top ZIP codes.
Hover or tap a state to see its numbers + top ZIP codes.
Per-capita = services ÷ 2023 state population × 100,000 (so high-population states aren't automatically "hotter"). Counts reflect the provider's location, not the patient's. Providers with fewer than 11 patients are hidden by CMS for privacy, so totals run low and per-100k can be noisy in small states — read this as relative geography, not exact counts. Source: CMS Medicare Physician & Other Practitioners — by Provider and Service, 2024.
🗃️ Data sources & freshness
Every figure on this page is computed from public datasets. Here's what each section draws on and how current it is.
HCPCS code & descriptor
CMS HCPCS Level II code file
Loaded
Payment limit & billing unit
CMS Medicare Part B ASP Pricing File (quarterly)
Q3 2026 · as of 2026-08-20
NDC ↔ HCPCS crosswalk
CMS ASP NDC-HCPCS crosswalk
5 NDCs mapped
NADAC acquisition cost
CMS National Average Drug Acquisition Cost (weekly)
Not available for mapped NDCs
Utilization & spend
CMS Part B Spending by Drug · PSPS · Physician & Other Practitioners
Latest data year 2026
Figures are estimates for reference and may lag the source files. Always verify against the current CMS files and your payer's policy before submitting claims.
⚠️ Practical billing caveats
- A crosswalk is not coverage. An NDC mapping or a published payment limit does not guarantee a payer will cover or pay this code. Check the specific plan's policy.
- Units ≠ milligrams. Bill the number of HCPCS units (dose ÷ the code's unit size), not the milligram dose. Use the calculator above.
- Discarded drug. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (and JZ when nothing is discarded) where the payer allows.
- Rounding & partial units. Many payers require whole units; round per the payer's policy, not automatically up.
- The code can cover more than this drug. Some HCPCS codes span multiple products or strengths — confirm the exact code for the product administered.
- Figures lag. ASP limits change quarterly and utilization data are released with a delay. Verify against the current CMS files before billing.
❓ J0875 billing FAQ
What is HCPCS code J0875?
J0875 is a HCPCS Level II J-code used to bill Injection, dalbavancin, 5 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J0875?
One unit of J0875 represents 5 MG. Report the number of units equal to the dose administered divided by 5 MG.
How many units of J0875 should I bill?
Divide the dose administered by the code's unit size (5 MG) to get the number of billing units, then round per your payer's policy. The calculator on this page converts a dose into billing units and projects a full course.
How much does Medicare pay for J0875?
The Medicare Part B payment limit is $11.293 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $11.067 per unit. Payment limits are revised quarterly.
Which NDCs bill under J0875?
5 NDCs currently map to J0875 in the CMS ASP NDC-HCPCS crosswalk. See the NDC crosswalk table above for each product, package, billing units and estimated reimbursement.
Does a crosswalk mean J0875 is covered?
No. An NDC-to-HCPCS crosswalk and a published payment limit do not guarantee coverage or payment. Coverage depends on the payer, the diagnosis and the site of care — always verify the current policy before billing.
For professional billing reference only — verify against the current CMS files before submitting claims.