HCPCS
J0875
1 unit = 5 mg
Phase 1
Identify what you're billing
Confirm the regimen (single 1,500 mg vs two-dose), confirm the vial NDC bills J0875 regardless of manufacturer, and confirm whether the dose is a zero-waste multiple of the 500 mg vial.
About Dalvance (dalbavancin) FDA label verified Jul 2026
Dalbavancin is a long-acting lipoglycopeptide antibiotic active against gram-positive organisms including MRSA. Its defining clinical feature is an exceptionally long half-life (roughly 6–11 days), which allows an entire course of therapy for acute bacterial skin and skin-structure infections (ABSSSI) to be delivered in a single 30-minute IV infusion, or in two infusions a week apart, rather than the daily-to-multiple-times-daily dosing that most IV antibiotics require over 1–2 weeks.
Marketed by AbbVie (via Allergan) as Dalvance, dalbavancin is now also available from generic manufacturers, and both brand and generic NDCs bill the identical HCPCS code. The commercial and clinical pitch are the same: a single infusion visit replaces a multi-week outpatient parenteral antibiotic therapy (OPAT) course that would otherwise require a PICC line, daily nursing visits, and daily vancomycin drug levels — a genuine ER-avoidance and hospital-avoidance play for the right ABSSSI patient.
From a billing standpoint, Dalvance is unusual in a good way: because it ships in only one vial size (500 mg) and the standard doses (1,500 mg, 1,000 mg, 500 mg) are all exact multiples of that vial, the typical claim has zero drug waste — a rare case among single-dose-vial IV antibiotics, most of which routinely generate JW lines. The complexity that does exist is concentrated elsewhere: the copay program is commercial-insurance-only, the renal-adjusted doses do generate waste, and payer utilization management has grown more aggressive about the per-dose cost of single-dose lipoglycopeptides even as they save money on the OPAT side of the ledger.
Brand vs generic dalbavancin — same J-code, one billing path CMS HCPCS aligned Jul 2026
Dalbavancin is a small-molecule (glycopeptide-derived) drug, not a biologic -- generic dalbavancin bills the identical HCPCS code and unit as brand Dalvance.
There is no biosimilar pathway question here: dalbavancin has generic competition, and every NDC —
AbbVie's brand Dalvance or any generic manufacturer's version — maps to the same J0875
at 5 mg per unit. The only practical difference for billers is which NDC was dispensed and, in some cases,
which copay program a patient is eligible for: the Dalvance Connects copay card is tied to
the branded product, so confirm which NDC was actually administered before directing a patient toward the
manufacturer copay program.
| Product | Manufacturer | HCPCS | Notes |
|---|---|---|---|
| Dalvance (brand) | AbbVie (Allergan) | J0875 | NDC 57970-0100-01. Eligible for Dalvance Connects copay assistance (commercial only). |
| Generic dalbavancin | Multiple generic manufacturers | J0875 | Same code, same 5 mg unit. Confirm the specific NDC does not carry a manufacturer copay program before assuming Dalvance Connects applies. |
What this means for the claim: bill
J0875 at 1 unit = 5 mg regardless of
brand vs generic. Record the actual NDC dispensed for inventory and 340B purposes, and route the patient to
the correct assistance program (Dalvance Connects for the branded NDC; generic assistance options, if any,
for a generic NDC).
Dose, units & the zero-waste vial math FDA label verified Jul 2026
J0875 is billed at 1 unit = 5 mg. Because dalbavancin ships only in 500 mg single-dose vials and standard doses are exact multiples of 500 mg, most Dalvance claims have zero waste -- the rare clean JZ case among single-dose-vial IV antibiotics.
FDA-labeled dosing regimens
| Regimen | Dose | Vials (500 mg each) | Discard |
|---|---|---|---|
| Single-dose (most common) | 1,500 mg, once, over 30 min | 3 vials (1,500 mg opened) | Zero — exact match |
| Two-dose regimen | 1,000 mg day 1 + 500 mg one week later | 2 vials (day 1) + 1 vial (week later) | Zero on both visits |
| Renal adjustment (CrCl <30, not on HD) — single-dose | 1,125 mg, once | 3 vials opened (1,500 mg) to draw 1,125 mg | 375 mg discarded — JW applies |
| Renal adjustment — two-dose | 750 mg day 1 + 375 mg one week later | 2 vials (1,000 mg) draw 750 mg; 1 vial (500 mg) draw 375 mg | 250 mg then 125 mg discarded — JW applies to both visits |
Worked example — standard single 1,500 mg dose (zero waste)
# STANDARD single-dose regimen (1,500 mg = 300 units)
Dose: 1,500 mg → bill J0875 × 300
Vials opened: exactly three 500 mg vials (1,500 mg drawn, 1,500 mg administered)
Discard: 0 mg → single line, modifier JZ, no separate discard line
Drug cost at ASP: 300 × $15.003 = $4,500.90
ASP+6% allowed (reference): 300 × $15.003 × 1.06 = ~$4,770.95 — Part B coinsurance ~20% ≈ ~$954.19 (absent copay assistance)
# TWO-DOSE regimen (1,000 mg then 500 mg one week later)
Visit 1: 1,000 mg → bill J0875 × 200, two vials opened, 0 mg discarded → JZ
Visit 2 (one week later): 500 mg → bill J0875 × 100, one vial opened, 0 mg discarded → JZ
# RENAL-ADJUSTED single dose (1,125 mg, CrCl <30, not on HD) -- the JW exception
Dose: 1,125 mg → bill J0875 × 225 (administered line, no waste modifier)
Vials opened: three 500 mg vials (1,500 mg) to draw 1,125 mg
Discard: 1,500 − 1,125 = 375 mg → separate line J0875 × 75 with modifier JW
Dose: 1,500 mg → bill J0875 × 300
Vials opened: exactly three 500 mg vials (1,500 mg drawn, 1,500 mg administered)
Discard: 0 mg → single line, modifier JZ, no separate discard line
Drug cost at ASP: 300 × $15.003 = $4,500.90
ASP+6% allowed (reference): 300 × $15.003 × 1.06 = ~$4,770.95 — Part B coinsurance ~20% ≈ ~$954.19 (absent copay assistance)
# TWO-DOSE regimen (1,000 mg then 500 mg one week later)
Visit 1: 1,000 mg → bill J0875 × 200, two vials opened, 0 mg discarded → JZ
Visit 2 (one week later): 500 mg → bill J0875 × 100, one vial opened, 0 mg discarded → JZ
# RENAL-ADJUSTED single dose (1,125 mg, CrCl <30, not on HD) -- the JW exception
Dose: 1,125 mg → bill J0875 × 225 (administered line, no waste modifier)
Vials opened: three 500 mg vials (1,500 mg) to draw 1,125 mg
Discard: 1,500 − 1,125 = 375 mg → separate line J0875 × 75 with modifier JW
JZ and JW are mutually exclusive on the same drug, same date of service. At the standard
1,500 mg / 1,000 mg / 500 mg doses, nothing is discarded, so the entire administered-units line carries
JZ and there is no JW line at all. At the renal-adjusted doses, the vial math no
longer divides evenly, so the administered line carries no modifier and a separate line
carries JW for the discard — never JZ and JW together for the same drug on the same
date of service.
Document the regimen (single vs two-dose vs renal-adjusted), the vials opened, and, where
applicable, the discard in the drug-preparation log. For the standard doses this is a short note
confirming zero waste; for renal-adjusted doses it must reconcile administered + discarded to the vial
count opened.
NDC reference NDCs verified vs the CMS NDC-HCPCS crosswalk, Jul 2026
One brand manufacturer plus generic competition, one vial size. All NDCs bill the same J0875 at 5 mg per unit.
| Manufacturer | NDC (11-digit) | Strength / package | HCPCS |
|---|---|---|---|
| AbbVie (Allergan) — brand Dalvance | 57970-0100-01 | 500 mg/25 mL single-dose vial | J0875 |
| Generic dalbavancin | 00480-3325-01 | 500 mg/25 mL single-dose vial | J0875 |
| Generic dalbavancin | 65219-0120-12 | 500 mg/25 mL single-dose vial | J0875 |
| Generic dalbavancin | 71288-0034-50 | 500 mg/25 mL single-dose vial | J0875 |
Confirm the NDC dispensed before directing a patient to Dalvance Connects. The AbbVie
copay program is tied to the branded NDC (
57970-0100-01); a generic NDC may not qualify.
Submit the 11-digit NDC with the N4 qualifier, unit of measure, and quantity matching the vials actually
used.
Single vial size, multiple manufacturers. Every dalbavancin NDC above bills
J0875 at the same 5 mg unit. There is no vial-size decision to make the way there is for
daptomycin (350 vs 500 mg) — every dose is built from 500 mg increments.
Phase 2
Code the claim
Report the single 30-minute IV infusion admin code, bill J0875 for the full dose with JZ at standard regimens, and pair the ABSSSI diagnosis.
Administration codes CPT verified Jul 2026
Dalvance is a single 30-minute therapeutic IV infusion -- almost always billed with one initial-hour code and no additional-hour add-on.
| CPT | Role on the claim | When to use |
|---|---|---|
96365 | Initial hour of a therapeutic (non-chemo) IV infusion | Primary code for the 30-minute Dalvance infusion. Bill once per infusion visit. |
96366 | Each additional infusion hour (add-on) | Rarely needed — the standard 30-minute Dalvance infusion completes within the first hour. Only applies if the visit is extended (e.g., paired with another infused drug or an extended observation period). |
96413 | Chemotherapy-class infusion administration | NOT appropriate. Dalvance is a therapeutic antibiotic infusion, not cytotoxic chemotherapy. |
Full code guidance: 96365/96366 · all admin CPT references.
Typical claim stack:
96365 + J0875 × 300 (or 200/100 for
the two-dose regimen) with modifier JZ on a single line — no discard line at
standard doses. E/M with modifier 25 only if a significant, separately identifiable visit occurs the same
day.
Why this is an office/infusion-suite visit, not an OPAT service line
Because the entire regimen completes in one (or two) infusion visits rather than a multi-day or multi-week course, Dalvance typically does not generate the S-code/G-code home-infusion service claims that recurring IV antibiotics do — there is no daily nursing visit to bill separately. The claim is a standard office/infusion-suite or hospital-outpatient encounter. See the IV antibiotics reference for the S-code/G-code pattern used by multi-day OPAT regimens for comparison.
Modifiers CMS verified Jul 2026
JZ / JW — single-dose vial rule, and why JZ dominates here
Per CMS’s July 2023 single-dose-container policy (CR 12056), every J0875 claim needs exactly one of JZ (no discard) or JW (discard). Dalvance ships only in 500 mg single-dose vials, so the modifier always applies — but because the standard doses (1,500 / 1,000 / 500 mg) are exact multiples of 500 mg, JZ is the dominant case, unlike most other single-dose-vial IV antibiotics on this site.
| Scenario | Vial(s) opened | Mg administered | Modifier |
|---|---|---|---|
| Standard single dose (1,500 mg) | Three 500 mg vials (1,500 mg) | 1,500 mg given, 0 discarded | JZ — single line, no discard |
| Two-dose regimen, visit 1 (1,000 mg) | Two 500 mg vials (1,000 mg) | 1,000 mg given, 0 discarded | JZ |
| Two-dose regimen, visit 2 (500 mg) | One 500 mg vial | 500 mg given, 0 discarded | JZ |
| Renal-adjusted single dose (1,125 mg) | Three 500 mg vials (1,500 mg) | 1,125 mg given, 375 mg discarded | JW — J0875 × 75 on a separate line (administered line carries no modifier) |
Claim-line structure: when nothing is discarded (the standard doses), bill a single
J0875 line for the full administered units with JZ. When something is discarded (the
renal-adjusted doses), the administered-units line carries no modifier and a
separate J0875 line carries JW for the discard. JZ and JW are never both
present for the same drug on the same date of service.
Modifier 25 — same-day E/M
Append modifier 25 to the office E/M (99202–99215) when a significant, separately identifiable evaluation and management service is performed the same day as the infusion — common at the initial visit when the ABSSSI diagnosis and treatment plan are established, or when assessing whether the two-dose regimen's second infusion is still indicated.
340B modifiers (JG, TB)
For 340B-acquired Dalvance at eligible covered entities, follow your MAC’s current 340B modifier policy (JG or TB as directed).
ICD-10-CM by indication FY2026 · verified Jul 2026
The diagnosis must support ABSSSI (the FDA-labeled indication). Off-label bone/joint use needs its own specific diagnosis and documented rationale.
| Indication | Representative ICD-10 | Notes |
|---|---|---|
| Cellulitis / erysipelas | L03.x | Most common ABSSSI diagnosis pairing. |
| Cutaneous abscess | L02.x | Pair with organism code (B95.x) when documented. |
| Other/major skin infections (ABSSSI) | L08.x | Use the most specific code supported by the encounter documentation. |
| MRSA as documented organism | B95.62 | Pair with the skin-infection site code when MRSA is confirmed. |
| Off-label: osteomyelitis | M86.x | Not FDA-labeled — document the long-half-life sequential-dosing rationale and any supporting literature. |
| Off-label: prosthetic-joint infection | T84.5x | Not FDA-labeled — document rationale; commonly requires peer-to-peer review. |
ABSSSI is the covered indication. A skin/skin-structure infection diagnosis with
documented severity (abscess, cellulitis with systemic signs, or a major wound infection) supports J0875 to
the medical benefit. Off-label bone/joint use needs its own diagnosis and a documented clinical rationale
— expect payer scrutiny given the high per-dose cost.
Site of care & ER-avoidance economics Verified Jul 2026
The single-visit design is the whole point: a Dalvance infusion can be given in an emergency department, urgent-care/infusion clinic, or physician office, and the patient walks out with an entire course of ABSSSI therapy completed (or, for the two-dose regimen, one infusion down and one scheduled a week later). That replaces what would otherwise be a hospital admission or a multi-week OPAT course with a PICC line, daily nursing visits, and daily vancomycin trough monitoring.
| Setting | POS | Claim form | Notes |
|---|---|---|---|
| Emergency department (ED-avoidance pathway) | 23 | UB-04 / 837I | Increasingly used as a discharge-instead-of-admit pathway for appropriate ABSSSI patients. |
| Infusion suite / physician office | 11 | CMS-1500 / 837P | Practice buys and bills J0875 + 96365; the most common outpatient setting. |
| Hospital outpatient (HOPD) | 19 / 22 | UB-04 / 837I | Facility bills the drug (often 340B) + admin. |
| Urgent care | 20 | CMS-1500 / 837P | Some urgent-care/infusion-capable clinics administer single-dose lipoglycopeptides directly. |
The economic argument cuts both ways in prior authorization. Payers recognize that
avoiding a hospital admission or a multi-week OPAT course saves money overall, but the per-dose drug
cost of a single Dalvance infusion (roughly $4,770 allowed at ASP+6%) is high relative to a single
day of most other IV antibiotics. Utilization management for dalbavancin and oritavancin has tightened in
2024–2026 specifically around this per-dose sticker price — document why oral therapy or
standard IV antibiotics (vancomycin) are not appropriate for this patient.
Claim form field mapping CMS verified Jul 2026
Office/ED/HOPD Dalvance is a single-visit (or two-visit) CMS-1500 (837P) or UB-04 (837I) claim -- no separate OPAT service claim is typically needed.
| Information | CMS-1500 (office) | UB-04 (facility) | Notes |
|---|---|---|---|
| HCPCS J-code (drug, administered) | 24D | FL 44 | J0875 — 5 mg per unit, e.g. 300 units for a 1,500 mg dose |
| Units (administered) | 24G | FL 46 | 300 (single-dose), or 200 then 100 for the two-dose regimen across two visits |
| NDC qualifier + 11-digit NDC + UoM + qty | 24A shaded area | FL 43 | N4 + 11-digit NDC + UN + mg; must match the vials used |
| JZ or JW modifier | 24D modifier slot | FL 44 modifier slot | Required per CR 12056; JZ at standard doses (zero waste), JW only for renal-adjusted doses |
| Admin CPT 96365 | 24D | FL 44 | Single 30-minute infusion, once per visit |
| E/M (99202–99215) with modifier 25 | 24D | FL 44 | Only when a significant, separately identifiable E/M is documented same day |
| ICD-10 (indication) | 21 (pointer in 24E) | FL 67 | ABSSSI diagnosis (e.g., L03.x cellulitis, L02.x abscess) plus organism code if known |
| NPI (rendering / billing) | 24J / 33a | FL 76 / 1 | |
| Prior-auth number | 23 | FL 63 | Commonly required by commercial plans given the per-dose cost; document failure/contraindication to oral or standard IV therapy |
Two-dose regimen means two separate claims, one week apart. Bill each visit on its own
claim with its own JZ line (200 units then 100 units) — don’t combine them into a single
300-unit claim, since they occur on different dates of service with different vial counts opened at each
visit.
Phase 3
Get paid
Dalvance coverage hinges on documenting ABSSSI severity and prior oral/standard-IV failure; the copay program only helps commercially insured patients.
Payer policy snapshot Reviewed Jul 2026 · verify current policy
Dalvance and oritavancin (the other single-dose lipoglycopeptide) are the IV antibiotics most likely to see step-therapy edits, given their high per-dose cost relative to standard IV antibiotics.
| Payer | PA / coverage | What they look for |
|---|---|---|
| Medicare Part B (MACs) | Covered for the FDA-approved ABSSSI indication under standard Part B drug coverage. No dalbavancin-specific NCD/LCD/coverage article or SAD-list entry found for any MAC as of this review. | Covered ABSSSI diagnosis; documented dose/regimen; JZ or JW reconciliation as applicable |
| Medicare Advantage | Follows Medicare coverage; some plans add prospective PA given the per-dose cost. | Plan PA where required; ABSSSI severity documentation |
| UnitedHealthcare / Aetna / Cigna / BCBS plans | PA commonly required. Step-therapy language increasingly asks for documented failure of, contraindication to, or inability to complete oral therapy or standard IV antibiotics (vancomycin) before approving a single-dose lipoglycopeptide. | ABSSSI severity; prior/failed oral therapy; inability to maintain IV access for a multi-day course; documented adherence concern as an alternative justification |
| State Medicaid (FFS + MCOs) | Covered for ABSSSI with state-specific PA forms; MCOs vary and may apply the same step-therapy pattern as commercial plans. | State PA form; covered-indication documentation |
Step therapy is the dominant lever, not indication coverage
Unlike drugs where coverage itself is contested, dalbavancin's ABSSSI indication is broadly accepted — the friction is in step therapy. Commercial payers increasingly want to see that oral antibiotics were tried and failed, or a specific reason oral/standard-IV therapy isn't appropriate (e.g., inability to maintain reliable IV access, documented non-adherence risk, or a need to avoid hospital admission). Build that justification into the initial note, not just the PA form.
No drug-specific coverage article found
As of this review, no MAC lists dalbavancin on a Self-Administered Drug (SAD) exclusion list, and no drug-specific Local Coverage Determination (LCD) or coverage article was found. Coverage runs through the standard Medicare Part B drug framework.
Medicare reimbursement — J0875 reimbursement (2026) CMS ASP verified Q2 2026
J0875 is an ASP-priced Part B drug. Because it's a single high-value dose rather than a daily drip, the patient's 20% coinsurance is a meaningfully larger single number than most IV antibiotics on this site -- which is exactly why the commercial copay card matters so much when it applies.
Q2 2026 payment snapshot — J0875
Effective April 1 – June 30, 2026 · ASP figure live-bound to the CMS file
ASP / 5 mg unit
$15.003
+6% ≈ $15.90/unit
Single dose (1,500 mg)
~$4,770.95
drug allowed · pt 20% ≈ ~$954
Two-dose (1,000+500 mg)
~$3,180.64 + $1,590.32
allowed across 2 visits · same total mg
What the practice is paid: ASP+6% per 5 mg unit (300 units for the standard 1,500 mg
dose), minus sequestration, plus the single admin CPT (96365). Because there is no waste at the standard
doses, the entire allowed amount is on one JZ line.
Sequestration: roughly a 2% reduction applies to the actual paid Part B amount. Patient
coinsurance is calculated on the allowed amount before sequestration.
Run the patient's exact number. The figures above are reference math at the current ASP;
deductible status, secondary coverage, and whether the Dalvance Connects copay card applies (commercial
only) change what the patient actually owes. Run a CareCost Estimate with
the real regimen and plan to see the out-of-pocket.
Coverage
There is no dalbavancin-specific NCD; coverage runs through the standard Medicare Part B drug framework for the FDA-approved ABSSSI indication. No SAD-list exclusion and no drug-specific LCD/article were identified as of this review.
Code history
- J0875 — permanent HCPCS, "Injection, dalbavancin, 5 mg." Applies to brand Dalvance and generic dalbavancin NDCs alike.
ASP updates quarterly. The $15.003/5 mg figure is the Q2 2026 ASP and is live-bound to the
CMS file on this page; verify the current quarter's ASP before quoting an exact allowed amount.
Patient assistance Verified Jul 2026
Because a single Dalvance dose carries a meaningfully high allowed amount (roughly $4,770 at ASP+6%), the manufacturer copay program is a load-bearing part of the patient-cost conversation for commercially insured patients — and its absence for government-insured patients is a common source of billing confusion worth flagging up front.
- Dalvance Connects (AbbVie) — commercial-insurance copay assistance. Eligible patients can pay as little as $0 out-of-pocket for Dalvance, up to a program maximum of $2,000 per calendar year. Claims must be submitted within 120 days of receiving Dalvance — confirm current terms at enrollment. Enroll at dalvance.com/reimbursement/patient-savings-program (dalvanceconnects.com redirects there). Not for patients with Medicare, Medicaid, VA, DOD, or TRICARE coverage. Verified active as of July 2026.
- myAbbVie Assist — free-drug program for qualifying uninsured and underinsured patients, with benefits-investigation and PA support for the practice. Unlike most manufacturer PAPs, it also accepts Medicare and Medicaid patients who meet its financial-need criteria — a real option for the government-insured patients the copay card excludes.
- Government-insured patients — Dalvance Connects does not apply. Medicare Part B patients owe standard ~20% coinsurance on the ASP+6% allowed amount (roughly $954 for a 1,500 mg dose, before any secondary coverage). Route qualifying patients to myAbbVie Assist (which accepts Medicare/Medicaid on financial need, above); independent infectious-disease foundation funds are uncommon.
- 340B — for eligible covered entities purchasing Dalvance under 340B, the discount accrues to the entity per the MAC's 340B modifier policy; it does not directly change the patient's coinsurance.
Set expectations before the infusion, not after. A patient assuming "the copay card covers
it" who turns out to have Medicare will be surprised by a four-figure coinsurance bill for a single visit.
Confirm insurance type and copay-card eligibility as part of the pre-infusion financial conversation.
Want the patient's real out-of-pocket for the exact regimen and plan — before applying assistance?
Run a CareCost Estimate with J0875 and the dose.
Phase 4
Fix problems
Step-therapy denials, misapplied waste modifiers, and copay-card eligibility mistakes (government payers) are the top Dalvance issues.
Common denials & how to fix them Reviewed Jul 2026
| Denial reason | Common cause | Fix |
|---|---|---|
| #1 — Step therapy not satisfied | PA denied because failure of, or contraindication to, oral antibiotics or standard IV therapy (vancomycin) wasn’t documented before a single-dose lipoglycopeptide was chosen. | Submit chart notes documenting the prior-therapy failure, intolerance, or the specific reason (unreliable IV access, adherence risk, hospital-avoidance need) that justified dalbavancin. Resubmit or appeal with that documentation attached. |
| #2 — JZ used where JW was required (or vice versa) | A renal-adjusted dose (1,125 mg or 750/375 mg) billed with JZ as if it were zero-waste, when it actually discards mg because it doesn’t divide evenly into 500 mg vials; or JW mistakenly applied to a standard zero-waste dose. | Confirm the regimen: standard doses (1,500/1,000/500 mg) are zero-waste (JZ); renal-adjusted doses (1,125/750/375 mg) discard mg and need JW on a separate line with no modifier on the administered line. Correct and resubmit. |
| #3 — Copay card applied to a government payer | Practice or patient assumed Dalvance Connects applied, but the patient has Medicare, Medicaid, VA, DOD, or TRICARE coverage. | Confirm insurance type before the infusion; Dalvance Connects is commercial-only. For government-insured patients, quote the standard ASP+6% coinsurance — and screen for myAbbVie Assist, which accepts Medicare/Medicaid patients meeting financial-need criteria. |
| #4 — Two-dose regimen billed as one claim | The 1,000 mg + 500 mg (one week later) regimen submitted as a single 300-unit claim instead of two separate claims on two dates of service. | Split into two claims matching the two actual visit dates: 200 units (day 1) and 100 units (week 2), each with its own JZ line. |
| #5 — Non-ABSSSI diagnosis without off-label documentation | Osteomyelitis or prosthetic-joint-infection diagnosis submitted without documented rationale for off-label sequential dosing. | Add the clinical rationale and any supporting literature/guideline citation to the chart and PA; expect peer-to-peer review for off-label bone/joint use given the cost. |
| NDC missing or mismatched | Drug line submitted without the N4 qualifier + 11-digit NDC, or an NDC that doesn’t match the vials used. | Add the correct 11-digit NDC for the vials used with the N4 qualifier, unit of measure, and quantity; resubmit. |
| Wrong admin CPT | 96413 (chemo administration) mistakenly used instead of 96365. | Correct to 96365 (therapeutic IV infusion) and resubmit. |
Frequently asked questions
What is the HCPCS J-code for Dalvance (dalbavancin)?
Dalbavancin (brand Dalvance or generic) is billed under J0875, "Injection, dalbavancin, 5 mg."
One billed unit = 5 mg, so the standard single 1,500 mg dose is billed as J0875 × 300.
Both the AbbVie brand NDC and the generic dalbavancin NDCs bill the same J0875 -- there is no separate code
by manufacturer.
How do I bill Dalvance vial waste with JZ?
Dalbavancin ships in a single 500 mg/25 mL single-dose vial size, and the standard doses are exact multiples of that vial: the single 1,500 mg dose uses exactly three 500 mg vials (300 units) with zero drug discarded, and the two-dose regimen (1,000 mg then 500 mg one week later) uses exactly two vials (200 units) and one vial (100 units) respectively, also with zero discard. Because nothing is left over, bill the full administered-units line with modifier JZ -- Dalvance is one of the few IV antibiotics on this site where JW almost never applies at standard doses. JW only appears for the renal-adjusted doses (1,125 mg, or 750 mg + 375 mg), which do not divide evenly into 500 mg vials and leave a discardable remainder.
What is the standard Dalvance dosing regimen for skin infections?
Dalvance is FDA-approved for acute bacterial skin and skin-structure infections (ABSSSI) in adults, dosed as either a single 1,500 mg IV infusion over 30 minutes, or a two-dose regimen of 1,000 mg on day 1 followed by 500 mg one week later. Both regimens are designed to complete an entire course of therapy in one or two office/infusion-suite visits rather than a multi-week course of daily IV antibiotics -- the central economic argument for choosing dalbavancin over a vancomycin OPAT line for appropriate patients.
Is there a copay program for Dalvance?
Yes. AbbVie's Dalvance Connects copay program can reduce eligible commercially insured patients' out-of-pocket cost to as little as $0, up to $2,000 per calendar year; claims must be submitted within 120 days of receiving Dalvance — confirm current terms at enrollment. It is restricted to commercial insurance — patients with Medicare, Medicaid, VA, DOD, or TRICARE coverage cannot use it. AbbVie's myAbbVie Assist program provides free drug for qualifying uninsured and underinsured patients — and, unlike most patient-assistance programs, it also accepts Medicare and Medicaid patients who meet its financial-need criteria. Confirmed active as of July 2026.
How much does a single 1,500 mg Dalvance dose cost at Medicare ASP?
At the Q2 2026 ASP of $15.003 per 5 mg unit, a 1,500 mg dose (300 units) prices at 300 × $15.003 = approximately $4,500.90 in drug cost, or about $4,770.95 at the ASP+6% Medicare Part B allowed amount. The patient's Part B coinsurance (absent supplemental coverage) would be roughly 20% of that allowed amount, before any copay-assistance program is applied.
Is Dalvance used for anything other than ABSSSI?
Dalbavancin's FDA-approved indication is acute bacterial skin and skin-structure infections (ABSSSI) in adults. Sequential or extended-interval dosing for osteomyelitis and prosthetic-joint infection is used off-label, supported by emerging clinical literature and its long half-life, but is not an FDA-approved indication -- document the off-label rationale and any supporting guideline or literature citation on the prior-authorization request.
Reference
Sources & methodology
Every claim on this page is sourced. Methodology and review history below.
Source documents
- DailyMed — Dalbavancin (Dalvance) prescribing information
- CMS HCPCS Level II — J0875
- CMS — Medicare Part B Drug ASP Pricing File
- CMS — JW/JZ modifier policy (CR 12056, eff. July 2023)
- FDA National Drug Code Directory — dalbavancin NDCs
- AMA CPT — therapeutic IV infusion codes (96365, 96366)
- CMS — ICD-10-CM (FY2026)
- AbbVie — Dalvance Connects patient savings program
- CMS Medicare Coverage Database
About this page
We maintain this page as a living reference for billers, coders, and revenue-cycle staff working with Dalvance claims in infectious disease, emergency medicine, and infusion-center practices. Coding and policy content is reviewed at least quarterly and updated whenever a source document changes. The J0875 ASP figure is live-bound to the CareCost CMS ASP layer, so the per-unit price reflects the current quarter automatically.
Found an error? Email hello@carecostestimate.com.
Refresh cadence
| Element | Cadence | How it’s refreshed |
|---|---|---|
| J0875 ASP / 5 mg unit | Quarterly | Live-bound to the CMS Part B ASP Pricing File. |
| HCPCS / CPT descriptors | Quarterly | Reviewed against CMS HCPCS and AMA CPT updates. |
| Payer policies (step therapy) | Semi-annual | Manual review against published IV-antibiotic and single-dose lipoglycopeptide medical policies. |
| NDC, dosing, FDA label | Event-driven | Tied to FDA label revisions and manufacturer/NDC changes. |
| Dalvance Connects program terms | Annual (or on notice) | Confirmed active July 2026 at dalvance.com/reimbursement/patient-savings-program; re-verified annually or when a change is reported. |
Reviewer
Verified against primary sources; independent SME sign-off pending. The billing codes on
this page — HCPCS J0875, the single-dose 96365 admin coding, the FY2026 ICD-10 selections, the
zero-waste vial math, and the JZ/JW discard reconciliation — were checked against FDA prescribing
information (DailyMed), CMS HCPCS & coverage resources, AMA CPT, and AbbVie's current patient-savings
program page in July 2026, and cross-checked in an internal fact-check review. A credentialed
clinical-coding SME sign-off is the final step before this notice is removed. Always verify the exact
NDC, regimen, covered diagnosis, and current payer/copay-program policy against your own source
documents before submitting a claim.
Change log
- — Blind QA review pass: corrected the renal-adjusted doses (1,125 mg; 750 mg + 375 mg) to their proper FDA-labeled status (they are in the label's dosage section, not off-label); split the oritavancin cross-reference into its two codes (Orbactiv J2407, Kimyrsa J2406 — separately priced); standardized the Dalvance Connects submission window to "within 120 days of receiving Dalvance"; documented that myAbbVie Assist accepts Medicare/Medicaid patients meeting financial-need criteria; replaced CPT descriptor text with original paraphrases.
- — Initial publication. Dalbavancin (Dalvance) billing reference: J0875 at 5 mg/unit with live ASP binding; brand-vs-generic same-J-code clarification; zero-waste 500 mg single-dose vial math (JZ) for the standard 1,500 mg and two-dose regimens, contrasted with the JW-generating renal-adjusted doses; single 30-minute infusion admin coding; ABSSSI ICD-10; ER-avoidance/OPAT-substitution site-of-care economics; confirmed-active Dalvance Connects commercial copay program with government-payer exclusion warning.
Methodology
Every claim on this page is sourced inline. Dosing, indications, and renal adjustment are taken from the current FDA prescribing information; the ASP figure is read live from the CMS Part B ASP file; administration codes are from AMA CPT; and copay-program terms are read directly from AbbVie's current patient-savings program page. We do not paraphrase from billing-software vendor blogs, and we flag anything not yet SME-verified rather than assert it.