HCPCS
J2406
1 unit = 10 mg
Phase 1
Identify what you're billing
Confirm the product is Kimyrsa (one 1,200 mg vial, J2406) and not Orbactiv (three 400 mg vials, J2407), and confirm the single 1-hour-infusion dose is the entire vial with zero waste.
About Kimyrsa (oritavancin) FDA label verified Jul 2026
Oritavancin is a long-acting lipoglycopeptide antibiotic active against gram-positive organisms including MRSA. Like dalbavancin (Dalvance), its long half-life allows an entire course of therapy for acute bacterial skin and skin-structure infections (ABSSSI) to be delivered in a single IV infusion rather than the daily dosing most IV antibiotics require over one to two weeks. Kimyrsa is the newer of two oritavancin products on the US market: a single 1,200 mg vial infused over 1 hour, versus Orbactiv’s three 400 mg vials infused over 3 hours for the same total dose.
Kimyrsa is marketed by CorMedix Inc., which completed its acquisition of Melinta Therapeutics in August 2025. The clinical and commercial pitch mirrors Dalvance’s: a single infusion visit can substitute for a multi-week outpatient parenteral antibiotic therapy (OPAT) course that would otherwise require a PICC line and daily nursing visits — and Kimyrsa’s 1-hour infusion is meaningfully shorter than Orbactiv’s 3-hour regimen for the identical 1,200 mg dose, a real chair-time and scheduling advantage for busy infusion centers.
From a billing standpoint, Kimyrsa is unusual in a good way at the vial-math level: because it ships in exactly one vial size (1,200 mg) sized to match the entire FDA-labeled dose, the standard claim has zero drug waste and bills a single JZ line. The complexity is concentrated elsewhere: confirming the correct product and code (Kimyrsa/J2406 vs Orbactiv/J2407 — Kimyrsa's unit ASP is roughly 53% higher for the same 1,200 mg total dose), and documenting the 120-hour heparin-hold window that follows every oritavancin dose regardless of which product was used.
Kimyrsa vs Orbactiv — same drug, different code, different price CMS HCPCS aligned Jul 2026
Both products are oritavancin dosed to the same 1,200 mg total -- but they are billed under separate HCPCS codes with separate ASPs, and mixing them up is a real wrong-code denial driver.
Unlike dalbavancin, which has one brand and generic competitors all billing the identical code, oritavancin
is marketed as two distinct branded products that are not billing-interchangeable.
Kimyrsa delivers the full 1,200 mg dose from a single vial over 1 hour and bills
J2406. Orbactiv delivers the identical 1,200 mg total dose from three
400 mg vials over 3 hours and bills J2407. Both codes are separately priced in the quarterly
CMS ASP file, and at Q2 2026 pricing, Kimyrsa is priced roughly 53% higher per dose than
Orbactiv for the same total milligrams — a real formulary and step-therapy consideration, not just a
coding footnote.
| Product | HCPCS | ASP (Q2 2026) | Vial(s) for 1,200 mg dose | Infusion time |
|---|---|---|---|---|
| Kimyrsa | J2406 | $43.719/10 mg | One 1,200 mg single-dose vial | 1 hour |
| Orbactiv | J2407 | $28.567/10 mg | Three 400 mg single-dose vials | 3 hours |
The trap: billing the wrong code for the product actually administered. Because both
products treat the same indication at the same total 1,200 mg dose, it is easy for a claim-scrubber or a
biller working from a generic "oritavancin" order to key the wrong code — for example, billing
J2407 (Orbactiv's code) for a dose that was actually administered from a Kimyrsa vial, or the
reverse. This is a wrong-code claim, not a rounding difference, and the ASP gap means it also
materially misprices the claim. Confirm the NDC of the vial(s) actually
purchased and administered before building the claim; auto-mapping "oritavancin" to a single default code
in the CDM or EHR order set is the failure mode.
Dose, units & the zero-waste vial math FDA label verified Jul 2026
J2406 is billed at 1 unit = 10 mg. Kimyrsa's single 1,200 mg vial is sized to exactly match the FDA-labeled dose, so the standard claim has zero waste.
FDA-labeled dosing
| Regimen | Dose | Vial(s) | Infusion time | Discard |
|---|---|---|---|---|
| Standard single dose (ABSSSI) | 1,200 mg, once | One 1,200 mg single-dose vial | 1 hour | Zero — exact match |
| Off-label sequential dosing (osteomyelitis, PJI) | Variable, guideline-informed; typically repeat 1,200 mg doses | One 1,200 mg vial per dose | 1 hour per dose | Zero per dose |
Worked example — standard single 1,200 mg dose (zero waste)
# STANDARD single-dose regimen (1,200 mg = 120 units)
Dose: 1,200 mg → bill J2406 × 120
Vial opened: exactly one 1,200 mg single-dose vial (1,200 mg drawn, 1,200 mg administered)
Discard: 0 mg → single line, modifier JZ, no separate discard line
Drug cost at ASP: 120 × $43.719 = $5,246.28
ASP+6% allowed (reference): 120 × $43.719 × 1.06 = ~$5,561.06 — Part B coinsurance ~20% ≈ ~$1,112.21 (absent copay assistance)
# SAME 1,200 mg TOTAL DOSE via Orbactiv, for comparison (J2407, not this page's code)
120 units × $28.567 = $3,428.04 drug cost → roughly 35% lower than the Kimyrsa figure above for the identical total mg
# With the KIMYRSA Copay Savings Program (commercial only)
Patient pays $50 toward the copay/coinsurance obligation; remaining eligible amount covered by the program up to a stated cap of $1,000–$1,200 (materials inconsistent — confirm exact current terms at enrollment)
Dose: 1,200 mg → bill J2406 × 120
Vial opened: exactly one 1,200 mg single-dose vial (1,200 mg drawn, 1,200 mg administered)
Discard: 0 mg → single line, modifier JZ, no separate discard line
Drug cost at ASP: 120 × $43.719 = $5,246.28
ASP+6% allowed (reference): 120 × $43.719 × 1.06 = ~$5,561.06 — Part B coinsurance ~20% ≈ ~$1,112.21 (absent copay assistance)
# SAME 1,200 mg TOTAL DOSE via Orbactiv, for comparison (J2407, not this page's code)
120 units × $28.567 = $3,428.04 drug cost → roughly 35% lower than the Kimyrsa figure above for the identical total mg
# With the KIMYRSA Copay Savings Program (commercial only)
Patient pays $50 toward the copay/coinsurance obligation; remaining eligible amount covered by the program up to a stated cap of $1,000–$1,200 (materials inconsistent — confirm exact current terms at enrollment)
JZ and JW are mutually exclusive on the same drug, same date of service. Because
Kimyrsa’s single vial is sized to exactly match the FDA-labeled 1,200 mg dose, the standard claim has
zero discard and bills a single JZ line. A JW discard line would only be relevant in an
off-label scenario where less than the full vial is administered and the remainder is discarded — a
rare case given the vial is sized to the on-label dose, unlike drugs with multiple vial sizes that
routinely generate partial-vial waste.
Document the product (Kimyrsa vs Orbactiv), the NDC, and the vial opened in the
drug-preparation log, even though the vial math itself is simple. For Kimyrsa this is a short note
confirming one 1,200 mg vial, zero waste, and the correct J2406 code.
NDC reference NDCs verified vs the CMS NDC-HCPCS crosswalk, Jul 2026
Kimyrsa has a single NDC and vial size. Orbactiv's NDC is shown for comparison -- confirm which product was dispensed before choosing the HCPCS code.
| Product | Manufacturer | NDC (11-digit) | Strength / package | HCPCS |
|---|---|---|---|---|
| Kimyrsa | CorMedix (Melinta label) | 70842-0225-01 | 1,200 mg single-dose vial | J2406 |
| Orbactiv (for comparison only) | CorMedix / Melinta lineage | 70842-0140-03 | 400 mg single-dose vial (three needed for a 1,200 mg dose) | J2407 |
Confirm the NDC before billing. Kimyrsa has only one vial size and one NDC currently in
the CMS crosswalk. If three smaller vials were opened for a 1,200 mg dose instead of one large vial, that
is a strong signal the product administered was actually Orbactiv, not Kimyrsa — verify before
submitting the claim under either code.
Phase 2
Code the claim
Report the 1-hour IV infusion admin code, bill J2406 for the full 1,200 mg dose with JZ, and pair the ABSSSI diagnosis.
Administration codes CPT verified Jul 2026
Kimyrsa is a single 1-hour therapeutic IV infusion -- shorter than Orbactiv's 3-hour regimen for the same total dose.
| CPT | Role on the claim | When to use |
|---|---|---|
96365 | Initial hour of a therapeutic (non-chemo) IV infusion | Primary code for the 1-hour Kimyrsa infusion. Bill once per infusion visit. |
96366 | Each additional infusion hour (add-on) | Not typically needed for Kimyrsa's 1-hour infusion — contrast with Orbactiv, whose 3-hour infusion may use this add-on. |
96413 | Chemotherapy-class infusion administration | NOT appropriate. Kimyrsa is a therapeutic antibiotic infusion, not cytotoxic chemotherapy. |
Full code guidance: 96365/96366 · all admin CPT references.
Typical claim stack:
96365 + J2406 × 120 with modifier
JZ on a single line — no discard line at the standard dose. E/M with modifier 25
only if a significant, separately identifiable visit occurs the same day.
Why this is usually an office/infusion-suite visit, not an OPAT service line
Because the entire regimen completes in a single infusion visit rather than a multi-day or multi-week course, Kimyrsa 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, ED, 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 J2406 claim needs exactly one of JZ (no discard) or JW (discard). Because Kimyrsa’s single 1,200 mg vial is sized to exactly match the FDA-labeled dose, JZ is essentially always the case at the standard dose — there is no smaller vial size that could leave a partial-vial remainder the way multi-size-vial drugs do.
| Scenario | Vial(s) opened | Mg administered | Modifier |
|---|---|---|---|
| Standard single dose (1,200 mg) | One 1,200 mg single-dose vial | 1,200 mg given, 0 discarded | JZ — single line, no discard |
Claim-line structure: bill the full 120-unit line with JZ — there
is no routine JW scenario for Kimyrsa at the standard labeled dose, since the vial size was designed to
match it exactly.
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, including the decision to use a single-dose lipoglycopeptide instead of a multi-day antibiotic course.
340B modifiers (JG, TB)
For 340B-acquired Kimyrsa 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 | L03.90 | Most common ABSSSI diagnosis pairing. |
| Cutaneous abscess | L02.91 | Pair with organism code (B95.x) when documented. |
| Other/major skin infections (ABSSSI) | L08.9 | 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 given the per-dose cost. |
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 J2406
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, especially relative to Orbactiv.
Site of care & the heparin-hold window Verified Jul 2026
The single-visit design is the whole point: a Kimyrsa 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 in 1 hour — shorter chair time than Orbactiv’s 3-hour infusion for the same total dose, and a genuine substitute for a hospital admission or a multi-week vancomycin OPAT course requiring a PICC line.
| 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 J2406 + 96365; the 1-hour infusion is an efficient use of chair time. |
| 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 120-hour (5-day) IV unfractionated heparin hold is a discharge-planning issue, not just a
clinical footnote. Oritavancin artificially prolongs coagulation lab results after infusion
— aPTT for up to 120 hours, PT/INR for up to 12 hours, ACT for up to 24 hours — so lab-guided
IV unfractionated heparin dosing cannot be trusted during that window. For a patient being discharged from the hospital or transitioning between care settings, confirm
the timing of the oritavancin dose before starting or resuming IV unfractionated heparin, and document the
hold period in the discharge/care-coordination note. This does not affect low molecular weight heparin or
oral anticoagulants the same way, but confirm current label guidance for any concurrent anticoagulant.
Formulary and step-therapy pressure cuts toward Orbactiv’s lower price. Because both
products treat the same ABSSSI indication at the same total dose, some payers’ formulary-tier or
step-therapy policies may favor the lower-ASP Orbactiv over Kimyrsa given that Kimyrsa's unit ASP is
roughly 53% higher — verify the specific payer’s preferred single-dose lipoglycopeptide before
scheduling, alongside the usual step-therapy documentation (failure of, or contraindication to, oral or
standard IV therapy) that applies to this drug class generally.
Claim form field mapping CMS verified Jul 2026
Office/ED/HOPD Kimyrsa is a single-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 | J2406 — 10 mg per unit, 120 units for the 1,200 mg dose |
| Units (administered) | 24G | FL 46 | 120 (single dose) |
| NDC qualifier + 11-digit NDC + UoM + qty | 24A shaded area | FL 43 | N4 + 70842-0225-01 + UN + mg; confirms this is Kimyrsa, not Orbactiv |
| JZ modifier | 24D modifier slot | FL 44 modifier slot | Required per CR 12056; JZ at the standard zero-waste dose |
| Admin CPT 96365 | 24D | FL 44 | Single 1-hour 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., L03.90 cellulitis, L02.91 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, and confirm which single-dose lipoglycopeptide the plan prefers |
The NDC on the claim is the disambiguation check.
70842-0225-01 is Kimyrsa's
1,200 mg vial; if the pharmacy record shows three 400 mg vials instead, the correct product and code is
Orbactiv (J2407), not Kimyrsa. Reconcile the NDC to the code before submitting.
Phase 3
Get paid
Kimyrsa coverage hinges on documenting ABSSSI severity, confirming the correct product/code, and setting patient cost expectations given the commercial-only copay program.
Payer policy snapshot Reviewed Jul 2026 · verify current policy
Kimyrsa and Orbactiv (the other oritavancin product) and Dalvance (dalbavancin) are the single-dose lipoglycopeptides 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 oritavancin-specific NCD/LCD/coverage article or SAD-list entry found for any MAC as of this review. | Covered ABSSSI diagnosis; correct product/NDC/code (J2406 vs J2407); JZ reconciliation |
| 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 before approving a single-dose lipoglycopeptide -- and some formularies specifically prefer the lower-cost Orbactiv over Kimyrsa. | ABSSSI severity; prior/failed oral therapy; inability to maintain IV access for a multi-day course; confirmation of the payer's preferred oritavancin product if one exists |
| 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 and product preference, not indication coverage, is the dominant lever
As with Dalvance, oritavancin’s ABSSSI indication is broadly accepted — the friction is in step therapy and, distinctively for this drug pair, which oritavancin product a given payer prefers. Because Kimyrsa and Orbactiv treat the same indication at the same total dose with a meaningful ASP gap, some commercial formularies specify a preferred product; verify before scheduling rather than assuming either code will be reimbursed without question.
No drug-specific coverage article found
As of this review, no MAC lists oritavancin on a Self-Administered Drug (SAD) exclusion list, and no drug-specific Local Coverage Determination (LCD) or coverage article was found for either Kimyrsa or Orbactiv. Coverage runs through the standard Medicare Part B drug framework.
Medicare reimbursement — J2406 reimbursement (2026) CMS ASP verified Q2 2026
J2406 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 program matters so much when it applies.
Q2 2026 payment snapshot — J2406
Effective April 1 – June 30, 2026 · ASP figure live-bound to the CMS file
ASP / 10 mg unit
$43.719
+6% ≈ $46.34/unit
Single dose (1,200 mg)
~$5,561.06
drug allowed · pt 20% ≈ ~$1,112.21
Same dose via Orbactiv (J2407)
~$3,633.72
allowed · ~35% lower than Kimyrsa for identical mg
What the practice is paid: ASP+6% per 10 mg unit (120 units for the standard 1,200 mg
dose), minus sequestration, plus the single admin CPT (96365). Because there is no waste at the standard
dose, 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 KIMYRSA Copay Savings Program applies (commercial
only) change what the patient actually owes. Run a CareCost Estimate with
the real plan to see the out-of-pocket.
Coverage
There is no oritavancin-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
- J2406 — permanent HCPCS, "Injection, oritavancin, 10 mg," specific to the Kimyrsa product.
- J2407 — separate permanent HCPCS for Orbactiv, the other oritavancin product, at its own ASP ($28.567/10 mg, Q2 2026).
ASP updates quarterly. The $43.719/10 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 Kimyrsa dose carries a meaningfully high allowed amount (roughly $5,561 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.
- KIMYRSA Copay Savings Program — commercial-insurance copay assistance. The patient pays $50 per dose toward the copay/coinsurance/deductible obligation; the program covers the remainder up to a stated maximum. Program materials describe that maximum inconsistently — one source states up to $1,000 of the remaining drug-copay obligation, another states up to $1,200 per treatment as the program maximum. Confirm the exact current cap when enrolling. Requires a minimum $50 copay/coinsurance/deductible obligation and US residency, age 18+. Enroll or verify at kimyrsa.com/support-programs or 1-844-546-9772 (1-844-KIMYRSA). Not for patients with Medicare, Medicaid, or other government coverage. Verified active as of July 2026.
- KIMYRSA Patient Assistance Program — free-drug program for qualifying uninsured patients, administered by the manufacturer. A patient cannot be enrolled in both the copay program and the patient assistance program simultaneously — they are mutually exclusive.
- Government-insured patients — the KIMYRSA Copay Savings Program does not apply. Medicare Part B patients owe standard ~20% coinsurance on the ASP+6% allowed amount (roughly $1,112 for the standard 1,200 mg dose, before any secondary coverage). Screen for the Patient Assistance Program if the patient also lacks other coverage; independent infectious-disease foundation funds for this indication are uncommon.
- 340B — for eligible covered entities purchasing Kimyrsa 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-program eligibility — and the exact current program cap — as
part of the pre-infusion financial conversation.
Want the patient's real out-of-pocket for the exact plan — before applying assistance?
Run a CareCost Estimate with J2406 and the dose.
Phase 4
Fix problems
Wrong oritavancin code, step-therapy denials, copay-card eligibility mistakes (government payers), and undocumented heparin-hold timing are the top Kimyrsa issues.
Common denials & how to fix them Reviewed Jul 2026
| Denial reason | Common cause | Fix |
|---|---|---|
| #1 — Wrong oritavancin code (J2407 billed for a Kimyrsa product, or vice versa) | A dose actually administered from a Kimyrsa 1,200 mg vial billed under Orbactiv's J2407 code (or the reverse) — commonly from a CDM/EHR order set that defaults to a single "oritavancin" code regardless of which product was dispensed. | Confirm the NDC of the vial(s) actually administered (one 1,200 mg vial = Kimyrsa/J2406; three 400 mg vials = Orbactiv/J2407) and submit a corrected claim with the matching code. |
| #2 — Step therapy not satisfied | PA denied because failure of, or contraindication to, oral antibiotics or standard IV therapy wasn’t documented before a single-dose lipoglycopeptide was chosen, or the payer's preferred oritavancin product wasn't used. | Submit chart notes documenting the prior-therapy failure or the specific reason (unreliable IV access, adherence risk, hospital-avoidance need) that justified Kimyrsa, and confirm whether the payer has a formulary preference between Kimyrsa and Orbactiv. Resubmit or appeal with that documentation attached. |
| #3 — Copay card applied to a government payer | Practice or patient assumed the KIMYRSA Copay Savings Program applied, but the patient has Medicare, Medicaid, or other government coverage. | Confirm insurance type before the infusion; the copay program is commercial-only. For government-insured patients, quote the standard ASP+6% coinsurance and screen for the separate Patient Assistance Program if the patient is also uninsured for drug coverage purposes. |
| #4 — Heparin-hold documentation missing | A patient discharged or transitioned to IV unfractionated heparin therapy within 120 hours (5 days) of an oritavancin dose without documentation addressing the artificially prolonged coagulation labs. | Document the oritavancin dose date/time and the heparin-hold window in the discharge/care-coordination note before any IV unfractionated heparin decision in that window; this is a clinical-safety documentation item that post-payment reviewers may also flag. |
| #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 vial used. | Add the correct 11-digit NDC (70842-0225-01 for Kimyrsa) 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 Kimyrsa (oritavancin)?
Kimyrsa is billed under HCPCS J2406 at 10 mg per unit, so the standard single 1,200 mg dose
is billed as J2406 × 120. This code is specific to the Kimyrsa product — Orbactiv, a
different oritavancin formulation from the same manufacturer lineage, bills the separate code
J2407 at its own ASP. Both are oritavancin, but they are not billing-interchangeable: confirm
which product and NDC was actually administered before choosing the code.
Is Kimyrsa the same as Orbactiv?
They are the same active ingredient (oritavancin) but different billable products. Kimyrsa
(J2406) is a single 1,200 mg vial infused over 1 hour. Orbactiv (J2407) delivers
the same 1,200 mg total dose from three 400 mg vials infused over 3 hours. They carry separate NDCs,
separate HCPCS codes, and separate ASPs — at the Q2 2026 ASP, Kimyrsa prices roughly 53% higher per
dose than Orbactiv for the identical 1,200 mg total dose. Billing J2407 for a Kimyrsa-administered dose
(or J2406 for an Orbactiv-administered dose) is a wrong-code claim, not a rounding difference.
How do I bill Kimyrsa vial waste with JZ?
Kimyrsa ships in a single 1,200 mg single-dose vial size, and the FDA-labeled dose is the entire vial — 1,200 mg (120 units) with zero drug discarded. Bill the full administered-units line with modifier JZ; there is no JW discard line at the standard labeled dose because the vial is sized to match it exactly.
What is the standard Kimyrsa dosing regimen?
Kimyrsa is FDA-approved for acute bacterial skin and skin-structure infections (ABSSSI) in adults, dosed as a single 1,200 mg IV infusion given over 1 hour. That single infusion is designed to complete an entire course of ABSSSI therapy in one visit, similar in concept to dalbavancin (Dalvance) but with a shorter infusion time than Orbactiv's 3-hour regimen for the same total dose.
Is there a copay program for Kimyrsa?
Yes. The KIMYRSA Copay Savings Program is commercial-insurance-only: the patient pays $50 per dose, and the program covers the remaining eligible out-of-pocket obligation — program materials describe the maximum benefit inconsistently as up to $1,000 in one place and up to $1,200 per treatment in another, so confirm the exact current cap at enrollment (1-844-546-9772 or kimyrsa.com/support-programs). It excludes Medicare, Medicaid, and other government payers. A separate free-drug patient assistance program is available for qualifying uninsured patients, but a patient cannot be enrolled in both programs simultaneously. Verified active as of July 2026.
Why does Kimyrsa affect heparin dosing after infusion?
Oritavancin artificially prolongs certain coagulation lab results — aPTT for up to 120 hours, PT/INR for up to 12 hours, and activated clotting time (ACT) for up to 24 hours after the infusion — which can make it look like a patient is more anticoagulated than they actually are. The FDA label states that IV unfractionated heparin should not be administered for 120 hours (5 days) after an oritavancin dose because the lab-based monitoring used to dose heparin safely cannot be trusted during that window. This is a real discharge-planning and OPAT care-coordination issue: confirm the timing of the oritavancin dose before starting or resuming IV unfractionated heparin.
Reference
Sources & methodology
Every claim on this page is sourced. Methodology and review history below.
Source documents
- DailyMed — Kimyrsa (oritavancin) prescribing information
- CMS HCPCS Level II — J2406
- CMS — Medicare Part B Drug ASP Pricing File
- CMS — JW/JZ modifier policy (CR 12056, eff. July 2023)
- FDA National Drug Code Directory — oritavancin NDCs
- AMA CPT — therapeutic IV infusion codes (96365, 96366)
- CMS — ICD-10-CM (FY2026)
- CorMedix — KIMYRSA Copay Savings and Patient Assistance Programs
- CorMedix Inc. — corporate site
- CMS Medicare Coverage Database
About this page
We maintain this page as a living reference for billers, coders, and revenue-cycle staff working with Kimyrsa 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 J2406 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 |
|---|---|---|
| J2406 (and J2407, for comparison) ASP / 10 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, product preference) | 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. |
| KIMYRSA program terms | Annual (or on notice) | Confirmed active July 2026 at kimyrsa.com/support-programs; 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 J2406, the single-dose 96365 admin coding, the FY2026 ICD-10 selections, the
zero-waste vial math, the JZ reconciliation, and the Kimyrsa-vs-Orbactiv code disambiguation — were
checked against FDA prescribing information (DailyMed), CMS HCPCS & coverage resources, AMA CPT, and
CorMedix's current patient-support 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, product, covered diagnosis, and current payer/copay-program policy against
your own source documents before submitting a claim.
Change log
- — Initial publication. Kimyrsa (oritavancin) billing reference: J2406 at 10 mg/unit with live ASP binding; Kimyrsa-vs-Orbactiv J-code/price disambiguation (J2406 vs J2407; Kimyrsa ~53% higher / Orbactiv ~35% lower per dose for the identical 1,200 mg total); zero-waste single 1,200 mg vial math (JZ); single 1-hour infusion admin coding; ABSSSI ICD-10; the 120-hour IV-unfractionated-heparin hold and its OPAT/discharge-planning implications; the KIMYRSA Copay Savings Program (commercial-only, $50/dose, program cap stated inconsistently as $1,000 vs $1,200 across materials) alongside the separate free-drug Patient Assistance Program.
Methodology
Every claim on this page is sourced inline. Dosing, indications, and the heparin interaction window are taken from the current FDA prescribing information; the ASP figures for both J2406 and J2407 are read live from the CMS Part B ASP file; administration codes are from AMA CPT; and copay-program terms are read directly from CorMedix's current patient-support program page, with the cap-figure inconsistency across program materials flagged explicitly rather than resolved by assumption. We do not paraphrase from billing-software vendor blogs, and we flag anything not yet SME-verified rather than assert it.