DALVANCE J Code: J0875

Drug & Product Overview

HCPCS Descriptor Injection, dalbavancin, 5 mg

HCPCS Added Date January 1, 2016

Manufacturer Multiple Manufacturers

Route of Administration Intravenous

Generic Status Multi-Source; Generic

Dosage Type Single-Dose

Dosage Form Injection, Powder, For Solution | Injection, Powder, Lyophilized, For Solution

About DALVANCE

Dalvance is a medication aligned to the HCPCS J Code: J0875 for billing, pricing, and reimbursement purposes in the United States. Classified under Antibiotic, it is administered via the intravenous route and manufactured by multiple companies.

According to CMS Drug Use Information: This medication is used to treat serious bacterial infections of the skin. It works by stopping the growth of bacteria.

Disclaimer: This is a summary and does not contain all possible information about this product. For complete information about this product or your specific health needs, ask your healthcare professional.

NDC Code Information

Based on publicly available CMS files. The list of NDCs below is not exhaustive.

NDC Code	Drug	Manufacturer	Billing Units / Pkg	Package Size
00480-3325-01	Dalbavancin	Teva Pharmaceuticals, Inc.	100	500 MG / 25 ML
57970-0100-01	Dalvance	Allergan, Inc.	100	500 MG / 25 ML
65219-0120-12	Dalbavancin Hydrochloride	Fresenius Kabi USA, LLC	100	500 MG / 25 ML
71288-0034-50	Dalbavancin	Meitheal Pharmaceuticals Inc	100	500 MG / 25 ML
81298-2390-01	Dalbavancin	Long Grove Pharmaceuticals, LLC	100	500 MG

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DALVANCE Pricing & Reimbursement

J0875 Private Payer Reimbursement

$15.52 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

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Historical Graphing and Billing Calculator

per HCPCS unit

As of Q3 2026

DALVANCE CPT Administration Codes

CPT Code	Description
96365	Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour
96366	Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)

JW / JZ modifiers apply

CMS has identified Dalvance (J0875) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →

DALVANCE Medically Unlikely Edits (MUE)

The most billing units of J0875 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 5 mg.

Practitioner Office & Hospital Outpatient

300 units / day

= 1,500 mg per day

MAI 3 · Date of Service Edit: Clinical. Per-day limit based on clinical expectations; excess units are denied but may be appealed with documentation of medical necessity. See all MUE limits →

DALVANCE Clinical Information

Indications and drug classification.

Treated Diseases & Conditions

This list of indications is not exhaustive and may be subject to errors. The information on BuyandBill.com is intended for informational purposes only and should not be used for medical advice.

Acute Bacterial Skin and Skin Structure Infections

Drug Class

Lipoglycopeptide Antibacterial [EPC]Lipoglycopeptides [CS]

Frequently Asked Questions

Is there an available Dalvance billing and coding guide?

Billing and coding information for DALVANCE can be found through Actavis. Visit Here →

Are there any available Dalvance patient assistance programs?

DALVANCE patient assistance information can be found through Actavis. Visit Here →

Where can I find Dalvance prescribing information?

DALVANCE prescribing information can be found at the link below: Visit Here →

Where can I find Dalvance side effect information?

Information regarding DALVANCE's side effects can be found at MedlinePlus Visit Here →

Does billing DALVANCE require JZ/JW wastage modifiers?

CMS has identified DALVANCE(J0875) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. See CMS guidelines on use of the JZ and JW wastage modifiers below.

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