Table of content for "Injection, dalbavancin" (HCPCS J0875)
General information on the “J0875” code
HCPCS Code: J0875
Long Description: Injection, dalbavancin, 5 mg
Short Description: Injection, dalbavancin
Original information is taken from J0875 page
Pricing indicators
Pricing Indicator Code 1: 51 – Drugs
Multiple Pricing Indicator Code A : Not applicable as HCPCS priced under one methodology
Certification and additional reference information
Coverage
Coverage: C – Carrier judgment
ASC Payment Group: YY
ASC Payment Group Effective Date: 20160101
Type of service
Berenson-Eggers Type of Service (BETOS): O1E – Other drugs
Type Of Service 1: 1 – Medical care
Type Of Service 2: P – Lump sum purchase of DME, prosthetics, orthotics
Misc information
Anesthesia Base Unit Quantity: 0
Code Added Date: 20160101
Code Effective Date: 20160101
Action Code: N – No maintenance for this code