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HCPCS J3375 · Level II · Part B drug

HCPCS J3375: Injection, vancomycin hydrochloride (tyzavan), not therapeutically equivalent

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: ASP payment limits October 2026 (effective October 1, 2026); MUE and NCCI edits 2026 Q4 (effective October 1, 2026); OPPS Addendum B July 2026 (effective July 1, 2026). Next CMS release: January 1, 2027 (ASP, MUE, NCCI and OPPS quarterly updates).

Key facts for J3375

Billing unit
10 MG
Inj, vanco (tyzavan) 10mg
ASP payment limit
$0.143
October 2026; +0.7% vs July 2026
Practitioner MUE
600
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J3375 is the Level II code for Injection, vancomycin hydrochloride (tyzavan), not therapeutically equivalent, billed per 10 MG. The Medicare Part B ASP payment limit for October 2026 is $0.143 per billing unit, up 0.7% from July 2026. The practitioner MUE allows up to 600 units per date of service (MAI 3). Under OPPS it carries status indicator N. J3375 is billed in units of 10 MG; the quantity administered, the NDC package and the units on the claim must reconcile, which is the check that prevents CARC 16 and 151 returns on this line. The ASP crosswalk maps 14 NDCs to it, sold as Tyzavan, Vancomycin HCl by Hikma Pharmaceuticals USA Inc., Xellia Pharmaceuticals USA, LLC.. No current Billing and Coding Article lists J3375, so coverage follows the FDA label, compendia and any applicable NCD.

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for J3375 at $0.143 per 10 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.142 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J3375
QuarterPayment limitPerCoinsurance
October 2026$0.14310 MG20%
July 2026$0.14210 MG—
Source: CMS Medicare Part B Drug Payment Limit File. Commercial and Medicaid payers set their own rates.

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk maps 14 NDCs from 2 labelers to J3375. Report the NDC in the claim's drug segment and bill the number of J3375 units that equals the quantity administered divided by 10 MG; the last column gives units per full package.

NDCs that crosswalk to J3375
NDCDrug nameLabelerPackage sizeBilling units / package
00143-9466-06TyzavanHikma Pharmaceuticals USA Inc.250 × 6750
00143-9467-06TyzavanHikma Pharmaceuticals USA Inc.350 × 61050
00143-9468-12TyzavanHikma Pharmaceuticals USA Inc.150 × 12900
00143-9469-06TyzavanHikma Pharmaceuticals USA Inc.300 × 6900
00143-9470-06TyzavanHikma Pharmaceuticals USA Inc.400 × 61200
00143-9471-12TyzavanHikma Pharmaceuticals USA Inc.100 × 12600
00143-9472-12TyzavanHikma Pharmaceuticals USA Inc.200 × 121200
70594-0041-03Vancomycin HClXellia Pharmaceuticals USA, LLC.100 × 12600
70594-0042-03Vancomycin HClXellia Pharmaceuticals USA, LLC.200 × 121200
70594-0043-02Vancomycin HClXellia Pharmaceuticals USA, LLC.200 × 6900
70594-0044-02Vancomycin HClXellia Pharmaceuticals USA, LLC.400 × 61200
70594-0056-03Vancomycin HClXellia Pharmaceuticals USA, LLC.150 × 12900
70594-0057-02Vancomycin HClXellia Pharmaceuticals USA, LLC.250 × 6750
70594-0058-02Vancomycin HClXellia Pharmaceuticals USA, LLC.350 × 61050

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J3375. For practitioners the limit is 600 units per date of service with adjudication indicator 3, a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation that the quantity was medically reasonable.

MUE values for J3375 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services6003 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital6003 Date of Service Edit: ClinicalPrescribing Information
DME supplier6003 Date of Service Edit: ClinicalPrescribing Information

NCCI edits and add-on relationships

No active practitioner PTP pair lists J3375 as a column-1 or column-2 code in v323r0. Drug supply codes are rarely bundled; the administration codes billed with them are where PTP edits usually apply.

J3375 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

No current Billing and Coding Article lists J3375 in its HCPCS table. Coverage then follows the drug's FDA label, compendia and any National Coverage Determination; check the Medicare Coverage Database before administering off-label.

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, J3375 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J3375 and how to prevent them

CARC 16 · M119

NDC missing, invalid or not matched to the HCPCS code

CARC 151 · N362

units billed exceed the MUE for the date of service

CARC 50 · N115

diagnosis not covered by the applicable coverage article or LCD

How QuickIntell checks J3375 before the claim leaves

QuickCode validates the NDC-to-unit conversion against the current ASP crosswalk, checks units against every published MUE setting and flags PTP and add-on conflicts on the same claim. QuickRCM routes CARC 16, 151 and 50 denials on drug lines with the matching coverage article attached so the appeal starts with evidence.

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Frequently asked questions — HCPCS J3375

What does HCPCS code J3375 describe?

J3375 is defined by CMS as "Injection, vancomycin hydrochloride (tyzavan), not therapeutically equivalent". Each billing unit represents 10 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J3375 in October 2026?

The ASP-based payment limit is $0.143 per 10 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.142.

How many units of J3375 can be billed per day?

The practitioner Medically Unlikely Edit is 600 units per date of service with adjudication indicator 3 (3 Date of Service Edit: Clinical). MAI 3 edits can be appealed with documentation that the units were medically reasonable. CMS cites "Prescribing Information" as the rationale.

Which NDCs map to J3375?

The October 2026 ASP crosswalk lists 14 NDCs from 2 labelers: Tyzavan (Hikma Pharmaceuticals USA Inc.); Vancomycin HCl (Xellia Pharmaceuticals USA, LLC.). For example NDC 00143-9466-06 is a 250 package equal to 750 billing units. The crosswalk's billing-units-per-package figure converts each package into J3375 units.

Does J3375 have NCCI bundling edits?

No active practitioner PTP pairs list J3375 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still apply.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-01. Verify against the primary file before billing or contracting decisions.

Disclaimer

This page is an operational reference compiled from CMS publications: the Medicare Part B drug payment limit and NDC crosswalk files, NCCI MUE and add-on edit tables, aggregate PTP statistics, OPPS Addendum B and the Medicare Coverage Database. Payment limits are Medicare national amounts; commercial and Medicaid payers differ. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.