`J3373` Inj, vancomycin hcl, 10 mg

Injection, vancomycin hydrochloride, 10 mg

Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 600 units per day (clinical), rationale: Prescribing Information
Outpatient hospital: max 600 units per day (clinical), rationale: Prescribing Information
DME supplier: max 600 units per day (clinical), rationale: Prescribing Information

Medicare pricing for J3373

Medicare Part B drug payment limit (ASP, October 2026)

J3373 payment limit: $0.032 per 10 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.

NDCs that bill under J3373 (CMS ASP NDC-HCPCS crosswalk, October 2026)

70860-0104-10 Vancomycin HCl, Athenex Pharmaceutical Division, LLC: 500 billing units per package
70860-0105-20 Vancomycin HCl, Athenex Pharmaceutical Division, LLC: 1000 billing units per package
00338-0122-04 Vancomycin HCl, Baxter Healthcare Corporation: 500 billing units per package (250 mL in 1 BAG)
00338-0124-04 Vancomycin HCl, Baxter Healthcare Corporation: 600 billing units per package (300 mL in 1 BAG)
00338-3551-48 Vancomycin HCl, Baxter Healthcare Corporation: 600 billing units per package (100 mL in 1 BAG)
00338-3552-48 Vancomycin HCl, Baxter Healthcare Corporation: 600 billing units per package (200 mL in 1 BAG)
00338-3580-48 Vancomycin HCl, Baxter Healthcare Corporation: 450 billing units per package (200 mL in 1 BAG)
00338-3581-01 Vancomycin HCl, Baxter Healthcare Corporation: 600 billing units per package (100 mL in 1 BAG)
00338-3582-01 Vancomycin HCl, Baxter Healthcare Corporation: 450 billing units per package (150 mL in 1 BAG)
00338-3583-01 Vancomycin HCl, Baxter Healthcare Corporation: 600 billing units per package (200 mL in 1 BAG)
68001-0407-75 Vancomycin HCl, BluePoint Laboratories: 1000 billing units per package (1 VIAL, GLASS in 1 CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL, GLASS)
72572-0029-10 Vancomycin HCl, Civica, Inc.: 1000 billing units per package (10 VIAL, SINGLE-DOSE in 1 CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL, SINGLE-DOSE)
72572-0105-01 Vancomycin HCl, Civica, Inc.: 500 billing units per package (1 VIAL, PHARMACY BULK PACKAGE in 1 CARTON / 100 mL in 1 VIAL, PHARMACY BULK PACKAGE)
72572-0207-01 Vancomycin HCl, Civica, Inc.: 1000 billing units per package (1 VIAL, PHARMACY BULK PACKAGE in 1 CARTON / 100 mL in 1 VIAL, PHARMACY BULK PACKAGE)
72572-0801-02 Vancomycin HCl, Civica, Inc.: 1000 billing units per package
72572-0803-01 Vancomycin HCl, Civica, Inc.: 500 billing units per package
72572-0805-01 Vancomycin HCl, Civica, Inc.: 1000 billing units per package
63323-0203-20 Vancomycin HCl, FreseniUS Kabi USA, LLC: 750 billing units per package (10 VIAL in 1 TRAY / 15 mL in 1 VIAL)
63323-0203-26 Vancomycin HCl, FreseniUS Kabi USA, LLC: 750 billing units per package (10 VIAL in 1 TRAY / 15 mL in 1 VIAL)
63323-0221-10 Vancomycin HCl, FreseniUS Kabi USA, LLC: 1250 billing units per package (25 VIAL in 1 TRAY / 10 mL in 1 VIAL)
63323-0221-16 Vancomycin HCl, FreseniUS Kabi USA, LLC: 1250 billing units per package (25 VIAL in 1 TRAY / 10 mL in 1 VIAL)
63323-0284-20 Vancomycin HCl, FreseniUS Kabi USA, LLC: 1000 billing units per package (10 VIAL in 1 TRAY / 20 mL in 1 VIAL)
63323-0284-26 Vancomycin HCl, FreseniUS Kabi USA, LLC: 1000 billing units per package (10 VIAL in 1 TRAY / 20 mL in 1 VIAL)
63323-0295-61 Vancomycin HCl, FreseniUS Kabi USA, LLC: 500 billing units per package (1 BOTTLE in 1 CARTON / 100 mL in 1 BOTTLE)
63323-0295-66 Vancomycin HCl, FreseniUS Kabi USA, LLC: 500 billing units per package (1 BOTTLE in 1 CARTON / 100 mL in 1 BOTTLE)
63323-0314-61 Vancomycin HCl, FreseniUS Kabi USA, LLC: 1000 billing units per package (1 BOTTLE in 1 CARTON / 100 mL in 1 BOTTLE)
63323-0314-66 Vancomycin HCl, FreseniUS Kabi USA, LLC: 1000 billing units per package (1 BOTTLE in 1 CARTON / 100 mL in 1 BOTTLE)
68462-0955-51 Vancomycin HCl, Glenmark Pharmaceuticals Inc., USA: 500 billing units per package (10 VIAL in 1 CARTON / 10 mL in 1 VIAL)
68462-0956-11 Vancomycin HCl, Glenmark Pharmaceuticals Inc., USA: 1000 billing units per package (10 VIAL in 1 CARTON / 20 mL in 1 VIAL)
00404-9965-99 Vancomycin HCl, Henry Schein Inc.: 50 billing units per package (1 VIAL in 1 BAG / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL)
00143-9355-10 Vancomycin HCl, Hikma Pharmaceuticals USA Inc.: 750 billing units per package (10 VIAL in 1 CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL)
00143-9357-10 Vancomycin HCl, Hikma Pharmaceuticals USA Inc.: 1000 billing units per package (10 VIAL in 1 CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL)
00143-9358-01 Vancomycin HCl, Hikma Pharmaceuticals USA Inc.: 500 billing units per package (1 INJECTION, POWDER, FOR SOLUTION in 1 CARTON)
00143-9359-01 Vancomycin HCl, Hikma Pharmaceuticals USA Inc.: 1000 billing units per package (1 INJECTION, POWDER, FOR SOLUTION in 1 BOTTLE)
71288-0022-11 Vancomycin HCl, Meitheal Pharmaceuticals Inc.: 500 billing units per package (10 VIAL, SINGLE-DOSE in 1 CARTON / 10 mL in 1 VIAL, SINGLE-DOSE)
71288-0023-21 Vancomycin HCl, Meitheal Pharmaceuticals Inc.: 1000 billing units per package (10 VIAL, SINGLE-DOSE in 1 CARTON / 20 mL in 1 VIAL, SINGLE-DOSE)
71288-0024-21 Vancomycin HCl, Meitheal Pharmaceuticals Inc.: 750 billing units per package (10 VIAL, SINGLE-DOSE in 1 CARTON / 15 mL in 1 VIAL, SINGLE-DOSE)
71288-0025-75 Vancomycin HCl, Meitheal Pharmaceuticals Inc.: 500 billing units per package (1 VIAL, PHARMACY BULK PACKAGE in 1 CARTON / 100 mL in 1 VIAL, PHARMACY BULK PACKAGE)
71288-0026-75 Vancomycin HCl, Meitheal Pharmaceuticals Inc.: 1000 billing units per package (1 VIAL, PHARMACY BULK PACKAGE in 1 CARTON / 95 mL in 1 VIAL, PHARMACY BULK PACKAGE)
67457-0339-50 Vancomycin HCl, Mylan Institutional LLC: 500 billing units per package (10 VIAL in 1 CARTON / 10 mL in 1 VIAL)

And 30 more NDCs.

Physician Fee Schedule (CY 2026, RVU26D)

Status E: excluded from the PFS by regulation.

Payer policies and prior authorization for J3373

Payer coverage policies that name J3373

J3373 appears in 1 coverage policy from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Injectable Medications (0020)	listed, no stance (range J2550-J3520)	Mar 5, 2026	payer document

Medicaid fee-for-service

AZ: $0.03 (outpatient_hospital), effective Jul 1, 2025
FL: $600.00 (physician_administered_drugs), effective Jan 1, 2026
IL: $18.00 (practitioner), effective Apr 1, 2026
IN: $0.03 (professional, Advanced Practice Nurse (85%), non-facility), effective Jul 1, 2025
KS: $0.02 (default, Exempt Physician), effective Jul 1, 2025
LA: $0.03 (professional), effective Nov 1, 2025
MS: $0.03 (comprehensive), effective Jul 1, 2025
NE: $0.03 (injectables), effective Jul 1, 2026
OH: $0.03 (provider_administered_drugs), effective Jul 1, 2025
OK: $0.03 (physician, non-facility), effective Jul 1, 2026
TX: $0.03 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Jul 1, 2025
VA: $0.03 (medical), effective Jul 1, 2025
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $0.03 (kidneycenters), effective Jul 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

J3373 Inj, vancomycin hcl, 10 mg