HCPCS Code Details - J1558

HCPCS Level II Code
Drugs administered other than oral method, chemotherapy drugs
HCPCS Code J1558
Description

Long description:
Injection, immune globulin (xembify), 100 mg

Short description:
Inj. xembify, 100 mg

HCPCS Modifier1
HCPCS Pricing indicator 51 - Drugs
Multiple pricing indicator A - Not applicable as HCPCS priced under one methodology
Coverage code C - Carrier judgment
ASC payment group code Effective Jul 01, 2020 - This procedure is approved to be performed in an ambulatory surgical center.
BETOS2 code O1E - Other drugs
HCPCS Action code N - No maintenance for this code
Type of service 1 - Medical care
Effective date Effective Jul 01, 2020
Date added Added Jul 01, 2020
HCPCS Coding Procedures

HCPCS Modifiers

In HCPCS Level II, modifiers are composed of two alpha or alphanumeric characters.

Example: E0260-NU - Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress
NU” identifies the hospital bed as new equipment

ASP Drug pricing - J1558

Effective Code Dosage Payment
Limit
Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
Jul 1, 2024 - Sep 30, 2024 100 MG 14.4 - - - - - -
April 1, 2024 - June 30, 2024 100 MG 14.132 - - - - - -
January 1, 2024 - March 31, 2024 100 MG 14.183 - - - - - -
October 1, 2023 - December 31, 2023 100 MG 13.971 20% - - - - -
Jul 1, 2023 - Sep 30, 2023 100 MG 13.999 20% - - - - -

See also

  • HCPCS C9072 · Injection, immune globulin (asceniv), 500 mg

  • HCPCS J1459 · Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg

  • HCPCS J1551 · Injection, immune globulin (cutaquig), 100 mg

  • HCPCS J1554 · Injection, immune globulin (asceniv), 500 mg

  • HCPCS J1555 · Injection, immune globulin (cuvitru), 100 mg

  • HCPCS J1556 · Injection, immune globulin (bivigam), 500 mg

  • HCPCS J1557 · Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg

  • HCPCS J1559 · Injection, immune globulin (hizentra), 100 mg

  • HCPCS J1561 · Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg

  • HCPCS J1562 · Injection, immune globulin (vivaglobin), 100 mg

  • HCPCS J1566 · Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg

  • HCPCS J1568 · Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg

  • HCPCS J1569 · Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg

  • HCPCS J1572 · Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg

  • HCPCS J1575 · Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin


1 Two-digit numeric codes are Level I code modifiers copyrighted© by the American Medical Association's Current Procedural Terminology (CPT).

2 BETOS stands for “Berenson-Eggers Type Of Service”