HCPCS Code Details - J1572

HCPCS Level II Code
Drugs administered other than oral method, chemotherapy drugs
HCPCS Code J1572
Description

Long description:
Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg

Short description:
Flebogamma injection

HCPCS Modifier1
HCPCS Pricing indicator 51 - Drugs
Multiple pricing indicator A - Not applicable as HCPCS priced under one methodology
Coverage code D - Special coverage instructions apply
ASC payment group code Effective Jan 01, 2008 - 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 Jan 01, 2009
Date added Added Jan 01, 2008
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 - J1572

Effective Code Dosage Payment
Limit
Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
April 1, 2019 - June 30, 2019 500 MG 36.425 - - - - - -
January 1, 2019 - March 31, 2019 500 MG 34.397 - - - - - -
October 1, 2018 - December 31, 2018 500 MG 35.067 - - - - - -
July 1, 2018 - September 30, 2018 500 MG 36.074 - - - - - -
April 1, 2018 - June 30, 2018 500 MG 35.146 - - - - - -

See also

  • HCPCS J1571 · Injection, hepatitis b immune globulin (hepagam b), intramuscular, 0.5 ml

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

  • HCPCS J1561 · Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 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 J1599 · Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg

  • HCPCS J1573 · Injection, hepatitis b immune globulin (hepagam b), intravenous, 0.5 ml


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”