J1459 HCPCS code: Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg
J1459 is the HCPCS Level II code for injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg. In 2024 Medicare paid an average of $36.75 per service for J1459 across 1,366,251 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 300 per day on DME suppliers. Medicare volume rose 65% from 2022 to 2024 (825,881 to 1,366,251 services). In 2024, 167 suppliers billed Medicare for J1459 (purchases), serving 462 beneficiaries; Florida, California, Pennsylvania accounted for 26% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2009-01-01 |
| Last action effective | 2009-01-01 |
Who bills J1459 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 167 |
| Referring clinicians | 404 |
| Medicare beneficiaries | 462 |
| States with claims | 44 |
| Share of services in top 3 states (Florida, California, Pennsylvania) | 26% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 151 | 413 |
| 2023 | 140 | 429 |
| 2024 | 167 | 462 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1459, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 825,881 | 1,219 | $44.34 | $35.36 |
| 2023 | 1,022,605 | 1,492 | $45.60 | $36.30 |
| 2024 | 1,366,251 | 1,662 | $46.17 | $36.75 |
States with the most J1459 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 334,598 | $37.23 |
| Texas | 170,093 | $36.06 |
| North Carolina | 138,844 | $37.70 |
| Alabama | 73,488 | $36.05 |
| Georgia | 60,312 | $37.38 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 300 | Clinical: Data |
| outpatient hospital claims | 300 | Clinical: Data |
| practitioner claims | 300 | Clinical: Data |
Medicare policy articles for this code
- A56718: Billing and Coding: Intravenous Immunoglobulin (IVIG) (Palmetto GBA (MAC - Part A, MAC - Part B))
- A56779: Billing and Coding: Intravenous Immune Globulin (CGS Administrators, LLC (MAC - Part A, MAC - Part B))
- A56786: Billing and Coding: Immune Globulin (Novitas Solutions, Inc. (MAC - Part A, MAC - Part B))
- A57160: Billing and Coding: Immune Thrombocytopenia (ITP) Therapy (CGS Administrators, LLC (MAC - Part A, MAC - Part B))
- A57187: Billing and Coding: Immune Globulin Intravenous (IVIg) (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B))
- A57554: Billing and Coding: Immune Globulins (WPS Insurance Corporation (MAC - Part A, MAC - Part B))
- A57778: Billing and Coding: Immune Globulin (First Coast Service Options, Inc. (MAC - Part A, MAC - Part B))
- A59105: Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG) (Wellpoint Federal (MAC - Part A, MAC - Part B))
Covered diagnoses (1,446 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| D69.3 | Immune thrombocytopenic purpura | 8 |
| C90.00 | Multiple myeloma not having achieved remission | 7 |
| C91.10 | Chronic lymphocytic leukemia of B-cell type not having achieved remission | 7 |
| C91.12 | Chronic lymphocytic leukemia of B-cell type in relapse | 7 |
| D59.0 | Drug-induced autoimmune hemolytic anemia | 7 |
| D59.11 | Warm autoimmune hemolytic anemia | 7 |
| D59.12 | Cold autoimmune hemolytic anemia | 7 |
| D59.13 | Mixed type autoimmune hemolytic anemia | 7 |
| D80.0 | Hereditary hypogammaglobulinemia | 7 |
| D80.2 | Selective deficiency of immunoglobulin A [IgA] | 7 |
Showing 10 of 1,446. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J1459
- 2009-01-01: J1459 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code J1459?
J1459 is the HCPCS Level II code for injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg. Short descriptor: "Inj ivig privigen 500 mg".
How much does Medicare pay for J1459?
In 2024, the average Medicare payment was $36.75 per service (average allowed $46.17).
Does Medicare cover J1459?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for J1459?
Medicare policy articles that cite J1459 list 1,446 covered ICD-10-CM diagnosis codes across 8 articles. The most cited include D69.3 (Immune thrombocytopenic purpura), C90.00 (Multiple myeloma not having achieved remission), C91.10 (Chronic lymphocytic leukemia of B-cell type not having achieved remission). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J1459 can be billed per day?
300 on DME suppliers; 300 on outpatient hospital claims; 300 on practitioner claims (NCCI medically unlikely edits).
Related J14 codes
- J1410 — Injection, estrogen conjugated, per 25 mg
- J1411 — Injection, etranacogene dezaparvovec-drlb, per therapeutic dose
- J1412 — Injection, valoctocogene roxaparvovec-rvox, per ml, containing nominal 2 x 10^13 vector genomes
- J1413 — Injection, delandistrogene moxeparvovec-rokl, per therapeutic dose
- J1414 — Injection, fidanacogene elaparvovec-dzkt, per therapeutic dose
- J1426 — Injection, casimersen, 10 mg
- J1427 — Injection, viltolarsen, 10 mg
- J1428 — Injection, eteplirsen, 10 mg
- J1429 — Injection, golodirsen, 10 mg
- J1430 — Injection, ethanolamine oleate, 100 mg
- J1434 — Injection, fosaprepitant (focinvez), 1 mg
- J1435 — Injection, estrone, per 1 mg
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Next steps
- Run a reimbursement report for a device billed under J1459
- Watch J1459 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1459
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.