J1556 HCPCS code: Injection, immune globulin (bivigam), 500 mg
J1556 is the HCPCS Level II code for injection, immune globulin (bivigam), 500 mg. In 2024 Medicare paid an average of $57.90 per service for J1556 across 733,163 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 240 per day on DME suppliers. Medicare volume fell 2% from 2022 to 2024 (750,288 to 733,163 services). In 2024, 62 suppliers billed Medicare for J1556 (purchases), serving 237 beneficiaries; Georgia, Pennsylvania, Florida accounted for 36% 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 | 2014-01-01 |
| Last action effective | 2014-01-01 |
Who bills J1556 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 62 |
| Referring clinicians | 193 |
| Medicare beneficiaries | 237 |
| States with claims | 27 |
| Share of services in top 3 states (Georgia, Pennsylvania, Florida) | 36% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 45 | 104 |
| 2023 | 63 | 257 |
| 2024 | 62 | 237 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1556, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 750,288 | 1,290 | $69.55 | $55.47 |
| 2023 | 1,013,312 | 1,459 | $70.51 | $56.14 |
| 2024 | 733,163 | 915 | $72.73 | $57.90 |
States with the most J1556 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Nevada | 152,175 | $57.94 |
| Florida | 131,834 | $57.99 |
| Ohio | 106,013 | $58.01 |
| Texas | 69,580 | $57.65 |
| Kansas | 46,531 | $57.99 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 240 | Prescribing Information |
| outpatient hospital claims | 240 | Prescribing Information |
| practitioner claims | 240 | Prescribing Information |
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 J1556
- 2014-01-01: J1556 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 J1556?
J1556 is the HCPCS Level II code for injection, immune globulin (bivigam), 500 mg. Short descriptor: "Inj, imm glob bivigam, 500mg".
How much does Medicare pay for J1556?
In 2024, the average Medicare payment was $57.90 per service (average allowed $72.73).
Does Medicare cover J1556?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for J1556?
Medicare policy articles that cite J1556 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 J1556 can be billed per day?
240 on DME suppliers; 240 on outpatient hospital claims; 240 on practitioner claims (NCCI medically unlikely edits).
Related J15 codes
- J1551 — Injection, immune globulin (cutaquig), 100 mg
- J1552 — Injection, immune globulin (alyglo), 500 mg
- J1554 — Injection, immune globulin (asceniv), 500 mg
- J1555 — Injection, immune globulin (cuvitru), 100 mg
- J1557 — Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg
- J1558 — Injection, immune globulin (xembify), 100 mg
- J1559 — Injection, immune globulin (hizentra), 100 mg
- J1560 — Injection, gamma globulin, intramuscular, over 10 cc
- J1561 — Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg
- J1562 — Injection, immune globulin (vivaglobin), 100 mg
- J1566 — Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg
- J1568 — Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under J1556
- Watch J1556 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1556
Sources: CMS HCPCS Level II release October 2025; 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.