J1557 HCPCS code: Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg
J1557 is the HCPCS Level II code for injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg. In 2024 Medicare paid an average of $37.06 per service for J1557 across 11,075 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 fell 21% from 2022 to 2024 (13,948 to 11,075 services). In 2024, 105 suppliers billed Medicare for J1557 (purchases), serving 324 beneficiaries; California, Florida, Texas accounted for 28% 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 | 2012-01-01 |
| Last action effective | 2012-01-01 |
Who bills J1557 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 105 |
| Referring clinicians | 276 |
| Medicare beneficiaries | 324 |
| States with claims | 33 |
| Share of services in top 3 states (California, Florida, Texas) | 28% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 97 | 257 |
| 2023 | 101 | 306 |
| 2024 | 105 | 324 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1557, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 13,948 | 24 | $48.90 | $38.98 |
| 2023 | 10,519 | 28 | $53.28 | $42.43 |
| 2024 | 11,075 | 14 | $46.54 | $37.06 |
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 J1557
- 2012-01-01: J1557 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 J1557?
J1557 is the HCPCS Level II code for injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg. Short descriptor: "Gammaplex injection".
How much does Medicare pay for J1557?
In 2024, the average Medicare payment was $37.06 per service (average allowed $46.54).
Does Medicare cover J1557?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for J1557?
Medicare policy articles that cite J1557 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 J1557 can be billed per day?
300 on DME suppliers; 300 on outpatient hospital claims; 300 on practitioner claims (NCCI medically unlikely edits).
Related J15 codes
- J1551 — Injection, immune globulin (cutaquig), 100 mg
- J1552 — Injection, immune globulin (alyglo), 500 mg
- J1553 — Injection, immune globulin (yimmugo), 100 mg
- J1554 — Injection, immune globulin (asceniv), 500 mg
- J1555 — Injection, immune globulin (cuvitru), 100 mg
- J1556 — Injection, immune globulin (bivigam), 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
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Next steps
- Run a reimbursement report for a device billed under J1557
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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.