J1558 HCPCS code: Injection, immune globulin (xembify), 100 mg
J1558 is the HCPCS Level II code for injection, immune globulin (xembify), 100 mg. In 2024 Medicare paid an average of $11.15 per service for J1558 across 2,730,097 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 1500 per day on DME suppliers. Medicare volume rose 39% from 2022 to 2024 (1,966,729 to 2,730,097 services). In 2024, 153 suppliers billed Medicare for J1558 (purchases), serving 747 beneficiaries; Georgia, Florida, California accounted for 34% 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 | 2020-07-01 |
| Last action effective | 2020-07-01 |
Who bills J1558 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 153 |
| Referring clinicians | 492 |
| Medicare beneficiaries | 747 |
| States with claims | 39 |
| Share of services in top 3 states (Georgia, Florida, California) | 34% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 97 | 496 |
| 2023 | 120 | 601 |
| 2024 | 153 | 747 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1558, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 1,966,729 | 496 | $13.58 | $10.70 |
| 2023 | 2,333,998 | 601 | $13.65 | $10.68 |
| 2024 | 2,730,097 | 747 | $14.25 | $11.15 |
States with the most J1558 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Georgia | 463,910 | $11.13 |
| Florida | 224,420 | $11.16 |
| California | 222,490 | $11.16 |
| Texas | 174,964 | $11.16 |
| North Carolina | 122,090 | $11.16 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 1500 | Clinical: CMS Workgroup |
| outpatient hospital claims | 480 | Prescribing Information |
| practitioner claims | 480 | Prescribing Information |
Medicare policy articles for this code
- A52507: External Infusion Pumps - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
- A56786: Billing and Coding: Immune Globulin (Novitas Solutions, Inc. (MAC - Part A, MAC - Part B))
- A57778: Billing and Coding: Immune Globulin (First Coast Service Options, Inc. (MAC - Part A, MAC - Part B))
Covered diagnoses (542 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| D80.0 | Hereditary hypogammaglobulinemia | 3 |
| D80.2 | Selective deficiency of immunoglobulin A [IgA] | 3 |
| D80.3 | Selective deficiency of immunoglobulin G [IgG] subclasses | 3 |
| D80.4 | Selective deficiency of immunoglobulin M [IgM] | 3 |
| D80.5 | Immunodeficiency with increased immunoglobulin M [IgM] | 3 |
| D80.6 | Antibody deficiency with near-normal immunoglobulins or with hyperimmunoglobulinemia | 3 |
| D80.7 | Transient hypogammaglobulinemia of infancy | 3 |
| D81.0 | Severe combined immunodeficiency [SCID] with reticular dysgenesis | 3 |
| D81.1 | Severe combined immunodeficiency [SCID] with low T- and B-cell numbers | 3 |
| D81.2 | Severe combined immunodeficiency [SCID] with low or normal B-cell numbers | 3 |
Showing 10 of 542. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J1558
- 2020-07-01: J1558 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 J1558?
J1558 is the HCPCS Level II code for injection, immune globulin (xembify), 100 mg. Short descriptor: "Inj. xembify, 100 mg".
How much does Medicare pay for J1558?
In 2024, the average Medicare payment was $11.15 per service (average allowed $14.25).
Does Medicare cover J1558?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for J1558?
Medicare policy articles that cite J1558 list 542 covered ICD-10-CM diagnosis codes across 3 articles. The most cited include D80.0 (Hereditary hypogammaglobulinemia), D80.2 (Selective deficiency of immunoglobulin A [IgA]), D80.3 (Selective deficiency of immunoglobulin G [IgG] subclasses). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J1558 can be billed per day?
1500 on DME suppliers; 480 on outpatient hospital claims; 480 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
- J1556 — Injection, immune globulin (bivigam), 500 mg
- J1557 — Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 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
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Next steps
- Run a reimbursement report for a device billed under J1558
- Watch J1558 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1558
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.