J1559 HCPCS code: Injection, immune globulin (hizentra), 100 mg
J1559 is the HCPCS Level II code for injection, immune globulin (hizentra), 100 mg. In 2024 Medicare paid an average of $9.21 per service for J1559 across 61,793 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 2400 per day on DME suppliers. Medicare volume rose 2% from 2022 to 2024 (60,338 to 61,793 services). In 2024, 401 suppliers billed Medicare for J1559 (purchases), serving 5,176 beneficiaries; Florida, California, Texas accounted for 24% 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 | 2011-01-01 |
| Last action effective | 2011-01-01 |
Who bills J1559 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 401 |
| Referring clinicians | 2,504 |
| Medicare beneficiaries | 5,176 |
| States with claims | 51 |
| Share of services in top 3 states (Florida, California, Texas) | 24% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 435 | 4,834 |
| 2023 | 407 | 4,995 |
| 2024 | 401 | 5,176 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1559, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 60,338 | 36 | $10.05 | $8.02 |
| 2023 | 65,550 | 39 | $10.95 | $8.72 |
| 2024 | 61,793 | 36 | $11.58 | $9.21 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 2400 | CMS Policy |
| outpatient hospital claims | 2400 | CMS Policy |
| practitioner claims | 2400 | CMS Policy |
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 J1559
- 2011-01-01: J1559 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 J1559?
J1559 is the HCPCS Level II code for injection, immune globulin (hizentra), 100 mg. Short descriptor: "Hizentra injection".
How much does Medicare pay for J1559?
In 2024, the average Medicare payment was $9.21 per service (average allowed $11.58).
Does Medicare cover J1559?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for J1559?
Medicare policy articles that cite J1559 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 J1559 can be billed per day?
2400 on DME suppliers; 2400 on outpatient hospital claims; 2400 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
- J1558 — Injection, immune globulin (xembify), 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 J1559
- Watch J1559 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1559
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.