J1566 HCPCS code: Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg
J1566 is the HCPCS Level II code for injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg. In 2024 Medicare paid an average of $61.90 per service for J1566 across 87,753 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 300 per day on DME suppliers. Medicare volume rose 42% from 2022 to 2024 (61,944 to 87,753 services). In 2024, 69 suppliers billed Medicare for J1566 (purchases), serving 141 beneficiaries; California, New Jersey, New York accounted for 34% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2006-01-01 |
| Last action effective | 2008-01-01 |
Who bills J1566 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 69 |
| Referring clinicians | 142 |
| Medicare beneficiaries | 141 |
| States with claims | 29 |
| Share of services in top 3 states (California, New Jersey, New York) | 34% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 61 | 113 |
| 2023 | 61 | 123 |
| 2024 | 69 | 141 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1566, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 61,944 | 133 | $69.71 | $55.60 |
| 2023 | 74,590 | 164 | $73.08 | $58.27 |
| 2024 | 87,753 | 224 | $77.77 | $61.90 |
States with the most J1566 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Missouri | 12,940 | $62.43 |
| California | 10,130 | $63.96 |
| Minnesota | 8,330 | $62.28 |
| Michigan | 7,206 | $62.20 |
| New York | 5,791 | $61.65 |
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 J1566
- 2006-01-01: J1566 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 J1566?
J1566 is the HCPCS Level II code for injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg. Short descriptor: "Immune globulin, powder".
How much does Medicare pay for J1566?
In 2024, the average Medicare payment was $61.90 per service (average allowed $77.77).
Does Medicare cover J1566?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for J1566?
Medicare policy articles that cite J1566 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 J1566 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
- 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
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 J1566
- Watch J1566 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1566
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.