J1571 HCPCS code: Injection, hepatitis b immune globulin (hepagam b), intramuscular, 0.5 ml
J1571 is the HCPCS Level II code for injection, hepatitis b immune globulin (hepagam b), intramuscular, 0.5 ml. 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 20 per day on outpatient hospital claims.
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 | 2008-01-01 |
| Last action effective | 2009-01-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 20 | Prescribing Information |
| practitioner claims | 20 | Prescribing Information |
Medicare policy articles for this code
- A57554: Billing and Coding: Immune Globulins (WPS Insurance Corporation (MAC - Part A, MAC - Part B))
Covered diagnoses (1,176 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| B16.1 | Acute hepatitis B with delta-agent without hepatic coma | 1 |
| B16.2 | Acute hepatitis B without delta-agent with hepatic coma | 1 |
| B16.9 | Acute hepatitis B without delta-agent and without hepatic coma | 1 |
| B17.0 | Acute delta-(super) infection of hepatitis B carrier | 1 |
| B18.0 | Chronic viral hepatitis B with delta-agent | 1 |
| B18.1 | Chronic viral hepatitis B without delta-agent | 1 |
| B19.10 | Unspecified viral hepatitis B without hepatic coma | 1 |
| B19.11 | Unspecified viral hepatitis B with hepatic coma | 1 |
| B20 | Human immunodeficiency virus [HIV] disease | 1 |
| C88.20 | Heavy chain disease not having achieved remission | 1 |
Showing 10 of 1,176. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J1571
- 2008-01-01: J1571 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 J1571?
J1571 is the HCPCS Level II code for injection, hepatitis b immune globulin (hepagam b), intramuscular, 0.5 ml. Short descriptor: "Hepagam b im injection".
Does Medicare cover J1571?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for J1571?
Medicare policy articles that cite J1571 list 1,176 covered ICD-10-CM diagnosis codes across 1 article. The most cited include B16.1 (Acute hepatitis B with delta-agent without hepatic coma), B16.2 (Acute hepatitis B without delta-agent with hepatic coma), B16.9 (Acute hepatitis B without delta-agent and without hepatic coma). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J1571 can be billed per day?
20 on outpatient hospital claims; 20 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
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Next steps
- Run a reimbursement report for a device billed under J1571
- Watch J1571 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1571
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.