J1572 HCPCS code: Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg
J1572 is the HCPCS Level II code for injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg. In 2024 Medicare paid an average of $40.83 per service for J1572 across 4,241 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 180 per day on DME suppliers. Medicare volume fell 64% from 2022 to 2024 (11,660 to 4,241 services). In 2024, about 15 clinicians billed Medicare for J1572 for 14 beneficiaries.
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 |
Who bills J1572 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 15 |
| Medicare beneficiaries | 14 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J1572, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 11,660 | 23 | $37.43 | $29.82 |
| 2023 | 5,720 | 17 | $43.10 | $34.64 |
| 2024 | 4,241 | 14 | $51.27 | $40.83 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 180 | Prescribing Information |
| outpatient hospital claims | 180 | Prescribing Information |
| practitioner claims | 180 | Prescribing Information |
Medicare policy articles for this code
- 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))
- 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))
Covered diagnoses (1,217 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 | 5 |
| C90.00 | Multiple myeloma not having achieved remission | 4 |
| C91.10 | Chronic lymphocytic leukemia of B-cell type not having achieved remission | 4 |
| C91.12 | Chronic lymphocytic leukemia of B-cell type in relapse | 4 |
| D59.0 | Drug-induced autoimmune hemolytic anemia | 4 |
| D59.11 | Warm autoimmune hemolytic anemia | 4 |
| D59.12 | Cold autoimmune hemolytic anemia | 4 |
| D59.13 | Mixed type autoimmune hemolytic anemia | 4 |
| D59.19 | Other autoimmune hemolytic anemia | 4 |
| D69.41 | Evans syndrome | 4 |
Showing 10 of 1,217. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J1572
- 2008-01-01: J1572 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 J1572?
J1572 is the HCPCS Level II code for injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg. Short descriptor: "Flebogamma injection".
How much does Medicare pay for J1572?
In 2024, the average Medicare payment was $40.83 per service (average allowed $51.27).
Does Medicare cover J1572?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for J1572?
Medicare policy articles that cite J1572 list 1,217 covered ICD-10-CM diagnosis codes across 5 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 J1572 can be billed per day?
180 on DME suppliers; 180 on outpatient hospital claims; 180 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
- 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 J1572
- Watch J1572 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1572
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.