J1574 HCPCS code: Injection, ganciclovir sodium (exela), not therapeutically equivalent to j1570, 500 mg
J1574 is the HCPCS Level II code for injection, ganciclovir sodium (exela), not therapeutically equivalent to j1570, 500 mg. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met.
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 | 2023-01-01 |
| Last action effective | 2024-07-01 |
What changed for J1574
- 2023-01-01: J1574 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 J1574?
J1574 is the HCPCS Level II code for injection, ganciclovir sodium (exela), not therapeutically equivalent to j1570, 500 mg. Short descriptor: "Inj, ganciclovir (exela)".
Does Medicare cover J1574?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
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 J1574
- Watch J1574 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J1574
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.