J1577 HCPCS code: Injection, immune globulin (qivigy), 100 mg

J1577 is the HCPCS Level II code for injection, immune globulin (qivigy), 100 mg. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case.

Code details

FieldValue
SectionJ codes — Drugs administered other than oral method
Coverage codeC — Carrier judgment
Pricing indicator51 — Drug or biological (priced per ASP/average sales price rules)
BETOS categoryO1E — Other drugs
Added2026-07-01
Last action effective2026-07-01

Medicare policy articles for this code

Covered diagnoses (1,360 ICD-10-CM codes)

The diagnoses most often listed as covered in the policy articles above:

ICD-10-CMDiagnosisArticles listing it
D80.0Hereditary hypogammaglobulinemia6
D80.2Selective deficiency of immunoglobulin A [IgA]6
D80.3Selective deficiency of immunoglobulin G [IgG] subclasses6
D80.4Selective deficiency of immunoglobulin M [IgM]6
D80.5Immunodeficiency with increased immunoglobulin M [IgM]6
D80.6Antibody deficiency with near-normal immunoglobulins or with hyperimmunoglobulinemia6
D80.7Transient hypogammaglobulinemia of infancy6
D81.0Severe combined immunodeficiency [SCID] with reticular dysgenesis6
D81.1Severe combined immunodeficiency [SCID] with low T- and B-cell numbers6
D81.2Severe combined immunodeficiency [SCID] with low or normal B-cell numbers6

Showing 10 of 1,360. The full list, non-covered diagnoses and CSV export are in Caduvo.

What changed for J1577

Frequently asked questions

What is HCPCS code J1577?

J1577 is the HCPCS Level II code for injection, immune globulin (qivigy), 100 mg. Short descriptor: "Inj, qivigy, 100mg".

Does Medicare cover J1577?

Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.

Which diagnoses support coverage for J1577?

Medicare policy articles that cite J1577 list 1,360 covered ICD-10-CM diagnosis codes across 6 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.

Related J15 codes

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Next steps

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.

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