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HCPCS J1460 · Level II · Part B drug

HCPCS J1460: Injection, gamma globulin, intramuscular, 1 cc

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: ASP payment limits October 2026 (effective October 1, 2026); MUE and NCCI edits 2026 Q4 (effective October 1, 2026); OPPS Addendum B July 2026 (effective July 1, 2026). Next CMS release: January 1, 2027 (ASP, MUE, NCCI and OPPS quarterly updates).

Key facts for J1460

Billing unit
1 CC
Gamma globulin 1 cc inj
ASP payment limit
$48.946
October 2026; +0.2% vs July 2026
Practitioner MUE
10
MAI 2
OPPS status
SI K
APC 1850
NCCI exposure
1 col-2 pairs
0% allow a modifier
Coverage articles
1
2 states

TL;DR

HCPCS J1460 is the Level II code for Injection, gamma globulin, intramuscular, 1 cc, billed per 1 CC. The Medicare Part B ASP payment limit for October 2026 is $48.946 per billing unit, up 0.2% from July 2026. The practitioner MUE allows up to 10 units per date of service (MAI 2). Under OPPS it carries status indicator K in APC 1850. J1460 is billed in units of 1 CC; the quantity administered, the NDC package and the units on the claim must reconcile, which is the check that prevents CARC 16 and 151 returns on this line. The ASP crosswalk maps 2 NDCs to it, sold as Gamastan by Grifols USA, LLC. It is the bundled column-2 code in 1 NCCI pair, most often with J1560. 1 Medicare coverage article lists the code across 2 states, including .

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for J1460 at $48.946 per 1 CC for October 2026, derived from manufacturer average sales price plus 6%, compared with $48.874 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J1460
QuarterPayment limitPerCoinsurance
October 2026$48.9461 CC20%
July 2026$48.8741 CC—
Source: CMS Medicare Part B Drug Payment Limit File. Commercial and Medicaid payers set their own rates.

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk maps 2 NDCs from 1 labeler to J1460. Report the NDC in the claim's drug segment and bill the number of J1460 units that equals the quantity administered divided by 1 CC; the last column gives units per full package.

NDCs that crosswalk to J1460
NDCDrug nameLabelerPackage sizeBilling units / package
13533-0335-04GamastanGrifols USA, LLC2 × 12
13533-0335-12GamastanGrifols USA, LLC10 × 110

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J1460. For practitioners the limit is 10 units per date of service with adjudication indicator 2, a date-of-service policy edit: the limit reflects CMS policy and units above it deny even if split across lines; appeals rarely succeed.

MUE values for J1460 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services102 Date of Service Edit: PolicyCode Descriptor / CPT Instruction
Facility outpatient hospital102 Date of Service Edit: PolicyCode Descriptor / CPT Instruction
DME supplier03 Date of Service Edit: ClinicalCMS Policy

NCCI edits and add-on relationships

In the practitioner PTP file v323r0 (effective October 1, 2026), J1460 is the column-2 code in 1 active pair, 0% of which allow a modifier (indicator 1), and the column-1 code in 0. 9 historical pairs have been deleted over time. CMS's most frequent rationale: More extensive procedure.

When billed with these column-1 codes, J1460 is the bundled component unless the pair allows a modifier and the documentation supports a distinct service.

Column-1 codes most often paired with J1460
Column-1 codePairs
J1560 Gamma globulin > 10 cc inj1

J1460 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

1 current Medicare Administrative Contractor article lists J1460 in their HCPCS tables, covering 2 states. Each article carries the covered and non-covered ICD-10 codes that medical-necessity denials (CARC 50) are adjudicated against.

Billing and Coding Articles listing J1460
ArticleTitleContractor(s)StatesRelated LCD
Billing and Coding: Immune Thrombocytopenia (ITP) TherapyCGS Administrators, LLCKY OHL38268

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, J1460 carries status indicator K and is assigned to APC 1850, with a published national unadjusted payment of $48.87. Status K means the drug is paid separately under OPPS at the ASP-based rate rather than packaged into the procedure.

Common denials for J1460 and how to prevent them

CARC 16 · M119

NDC missing, invalid or not matched to the HCPCS code

CARC 151 · N362

units billed exceed the MUE for the date of service

CARC 50 · N115

diagnosis not covered by the applicable coverage article or LCD

How QuickIntell checks J1460 before the claim leaves

QuickCode validates the NDC-to-unit conversion against the current ASP crosswalk, checks units against every published MUE setting and flags PTP and add-on conflicts on the same claim. QuickRCM routes CARC 16, 151 and 50 denials on drug lines with the matching coverage article attached so the appeal starts with evidence.

Explore QuickCodeExplore QuickRCMBook a demo

Frequently asked questions — HCPCS J1460

What does HCPCS code J1460 describe?

J1460 is defined by CMS as "Injection, gamma globulin, intramuscular, 1 cc". Each billing unit represents 1 CC, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J1460 in October 2026?

The ASP-based payment limit is $48.946 per 1 CC, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $48.874.

How many units of J1460 can be billed per day?

The practitioner Medically Unlikely Edit is 10 units per date of service with adjudication indicator 2 (2 Date of Service Edit: Policy). MAI 2 edits are policy limits and are rarely overturned on appeal. CMS cites "Code Descriptor / CPT Instruction" as the rationale.

Which NDCs map to J1460?

The October 2026 ASP crosswalk lists 2 NDCs from 1 labeler: Gamastan (Grifols USA, LLC). For example NDC 13533-0335-04 is a 2 package equal to 2 billing units. The crosswalk's billing-units-per-package figure converts each package into J1460 units.

Does J1460 have NCCI bundling edits?

In the v323r0 practitioner PTP file, J1460 appears as the column-2 (bundled) code in 1 active pairs and as the column-1 code in 0. 0% of the column-2 pairs allow a modifier (indicator 1). The most frequent column-1 partners are J1560, and CMS's leading rationale is "More extensive procedure".

Which Medicare coverage articles mention J1460?

1 current Billing and Coding Article in the Medicare Coverage Database list J1460, covering 2 states: (Billing and Coding: Immune Thrombocytopenia (ITP) Therapy).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-01. Verify against the primary file before billing or contracting decisions.

Disclaimer

This page is an operational reference compiled from CMS publications: the Medicare Part B drug payment limit and NDC crosswalk files, NCCI MUE and add-on edit tables, aggregate PTP statistics, OPPS Addendum B and the Medicare Coverage Database. Payment limits are Medicare national amounts; commercial and Medicaid payers differ. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.