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HCPCS J1560 · Level II · Part B drug

HCPCS J1560: Injection, gamma globulin, intramuscular, over 10 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 J1560

Billing unit
10 CC
Gamma globulin > 10 cc inj
ASP payment limit
$118.153
October 2026; -27.3% vs July 2026
Practitioner MUE
1
MAI 2
OPPS status
SI K
APC 1851
NCCI exposure
0 col-2 pairs
Coverage articles
1
2 states

TL;DR

HCPCS J1560 is the Level II code for Injection, gamma globulin, intramuscular, over 10 cc, billed per 10 CC. The Medicare Part B ASP payment limit for October 2026 is $118.153 per billing unit, down 27.3% from July 2026. The practitioner MUE allows up to 1 units per date of service (MAI 2). Under OPPS it carries status indicator K in APC 1851. J1560 is billed in units of 10 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. 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 J1560 at $118.153 per 10 CC for October 2026, derived from manufacturer average sales price plus 6%, compared with $162.519 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J1560
QuarterPayment limitPerCoinsurance
October 2026$118.15310 CC20%
July 2026$162.51910 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 J1560. Report the NDC in the claim's drug segment and bill the number of J1560 units that equals the quantity administered divided by 10 CC; the last column gives units per full package.

NDCs that crosswalk to J1560
NDCDrug nameLabelerPackage sizeBilling units / package
13533-0335-04GamastanGrifols USA, LLC2 × 11
13533-0335-12GamastanGrifols USA, LLC10 × 11

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J1560. For practitioners the limit is 1 unit 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 J1560 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction
Facility outpatient hospital12 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), J1560 is the column-2 code in 0 active pairs, and the column-1 code in 1. 9 historical pairs have been deleted over time.

These codes are considered components of J1560 when reported together on the same date of service.

Column-2 codes most often bundled into J1560
Column-2 codePairs
J1460 Gamma globulin 1 cc inj1

J1560 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 J1560 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 J1560
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, J1560 carries status indicator K and is assigned to APC 1851, with a published national unadjusted payment of $162.52. Status K means the drug is paid separately under OPPS at the ASP-based rate rather than packaged into the procedure.

Common denials for J1560 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 J1560 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 J1560

What does HCPCS code J1560 describe?

J1560 is defined by CMS as "Injection, gamma globulin, intramuscular, over 10 cc". Each billing unit represents 10 CC, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J1560 in October 2026?

The ASP-based payment limit is $118.153 per 10 CC, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $162.519.

How many units of J1560 can be billed per day?

The practitioner Medically Unlikely Edit is 1 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 J1560?

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 1 billing unit. The crosswalk's billing-units-per-package figure converts each package into J1560 units.

Does J1560 have NCCI bundling edits?

In the v323r0 practitioner PTP file, J1560 appears as the column-2 (bundled) code in 0 active pairs and as the column-1 code in 1. The most frequent column-1 partners are .

Which Medicare coverage articles mention J1560?

1 current Billing and Coding Article in the Medicare Coverage Database list J1560, 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.