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HCPCS J1572 · Level II · Part B drug

J1572: immune globulin, HCPCS Level II J code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: OPPS Addendum B: October 2026 (effective October 1, 2026); OPPS NDC-HCPCS crosswalk: October 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); ASC Addendum BB (covered ancillary services): October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update).

Key facts for J1572

Billing unit
500 mg
Flebogamma injection
OPPS payment rate
$90.74
no ASP limit; SI K, October 2026
Practitioner MUE
180
MAI 3
OPPS status
SI K
APC 0947
NCCI exposure
no PTP pairs
Coverage articles
5
14 states

TL;DR

HCPCS J1572 is the Level II code for Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg, billed per 500 mg. CMS publishes no ASP payment limit for it; hospital outpatient departments are paid separately under OPPS (status indicator K, $90.74 per billing unit in October 2026). The practitioner MUE allows up to 180 units per date of service (MAI 3). J1572 is billed in units of 500 mg; 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. Other HCPCS codes whose descriptor names immune globulin: J1569 (Gammagard Liquid from Takeda Pharmaceuticals America, Inc.; billed per 500 mg); J1568 (Octagam; billed per 500 mg); J1576 (Panzyga; billed per 500 mg); J1577 (Qivigy from Kedrion Biopharma Inc; billed per 100 mg); J1566 (Gammagard S/D from Takeda Pharmaceuticals America, Inc.; lyophilized, powder; billed per 500 mg); J1561 (Gamunex-C/Gammaked; billed per 500 mg). 5 Medicare coverage articles list the code across 11 states plus DC and 2 territories, including A56779.

Medicare payment: OPPS rate (no ASP limit)

J1572 does not appear in the October 2026 Part B ASP payment limit file. CMS pays it separately to hospital outpatient departments under OPPS with status indicator K in APC 0947, at a national unadjusted rate of $90.74 per 500 mg. Status K is a separately paid, non-pass-through drug or biological, including therapeutic radiopharmaceuticals. In a physician office the Medicare contractor prices the drug, often from invoice; commercial and Medicaid payers set their own rates.

NDC to HCPCS billing-unit conversion

The October 2026 OPPS crosswalk lists no NDC for J1572. Report the NDC from the product label and confirm the units conversion from the HCPCS descriptor (Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg).

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J1572. For practitioners the limit is 180 units per date of service with adjudication indicator 3, a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation that the quantity was medically reasonable.

MUE values for J1572 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services1803 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital1803 Date of Service Edit: ClinicalPrescribing Information
DME supplier1803 Date of Service Edit: ClinicalPrescribing Information

MUE for J1572 in every setting opens the lookup with this code filled in, next to any other code on the same claim.

NCCI edits and add-on relationships

No active practitioner PTP pair lists J1572 as a column-1 or column-2 code in v323r0. Drug supply codes are rarely bundled; the administration codes billed with them are where PTP edits usually apply.

The counts above are exposure, not answers for a specific claim. Check J1572 against another code to see whether a given pair bundles, which code is paid and whether a modifier can separate them.

J1572 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

5 current Medicare Administrative Contractor articles list J1572 in their HCPCS tables, covering 14 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 J1572
ArticleTitleContractor(s)StatesRelated LCD
A56779Billing and Coding: Intravenous Immune GlobulinCGS Administrators, LLCKY OHL35891
A56786Billing and Coding: Immune GlobulinNovitas Solutions, Inc.DC DE MD NJ PAL35093
A57160Billing and Coding: Immune Thrombocytopenia (ITP) TherapyCGS Administrators, LLCKY OHL38268
A57554Billing and Coding: Immune GlobulinsWisconsin Physicians Service Insurance CorporationIA KS MO NEL34771
A57778Billing and Coding: Immune GlobulinFirst Coast Service Options, Inc.FL PR VIL34007

Local coverage policies that list J1572

6 active Local Coverage Determinations list J1572 in the policy or in its billing and coding article. Each applies only in its contractor's jurisdiction; check the one for the state where the drug is administered.

Hospital outpatient (OPPS) status

In the October 2026 OPPS Addendum B, J1572 carries status indicator K and is assigned to APC 0947, with a published national unadjusted payment of $90.74. Status K means the drug is paid separately under OPPS rather than packaged into the procedure.

Ambulatory surgical center (ASC) payment

In the October 2026 ASC Addendum BB (covered ancillary services), J1572 carries payment indicator K2, which CMS defines as "Drugs, biologicals, and radiopharmaceuticals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate". The national ASC payment is $90.74 per 500 mg, paid only when the drug is furnished integral to a covered surgical procedure.

Common denials for J1572 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 J1572 before the claim leaves

QuickCode validates the NDC-to-unit conversion against the current OPPS NDC-HCPCS 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.

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In QuickIntell research

Frequently asked questions — HCPCS J1572

What does HCPCS code J1572 describe?

J1572 is defined by CMS as "Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg". Each billing unit represents 500 mg, so the units reported on the claim must equal the dose administered divided by that unit.

Is J1572 a CPT code?

No. J1572 is a HCPCS Level II code, the letter-plus-four-digit set CMS maintains for drugs such as immune globulin; CPT codes are five-character codes maintained by the AMA. On a Part B claim J1572 reports the drug itself in 500 mg units, and the administration is billed on its own line.

What does Medicare pay for J1572 in a hospital outpatient department?

J1572 has no Part B ASP limit; the October 2026 OPPS Addendum B pays it separately under status K, APC 0947, at $90.74 per 500 mg, and ASC Addendum BB gives it payment indicator K2 at $90.74.

How many units of J1572 can be billed per day?

The practitioner Medically Unlikely Edit is 180 units per date of service with adjudication indicator 3 (Date of Service Edit: Clinical). MAI 3 edits can be appealed with documentation that the units were medically reasonable. CMS cites "Prescribing Information" as the rationale.

Does J1572 have NCCI bundling edits?

No active practitioner PTP pairs list J1572 as a column-1 or column-2 code in the v323r0 release.

J1572 vs J1569: what is the difference?

Both are HCPCS Level II codes whose descriptor names immune globulin. What sets J1569 apart: Gammagard Liquid from Takeda Pharmaceuticals America, Inc.; billed per 500 mg. J1572 is billed per 500 mg, OPPS rate $90.74, MUE 180; J1569 is billed per 500 mg, limit $49.495, MUE 400. Report the code whose descriptor matches the product and setting in the record.

J1572 vs J1568: what is the difference?

Both are HCPCS Level II codes whose descriptor names immune globulin. What sets J1568 apart: Octagam; billed per 500 mg. J1572 is billed per 500 mg, OPPS rate $90.74, MUE 180; J1568 is billed per 500 mg, limit $47.133, MUE 300. Report the code whose descriptor matches the product and setting in the record.

Which Medicare coverage articles mention J1572?

5 current Billing and Coding Articles in the Medicare Coverage Database list J1572, covering 11 states plus DC and 2 territories: A56779 (Billing and Coding: Intravenous Immune Globulin); A56786 (Billing and Coding: Immune Globulin); A57160 (Billing and Coding: Immune Thrombocytopenia (ITP) Therapy).

CMS guidance

The Medicare Learning Network publication that CMS issues on this topic, cited by ICN and publication date:

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

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, ASC Addendum BB and the Medicare Coverage Database. Payment limits and rates 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.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.