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J1572 - HCPCS Level II | Verity

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HCPCS Level IIdrugActive

J1572

Flebogamma injection

BETOS: O1E

Effective: 2009-01-01

Referenced in 14 policies

Description

Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg

Drug Products

FDA-registered drug products mapped to this HCPCS code

FLEBOGAMMA (DIF,PF) 5 GM/100 ML

NDC: 61953-0004-02IV

Billing: ML

FLEBOGAMMA (DIF,PF) 5 GM/100 ML

NDC: 61953-0004-03IV

Billing: ML

FLEBOGAMMA (DIF,PF) 5 GM/100 ML

NDC: 61953-0004-04IV

Billing: ML

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Medicare Part B Drug Pricing

ASP-Based Payment

This drug code is paid under Medicare Part B using the Average Sales Price (ASP) + 6% methodology.

ASP pricing data not currently available for this code.

Coverage Policies

This code is referenced in 14 Medicare coverage policies

Sample Policies

CIGNA-0447PayerPolicynot covered

Autism Spectrum Disorders/Pervasive Developmental Disorders: Assessment and Treatment - (0447)

AETNA-CPB-0648PayerPolicycovered

Autism Spectrum Disorders

+ 12 more policies

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About HCPCS Level II

Healthcare Common Procedure Coding System Level II codes for supplies, equipment, and non-physician services

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