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J1574 - HCPCS Level II | Verity

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HCPCS Level IIdrugActive

J1574

Inj, ganciclovir (exela)

BETOS: O1E

Effective: 2024-07-01

Referenced in 2 policies

Description

Injection, ganciclovir sodium (exela), not therapeutically equivalent to j1570, 500 mg

Drug Products

FDA-registered drug products mapped to this HCPCS code

GANCICLOVIR-SODIUM CHLORIDE (PF) 500 MG/250 ML-0.8%

NDC: 51754-2500-03IV

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 2 Medicare coverage policies

Sample Policies

L33794LCDcovered

External Infusion Pumps

L40247LCDcovered

External Infusion Pumps

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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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