Intravenous Immune Globulin (IVIG) is one of the most expensive drugs administered in the outpatient setting. Billing the wrong HCPCS J-Code for specific brand names like Gamunex-C or Privigen will result in massive revenue losses.
J1569: Gamunex-C and Gammaked
If you administer Gamunex-C or Gammaked, the correct HCPCS code is J1569 ↗ (Injection, immune globulin, baxter enterprises, 500 mg). Pay close attention to your units: 1 billing unit equals 500 mg. If you administer 10 grams, you must bill 20 units.
J1459: Privigen
If you administer Privigen, the correct HCPCS code is J1459 ↗ (Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg). Again, the unit multiplier is 500 mg.
Administration Codes
Do not forget to bill the administration CPT codes alongside the J-Codes. IVIG administration is typically billed using the complex infusion codes (e.g., CPT 96365 for the initial hour, and CPT 96366 for each additional hour).
NCCI Edits
Ensure that your hydration codes (96360) are not bundled into your IVIG administration codes if they are running concurrently, as Medicare will only pay for the primary therapeutic infusion.