J1460 Gamma Globulin IM — HCPCS Reimbursement

HCPCS Level II code J1460 designates a single intramuscular injection of gamma globulin (1 cc). This code matters nationally because immunoglobulin products are used across multiple clinical indications—such as passive immunization and certain immune-mediated conditions—and are commonly billed in outpatient and ambulatory care settings. Payers apply distinct coverage policies and payment edits for injectable biologics, making accurate coding important for clinical documentation and claims processing.

Key payers in typical analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise benchmarks on how this service is billed and reimbursed across major payers, a summary of clinical context for intramuscular immune globulin administration, and notes on common billing considerations. The publication highlights where national payment policies and coverage guidance intersect with clinical use, without state-level specificity. Data not available in the input for payer-specific reimbursement rates, associated taxonomies, and ICD-10 diagnoses are omitted from this summary.

Billing Code Overview

HCPCS Level II code J1460 represents an injection of gamma globulin administered intramuscularly, with a billed quantity of 1 cc. This code describes a single intramuscular dose of immune globulin used for passive immunization or immune modulation.

Service Type: Intramuscular injection

Typical Site of Service: Outpatient clinic, physician office, or other ambulatory care settings where intramuscular injections are administered

Clinical Context

A typical patient is an adult or pediatric patient presenting for intramuscular immune globulin (IGIM) administration, billed as J1460 (injection, gamma globulin, intramuscular, 1 cc). Common clinical indications include prophylaxis after potential exposure to hepatitis A, measles, rubella, or for short-term passive immunity in immunocompromised patients or neonates. The procedure is performed in an outpatient clinic, public health department, emergency department, urgent care, or pediatric office.

Workflow:

Patient check-in, review of indications, allergies, and consent.
Verification of ICD-10 diagnosis supporting passive immunization and review of prior immunization history.
Medication preparation by licensed clinician or pharmacist: dose calculation, syringe draw-up, and labeling.
Administration of J1460 via intramuscular injection (typical sites: deltoid for adults/older children, anterolateral thigh for infants) with standard aseptic technique.
Post-injection observation for immediate adverse reactions (usually 15–30 minutes) and documentation of lot number, expiration date, site, dose, and patient response.
Billing with J1460 per 1 cc unit administered; use of applicable modifier codes to indicate circumstances such as unusual services, discontinued procedures, or multiple payer scenarios.

Typical site of service: outpatient clinic, public health clinic, emergency department, urgent care, pediatric office.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — standard service	Use when no additional modifier is applicable and service is routine.

11 | Administrative use (payer-specific) | Use per payer instructions when required to indicate normal service adjudication.

22 | Increased procedural services | Use when substantially greater service or complexity was provided beyond typical administration.

23 | Unusual anesthesia | Rarely applicable; use if an unusual anesthesia circumstance applied to the intramuscular injection.

52 | Reduced services | Use when the injection was partially reduced or not completed as originally planned.

53 | Discontinued procedure | Use when the planned injection procedure was started but discontinued for patient safety.

62 | Two surgeons (or clinicians) | Use if two clinicians from different specialties shared responsibility for administration or related procedure.

78 | Return to OR/procedure for related procedure during postoperative period | Use only if a related subsequent procedure occurred that required return to a procedure area.

80 | Assistant at surgery | Use if an assistant provided clinically relevant assistance during a related procedural encounter.

82 | Assistant not available — qualified resident or assistant not available | Use when an assistant was needed but unavailable and documented.

JW | Drug discarded/not administered | Use when part or all of a single-dose vial was discarded and must be reported per payer rules.

JZ | Drug not billed as discarded; full dose administered | Use when the full dispensed dose was administered to the patient.

KX | Requirements met — documentation on file | Use when payer-required medical necessity criteria are met and documented.

QX | CRNA service: CRNA with medical direction by physician | Use if a certified registered nurse anesthetist provided anesthesia services that relate to the encounter.

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary care clinicians who administer IM immunoglobulin in outpatient settings.

207R00000X | Internal Medicine | Adult medicine clinicians providing prophylactic immunoglobulin injections.

207K00000X | Pediatrics | Pediatricians administering IGIM to infants and children.

363L00000X | Emergency Medicine | Emergency clinicians providing post-exposure prophylaxis in ED and urgent care.

163W00000X | Public Health | Public health clinic practitioners and immunizers administering passive immunization.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z20.3`	Contact with and (suspected) exposure to hepatitis A	Common indication for passive immunization with intramuscular gamma globulin after exposure.

Z20.821 | Contact with and (suspected) exposure to SARS-CoV-2 | May prompt consideration of passive immunoglobulin in select immunocompromised patients or investigational contexts.

Z23 | Encounter for immunization | Documenting administration of passive immunization when given for prophylactic purposes.

B16.9 | Hepatitis A without hepatic coma, unspecified | May be used when patient has acute hepatitis A and close contacts require prophylaxis; supports public health use.

Z38.00 | Single liveborn infant, delivered vaginally | Neonates born to mothers with certain infections or lacking passive immunity may receive IGIM for short-term protection.

D80.9 | Immunodeficiency, unspecified | Immunocompromised patients with primary immunodeficiency may receive immunoglobulin for passive protection.

T88.1XXA | Other complications following immunization, initial encounter | Captures adverse reactions to prior immunization guiding need for passive immunoglobulin instead of active vaccination.

Z51.89 | Encounter for other specified aftercare | Used for follow-up visits related to immunoglobulin administration or monitoring.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96372`	Therapeutic, prophylactic, or diagnostic injection (subcutaneous or intramuscular); each injection	Commonly used for billing intramuscular injections when payers require CPT for administration separate from drug HCPCS; documents administration encounter.

90471 | Immunization administration (includes percutaneous, intranasal, or oral), single vaccine | Used when vaccine administration is performed in the same visit; not for IGIM but relevant when patient receives vaccine instead of or in addition to IGIM.

99070 | Supplies and materials provided by physician over and above those usually included with the office visit | Used to report non-drug supplies related to injection (e.g., syringes, alcohol swabs) when payer allows separate supply billing.

96360 | Intravenous infusion, hydration; initial, 31 minutes to 1 hour | Included as a related code in workflows where IV access or observation for infusion-related reactions is clinically required; not routine for IM injection but relevant for higher-acuity patients.

36415 | Collection of venous blood by venipuncture | May be performed in same encounter for baseline serology (e.g., hepatitis serologies) prior to or following passive immunization.

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Summary & Overview

HCPCS J1460: Gamma Globulin Injection, Intramuscular, 1 cc