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HCPCS J1568: Intravenous Immune Globulin (Octagam), 500 mg

HCPCS Level II code J1568 represents intravenous immune globulin, Octagam, in a liquid (non-lyophilized) formulation, billed per 500 mg. This code identifies a high-cost biologic therapy used for immune modulation and replacement across multiple clinical indications, and it is important for national billing, utilization tracking, and payer policy around specialty infusion medications. Payers commonly managing coverage for this product nationally include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare.

Readers will find benchmarks for unit-based billing and utilization patterns, an overview of payer coverage frameworks and prior authorization trends, and the clinical context for Octagam administration (indication types and infusion settings). The publication summarizes common billing considerations, typical sites of service for intravenous infusion, and how unit-based HCPCS coding translates to dosing and charge calculation. Data not available in the input where specific utilization or payer policy details are required.

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Billing Code Overview

HCPCS Level II code J1568 describes an intravenous immune globulin (Octagam) preparation supplied as a non-lyophilized (liquid) formulation, billed per 500 mg unit. This product is an immune globulin used for passive immunotherapy and immune modulation in clinical indications that require intravenous immunoglobulin.

Service type: Parenteral infusion medication (intravenous therapeutic drug)
Typical site of service: Hospital outpatient infusion center, ambulatory infusion clinic, or physician office infusion suite where intravenous infusions are administered

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HCPCS J1568: Intravenous Immune Globulin (Octagam), 500 mg

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Billing Code Overview

Service type: Parenteral infusion medication (intravenous therapeutic drug)
Typical site of service: Hospital outpatient infusion center, ambulatory infusion clinic, or physician office infusion suite where intravenous infusions are administered

Clinical & Coding Specifications

Clinical Context

A typical patient receiving J1568 is an adult or pediatric patient requiring intravenous immune globulin (IVIG) replacement or immunomodulatory therapy, administered as Octagam 500 mg vial(s) in liquid form. A realistic scenario: a 45-year-old female with common variable immunodeficiency presents to an outpatient infusion center for scheduled IVIG therapy every 3–4 weeks. Pre-infusion nursing assessment includes verification of diagnosis and orders, baseline vital signs, review of prior infusion tolerance, and assessment for active infection or contraindications. The pharmacy prepares weight‑based IVIG dosing using J1568 vials, verifies lot numbers, and labels infusion bags. During infusion, a registered nurse initiates IV access, programs the infusion pump for a gradual titration per institutional protocol, monitors for infusion reactions (headache, flushing, hypotension, anaphylaxis), and documents vital signs at protocol intervals. Post‑infusion observation captures adverse events and disposition. Billing uses J1568 to report each 500 mg vial of Octagam administered; total billed units reflect the total milligrams infused divided by 500 mg. Typical sites of service include outpatient infusion centers, hospital outpatient departments, skilled nursing facilities, and occasionally inpatient settings for acute immune-mediated conditions.

Coding Specifications

Modifier	Description	When to Use
`JW`	Drug amount discarded/not administered	When partial vial waste of `J1568` occurs and payer requires reporting of discarded biologic product.
`JG`	Drug administrative reason — not active ingredient	When drug was provided under a specific program requiring this modifier for reporting non-covered or restricted biologics.
`QX`	CRNA service with medical direction by physician	When a certified registered nurse anesthetist is billing professional services relevant to anesthesia during infusion (rare for IVIG but applicable if sedation/anesthesia provided).
`Q6`	Service furnished as part of a clinical trial	When the infusion is provided under a qualifying clinical trial protocol.
`59`	Distinct procedural service	When reporting an unrelated, separately identifiable procedure or service on the same day as IVIG infusion.
`76`	Repeat procedure or service by same provider	When an infusion or related service is repeated later the same day by the same provider.
`78`	Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period	Rarely used but applicable if an infusion complication requires urgent return to a procedure area.
`80`	Assistant at surgery	If an assistant surgeon is reported for a concurrent surgical procedure performed with IVIG administration in an operative setting.
`22`	Increased procedural services	When complexity of infusion administration is substantially greater than typical (documented justification required).
`52`	Reduced services	When a planned portion of the infusion service was reduced or not performed.
`GZ`	Item/service expected to be denied as not reasonable and necessary when no Advance Beneficiary Notice (ABN) on file	When payer noncoverage is anticipated and no ABN provided.
`GY`	Item/service statutorily excluded or does not meet definition of any Medicare benefit	When IVIG use is not a Medicare benefit for the specific indication billed.
`JW`	(Duplicate omitted)	(Duplicate omitted)
`59`	(Duplicate omitted)	(Duplicate omitted)

Taxonomy Code	Specialty	Notes
`164W00000X`	Allergy & Immunology	Common specialty ordering and managing IVIG therapy for primary immunodeficiency and autoimmune indications.
`207RC0000X`	Hematology & Oncology	Manages IVIG for immune thrombocytopenia, hemolytic anemias, and other hematologic immune conditions.
`2084P0800X`	Rheumatology	Uses IVIG for refractory autoimmune neuromuscular and systemic autoimmune disorders.
`363A00000X`	Transfusion Medicine	Oversees hospital-based IVIG preparation, compatibility considerations, and administration protocols.
`261Q00000X`	Infusion Therapy (Nursing)	Nursing specialty providing infusion administration, monitoring, and documentation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`D83.9`	Common variable immunodeficiency, unspecified	Primary immunodeficiency commonly treated with regular IVIG replacement using `J1568`.
`D80.9`	Immunodeficiency due to humoral (antibody) defect, unspecified	Indicates antibody deficiency warranting IVIG replacement therapy.
`D69.3`	Immune thrombocytopenic purpura	IVIG is used as an immunomodulatory therapy for acute or refractory cases.
`G61.0`	Guillain-Barré syndrome	IVIG is a first-line immunotherapy for acute inflammatory demyelinating polyneuropathy.
`M32.9`	Systemic lupus erythematosus, unspecified	IVIG is used in select severe or refractory autoimmune manifestations.
`M35.3`	Polymyositis	IVIG may be used for refractory inflammatory myopathies.
`D59.2`	Autoimmune hemolytic anemia	IVIG can be used as adjunct therapy in acute hemolytic episodes.
`G36.0`	Acute disseminated encephalitis (ADEM)	IVIG is considered in severe immune‑mediated central nervous system disorders.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	Used to bill the initial infusion administration time for IVIG when infusion duration is within the first hour and facility/professional billing criteria are met.
`96366`	Intravenous infusion, each additional hour (list separately in addition to code for primary service)	Billed for each additional hour of continuous IVIG infusion after the initial hour when time‑based infusion services are reported.
`96413`	Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug	Occasionally used in institutional workflows for complex biologic infusions when coding follows oncology infusion protocols; verify payer guidance.
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	May be used for concurrent injectable medications administered as premedication (e.g., subcutaneous agents) depending on the service provided.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	Used for pre‑infusion or follow‑up visits where evaluation/management services are separately reported from the infusion.
`36415`	Collection of venous blood by venipuncture	Performed prior to infusion for baseline labs; billed when separate venipuncture services are provided.

Related Codes

HCPCS-J0013-ESKETAMINE-NASAL-SPRAY-1MG

HCPCS Level II J0013: Esketamine Nasal Spray, 1 mg

HCPCS-J0120-INJECTION-TETRACYCLINE-250MG

HCPCS J0120: Injection, Tetracycline, Up to 250 mg

HCPCS-J0121-OMADACYCLINE-INJECTION-1MG

HCPCS J0121: Omadacycline Injection, 1 mg

HCPCS-J0122-ERAVACYCLINE-INJECTION-1MG

HCPCS J0122: Injection, Eravacycline, 1 mg

HCPCS-J0129-ABATACEPT-INJECTION-10MG-PHYSICIAN-SUPERVISED

HCPCS J0129: Abatacept Injection, 10 mg

HCPCS-J0130-INJECTION-ABCIXIMAB-10MG

HCPCS Level II J0130: Injection abciximab, 10 mg

HCPCS-J0131-INJECTION-ACETAMINOPHEN-10MG-PARENTERAL-ANALGESIC

HCPCS J0131: Injection Acetaminophen, 10 mg

HCPCS-J0132-INJECTION-ACETYLCYSTEINE-100MG-INJECTABLE-MEDICATION

HCPCS J0132: Injection, Acetylcysteine 100 mg

HCPCS-J0133-ACYCLOVIR-INJECTION-5MG

HCPCS J0133: Injection, Acyclovir 5 mg

HCPCS-J0134-ACETAMINOPHEN-INJECTION-FRESENIUS-KABI-10MG

HCPCS J0134: Injection, Acetaminophen (Fresenius Kabi), 10 mg

Showing 1–10 of 991

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`JW`	Drug amount discarded/not administered	When partial vial waste of `J1568` occurs and payer requires reporting of discarded biologic product.
`JG`	Drug administrative reason — not active ingredient	When drug was provided under a specific program requiring this modifier for reporting non-covered or restricted biologics.
`QX`	CRNA service with medical direction by physician	When a certified registered nurse anesthetist is billing professional services relevant to anesthesia during infusion (rare for IVIG but applicable if sedation/anesthesia provided).
`Q6`	Service furnished as part of a clinical trial	When the infusion is provided under a qualifying clinical trial protocol.
`59`	Distinct procedural service	When reporting an unrelated, separately identifiable procedure or service on the same day as IVIG infusion.
`76`	Repeat procedure or service by same provider	When an infusion or related service is repeated later the same day by the same provider.
`78`	Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period	Rarely used but applicable if an infusion complication requires urgent return to a procedure area.
`80`	Assistant at surgery	If an assistant surgeon is reported for a concurrent surgical procedure performed with IVIG administration in an operative setting.
`22`	Increased procedural services	When complexity of infusion administration is substantially greater than typical (documented justification required).
`52`	Reduced services	When a planned portion of the infusion service was reduced or not performed.
`GZ`	Item/service expected to be denied as not reasonable and necessary when no Advance Beneficiary Notice (ABN) on file	When payer noncoverage is anticipated and no ABN provided.
`GY`	Item/service statutorily excluded or does not meet definition of any Medicare benefit	When IVIG use is not a Medicare benefit for the specific indication billed.
`JW`	(Duplicate omitted)	(Duplicate omitted)
`59`	(Duplicate omitted)	(Duplicate omitted)

Taxonomy Code	Specialty	Notes
`164W00000X`	Allergy & Immunology	Common specialty ordering and managing IVIG therapy for primary immunodeficiency and autoimmune indications.
`207RC0000X`	Hematology & Oncology	Manages IVIG for immune thrombocytopenia, hemolytic anemias, and other hematologic immune conditions.
`2084P0800X`	Rheumatology	Uses IVIG for refractory autoimmune neuromuscular and systemic autoimmune disorders.
`363A00000X`	Transfusion Medicine	Oversees hospital-based IVIG preparation, compatibility considerations, and administration protocols.
`261Q00000X`	Infusion Therapy (Nursing)	Nursing specialty providing infusion administration, monitoring, and documentation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`D83.9`	Common variable immunodeficiency, unspecified	Primary immunodeficiency commonly treated with regular IVIG replacement using `J1568`.
`D80.9`	Immunodeficiency due to humoral (antibody) defect, unspecified	Indicates antibody deficiency warranting IVIG replacement therapy.
`D69.3`	Immune thrombocytopenic purpura	IVIG is used as an immunomodulatory therapy for acute or refractory cases.
`G61.0`	Guillain-Barré syndrome	IVIG is a first-line immunotherapy for acute inflammatory demyelinating polyneuropathy.
`M32.9`	Systemic lupus erythematosus, unspecified	IVIG is used in select severe or refractory autoimmune manifestations.
`M35.3`	Polymyositis	IVIG may be used for refractory inflammatory myopathies.
`D59.2`	Autoimmune hemolytic anemia	IVIG can be used as adjunct therapy in acute hemolytic episodes.
`G36.0`	Acute disseminated encephalitis (ADEM)	IVIG is considered in severe immune‑mediated central nervous system disorders.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	Used to bill the initial infusion administration time for IVIG when infusion duration is within the first hour and facility/professional billing criteria are met.
`96366`	Intravenous infusion, each additional hour (list separately in addition to code for primary service)	Billed for each additional hour of continuous IVIG infusion after the initial hour when time‑based infusion services are reported.
`96413`	Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug	Occasionally used in institutional workflows for complex biologic infusions when coding follows oncology infusion protocols; verify payer guidance.
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	May be used for concurrent injectable medications administered as premedication (e.g., subcutaneous agents) depending on the service provided.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	Used for pre‑infusion or follow‑up visits where evaluation/management services are separately reported from the infusion.
`36415`	Collection of venous blood by venipuncture	Performed prior to infusion for baseline labs; billed when separate venipuncture services are provided.

Related Codes

HCPCS-J0013-ESKETAMINE-NASAL-SPRAY-1MG

HCPCS Level II J0013: Esketamine Nasal Spray, 1 mg

HCPCS-J0120-INJECTION-TETRACYCLINE-250MG

HCPCS J0120: Injection, Tetracycline, Up to 250 mg

HCPCS-J0121-OMADACYCLINE-INJECTION-1MG

HCPCS J0121: Omadacycline Injection, 1 mg

HCPCS-J0122-ERAVACYCLINE-INJECTION-1MG

HCPCS J0122: Injection, Eravacycline, 1 mg

HCPCS-J0129-ABATACEPT-INJECTION-10MG-PHYSICIAN-SUPERVISED

HCPCS J0129: Abatacept Injection, 10 mg

HCPCS-J0130-INJECTION-ABCIXIMAB-10MG

HCPCS Level II J0130: Injection abciximab, 10 mg

HCPCS-J0131-INJECTION-ACETAMINOPHEN-10MG-PARENTERAL-ANALGESIC

HCPCS J0131: Injection Acetaminophen, 10 mg

HCPCS-J0132-INJECTION-ACETYLCYSTEINE-100MG-INJECTABLE-MEDICATION

HCPCS J0132: Injection, Acetylcysteine 100 mg

HCPCS-J0133-ACYCLOVIR-INJECTION-5MG

HCPCS J0133: Injection, Acyclovir 5 mg

HCPCS-J0134-ACETAMINOPHEN-INJECTION-FRESENIUS-KABI-10MG

HCPCS J0134: Injection, Acetaminophen (Fresenius Kabi), 10 mg

Showing 1–10 of 991

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.