Does J1560 require prior authorization?

No, J1560 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for J1560?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`J1560`, Injection, gamma globulin, intramuscular, over 10 cc

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Signed and dated office visit records and operative reports are required; all services ordered or rendered to Medicare beneficiaries must be signed.
For services requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.

The patient's medical record must include the ordering provider's assessment related to the patient's complaint for that visit and relevant medical history.

Document results of pertinent tests/procedures; for diagnostic tests report the test result if known, otherwise report the symptoms that prompted the test.

When using modifier -GA, an ABN (Form CMS-R-131) should be signed by the beneficiary to indicate acceptance of payment responsibility, and for claims submitted to the Part A MAC occurrence code 32 and the date of the ABN are required.

Providers should review NCCI and OPPS requirements prior to billing as procedure codes may be subject to NCCI edits or OPPS packaging edits.

Key Coverage Criteria

IVIG is covered only for indications specified as covered in the related Local Coverage Determination (LCD) and when medical necessity criteria in that LCD are met.
IVIG may be indicated for pure red cell aplasia–related anemia.
Intramuscular immune globulin (gamma globulin) is indicated for post-exposure prophylaxis to hepatitis A.
IG is indicated for measles (rubeola) post-exposure prophylaxis in susceptible patients exposed less than 3 days prior to treatment.
IG is indicated for rubella prophylaxis in a woman in early pregnancy who is exposed and lacks immunity.
IVIG may be used for post-transfusion purpura and can be considered first-line for severely affected patients.

6 Active Policies

CGS-J15-L38268, Immune Thrombocytopenia (ITP) Therapy

J15

CGS-J18-L38268, Immune Thrombocytopenia (ITP) Therapy

J18

WPS-J5-L34771, Immune Globulins

J5

A57554, Billing and Coding: Immune Globulins

J5

WPS-J8-L34771, Immune Globulins

J8

A57160, Billing and Coding: Immune Thrombocytopenia (ITP) Therapy

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J1560, Injection, gamma globulin, intramuscular, over 10 cc