Table of content for "Flebogamma injection" (HCPCS J1572)
General information on the “J1572” code
HCPCS Code: J1572
Long Description: Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg
Short Description: Flebogamma injection
Original information is taken from J1572 page
Pricing indicators
Pricing Indicator Code 1: 51 – Drugs
Multiple Pricing Indicator Code A : Not applicable as HCPCS priced under one methodology
Certification and additional reference information
Coverage
Coverage: D – Special coverage instructions apply
ASC Payment Group: YY
ASC Payment Group Effective Date: 20080101
Type of service
Berenson-Eggers Type of Service (BETOS): O1E – Other drugs
Type Of Service 1: 1 – Medical care
Type Of Service 2: P – Lump sum purchase of DME, prosthetics, orthotics
Misc information
Anesthesia Base Unit Quantity: 0
Code Added Date: 20080101
Code Effective Date: 20090101
Action Code: N – No maintenance for this code