| HCPCS Code: |
J1572 |
| Long Description: |
Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g. liquid), 500 mg |
| Short Description: |
Flebogamma injection |
| Pricing Indicator 1: |
51 (Drugs) |
| Multiple Pricing Code: |
A (Not applicable as HCPCS priced under one methodology) |
| MCM Reference Section Number 1: |
2049 |
| Statute Number: |
|
| Coverage Code: |
D (Special coverage instructions apply) |
| ASC Payment Group Code: |
YY |
| ASC Payment Group Date: |
01-01-2008 |
| Processing Note Number: |
|
| Berenson-Eggers Type of Service (BETOS) Code: |
O1E (Other drugs) |
| Type of Service Code 1: |
1 (Medical care) |
| Type of Service Code 2: |
P (Lump sum purchase of DME, prosthetics, orthotics) |
| Anesthesia Base Unit Quality: |
0 |
| Code Added: |
01-01-2008 |
| Action Effective Date: |
01-01-2009 |
| Action Code: |
N (No maintenance for this code) |
