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Suggested Coding
Properly coding your claim forms will help facilitate timely claims processing and reduce the risk of having claims denied. Coding requirements vary by insurer and the setting of care in which GAMMAGARD LIQUID therapy and GAMMAGARD S/D therapy are administered.
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GAMMAGARD Therapy Coding Guide
A handy reference sheet with suggested codes for GAMMAGARD LIQUID therapy, GAMMAGARD S/D therapy, and immune system disorders.
GAMMAGARD Therapy Coding Chart
This chart highlights suggested coding for GAMMAGARD LIQUID [Immune Globulin Intravenous (Human)] 10% and GAMMAGARD S/D [Immune Globulin Intravenous (Human)]. It is not a comprehensive listing of codes and physician and hospital staff may deem other codes more appropriate. It is the providers' responsibility to select the coding options that most accurately reflect the setting and services rendered.
HCPCS Codes** |
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Physician Office Billing |
J1566 |
Injection, Immune Globulin, Intravenous, Lyophilized (e.g. Powder), 500 mg Injection, Immune Globulin, Intravenous, Lyophilized (GAMMAGARD S/D IgA less than 1 µg/mL in a 5% solution) |
| J1569 | Injection, Immune Globulin (GAMMAGARD LIQUID), Intravenous, Non-Lyophilized (e.g. Liquid), 500 mg | |
Administration Codes*** |
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Physician Office |
96365* | IV infusion for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
| 96366* (Add-on code) |
IV infusion for therapy, prophylaxis, or diagnosis; each additional hour (List separately in addition to code for primary procedure) | |
| 96367* (Add-on code) |
IV infusion for therapy, prophylaxis, or diagnosis; additional sequential infusion, up to one hour (List separately in addition to code for primary procedure) | |
| 96368* (Add-on code) |
IV infusion for therapy, prophylaxis, or diagnosis; concurrent infusion (List separately in addition to code for primary procedure) | |
NDC Codes
| NDC | Code | Product Size |
| GAMMAGARD S/D (5% or 10%) |
00944-2620-01 | 0.5 Grams |
| 00944-2620-02 | 2.5 Grams | |
| 00944-2620-03 | 5.0 Grams | |
| 00944-2620-04 | 10.0 Grams | |
| GAMMAGARD S/D [Immune Globulin Intravenous (Human)], IgA less than 1 µg/mL in a 5% solution |
00944-2655-03 | 5.0 grams |
| 00944-2655-04 | 10.0 grams | |
| GAMMAGARD LIQUID 10% | 00944-2700-02 | 1.0 Grams |
| 00944-2700-03 | 2.5 Grams | |
| 00944-2700-04 | 5.0 Grams | |
| 00944-2700-05 | 10.0 Grams | |
| 00944-2700-06 | 20.0 Grams |
*Effective January 1, 2009 CMS has discontinued the pre-administration code G0332. Information can be retrieved on the CMS website by
accessing the following link:
http://www.cms.hhs.gov/apps/media/fact_sheets.asp
Date: October 30, 2008- “FINAL CY2009 PAYMENT POLICIES FOR DRUGS, BIOLOGICALS, AND RADIOPHARMACEUTICALS FOR
HOSPITAL OUTPATIENT DEPARTMENTS”
Effective January 1, 2009, administration codes 90765, 90766, 90767 and 90768 have been deleted and replaced with 96365, 96366, 96367
and 96368.
**HCPCS Level II codes copyright 2009 Ingenix, Inc. All rights reserved.
***CPT codes copyright 2009 American Medical Association. All Rights Reserved. CPT is a trademark of the AMA. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein.
The information contained in this Coding Reference Guide is provided for informational purposes only. Every reasonable effort has been made to verify the accuracy of the information; however, this guide is not intended to provide specific guidance on how to utilize, code, bill, or charge for any product or service. Healthcare providers should make the ultimate determination as to when to use a specific product based on clinical appropriateness for a particular patient.Third-party payment for medical products and services is affected by numerous factors, and Baxter cannot guarantee success in obtaining insurance payments.
For additional information please contact the Baxter IVIG Reimbursement Helpline at 1-877-655-GARD (4273).
Please see the detailed Important Risk Information and Full Prescribing Information for GAMMAGARD LIQUID [Immune Globulin Intravenous (Human)] for full prescribing details.
Please see the detailed Important Risk Information and Full Prescribing Information for GAMMAGARD S/D [Immune Globulin Intravenous (Human)] for full prescribing details.
Please see the detailed Important Risk Information and Full Prescribing Information for GAMMAGARD S/D [Immune Globulin Intravenous (Human)], IgA less than 1 µg/mL in a 5% solution for full prescribing details.
