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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 and GAMMAGARD S/D [Immune Globulin Intravenous (Human)] IgA less than 1 µg/mL in a 5% solution are administered.

GAMMAGARD LIQUID Coding Guide


GAMMAGARD LIQUID Coding Guide

A handy reference sheet with billing codes for
GAMMAGARD LIQUID.

 Download GAMMAGARD Coding Guide

 Download Full Prescribing Information

This chart highlights coding for GAMMAGARD LIQUID and GAMMAGARD S/D. 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**
GAMMAGARD S/D, IgA less than 1 μg/mL in a 5% solution: Intravenous J1566

Injection, Immune Globulin, Intravenous Lyophilized (e.g., Powder), not otherwise specified, 500 mg

GAMMAGARD LIQUID J1569

Injection, Immune Globulin (GAMMAGARD LIQUID), Intravenous, Non-Lyophilized (e.g., Liquid), 500 mg

GAMMAGARD LIQUID: Subcutaneous J1569-JB

Injection, Immune Globulin (GAMMAGARD LIQUID), Intravenous, Non-Lyophilized (e.g., Liquid), 500 mg

Home Infusion Therapy S9338

Home infusion therapy, immunotherapy, administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem


CPT® Codes***
Intravenous Administration 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)

Subcutaneous Administration 96369

Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); initial, up to 1 hour, including pump set-up and establishment of subcutaneous infusion site(s) Excludes infusions of 15 minutes or less (96372)

  96370

Each additional hour (List separately in addition to code for primary procedure) Includes infusions of more than 30 minutes beyond 1 hour

  96371

Additional pump set-up with establishment of new subcutaneous infusion site(s) (List separately in addition to code for primary procedure)


NDC Codes
 

NDC Code

Product Size

GAMMAGARD LIQUID 0944-2700-02
0944-2700-03
0944-2700-04
0944-2700-05
0944-2700-06
0944-2700-07
1.0 g
2.5 g
5.0 g
10.0 g
20.0 g
30.0 g
GAMMAGARD S/D IgA less than 1 μg/mL in a 5% solution

0944-2656-03

5.0 g

 

0944-2658-04

10.0 g

**Healthcare Common Procedure Coding System (HCPCS) Level II codes ©2016 Ingenix, Inc. All rights reserved. Healthcare providers should contact payers for guidance on appropriate coding.

***Current Procedural Terminology (CPT) codes copyright 2014 American Medical Association (AMA). All rights reserved. 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 information 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 contact payers for guidance on appropriate coding. Healthcare providers should also 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 Shire cannot guarantee success in obtaining insurance payments.

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