## **What is the HCPCS code J1459 for?**
The HCPCS code J1459 is meant to designate the provision of non-lyophilized immune globulin intravenous injection (Privigen), specifically a 500 mg dose.
Privigen is a liquid form of immune globulin that boosts a patient's immune system with antibodies, which decreases infection rates. It also helps improve the neurological functions of patients who have chronic inflammatory demyelinating polyneuropathy (CIPD).
Besides CIPD, it's meant to be used on patients who have primary immunodeficiency diseases and other kinds of conditions that compromise and weaken one's immune system.
Please note this injection is administered intravenously.
## **Documentation requirements for J1459**
Before you decide to file for claims related to HCPCS codes, you'll need to provide documentation that satisfies your insurer's coding guidelines and requirements (e.g., Medicare coverage), along with any related policy articles and local coverage determinations you need to be aware of and follow. To assist providers, here are examples of what you'll need:
- The full name of the patient
- The full name and credentials of the healthcare professionals who handled the patient
- The name and address of the location where the injection was administered (with indications on what kind of facility it is, like outpatient hospital, infusion center, or physician office)
- Relevant information and indications concerning the patient's medical record/history, current condition(s), and relevant tests conducted, and their results, to support medical necessity
- Drug information (e.g., name, strength, dosage, total dosage administered, route of administration, start and stop times of the infusion, lot number, National Drug Code, manufacturer, expiration date, etc.)
- Physician order and infusion protocols
## **Billing requirements for J1459**
Besides the documentation requirements above, please make sure to take note of the following:
- 500 mg = 1 unit
- CPT primary procedure code 96365 since this is administered intravenously, plus CPT code 96366 for each additional hour of infusion time
- Relevant ICD diagnosis codes related to your patient's condition, such as D81.0 - Severe combined immunodeficiency [SCID] with reticular dysgenesis; D80.8 - Other immunodeficiencies with predominantly antibody defects
- Use either of two modifiers: JW if there's unused medication in a vial (wastage), or JZ if there's no unused medication
## **Other similar codes**
- **J1568**- Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg
- **J1569** - Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg
- **J1557** - Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg
- **J1561** - Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg
- **J1566** - Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg
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