Intake card: J1569

HCPCS codeJ1569 (active)

Billing unit500 MG

Part B limit$49.495 per unit (Q4 2026)

Max units / day (MUE)Practitioner 400 · Outpatient hospital 400 · DME supplier 400

JW / JZContainer type is not stated in the FDA package text; check the label.

Hospital outpatientK Paid separately (non-pass-through drug or biological) · $49.495 per unit (Q4 2026)

Home infusionPart B pays the drug at home only under the DME benefit (e.g. a pump drug under the External Infusion Pump policy, or IVIG for primary immune deficiency); otherwise Part D. Home infusion therapy services are paid only to Medicare HIT suppliers.

CoverageLCDs and articles for J1569 (Medicare Coverage Database)

Professional claims$49.50 maximum allowable · no PA flag

Hospital outpatientPaid by EAPG (3M grouper weight × the hospital's conversion factor); certain high-cost drugs are paid outside EAPG.

Home infusionHCA pays supply, pump, and parenteral nutrition codes from its home infusion schedule; per diem S-codes are not on it.

AAC = actual acquisition cost, based on NDC or invoice; BR = by report; NC = not covered; DC = not covered, see a different code; DP = covered under another program (see comments); PA = prior authorization; EPA = expedited prior authorization (see the billing guide); CPA = contractor prior authorization (Qualis). For professional claims; hospital-administered drugs are paid under HCA's outpatient (OPPS/EAPG) rules.

• GAMMAGARD Liquid (billed with this code)
• GAMMAGARD Liquid ERC (billed with this code)

Reference and biosimilar links come from the FDA Purple Book; substitution follows FDA licensure, payer policy, and state law.