Question 1

What is HCPCS code J1557?

Accepted Answer

HCPCS code J1557 is "Gammaplex injection". Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg

Question 2

What category is J1557 in?

Accepted Answer

J1557 belongs to HCPCS Category J (Drugs Administered Other Than Oral).

Question 3

When should I use HCPCS code J1557?

Accepted Answer

Use J1557 when billing for gammaplex injection. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

What ICD-10 codes are commonly used with J1557?

Accepted Answer

Common ICD-10 diagnosis codes used with J1557 include: A41.01 (Sepsis due to Methicillin susceptible Staphylococcus aureus), A41.02 (Sepsis due to Methicillin resistant Staphylococcus aureus), A41.1 (Sepsis due to other specified staphylococcus), A41.2 (Sepsis due to unspecified staphylococcus). Always ensure proper medical documentation supports the medical necessity for the HCPCS code being billed.

Question 5

Is J1557 covered by Medicare?

Accepted Answer

Coverage for J1557 (Gammaplex injection) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 6

What documentation is required for J1557?

Accepted Answer

Documentation for J1557 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).