Question 1

What is HCPCS code J1560?

Accepted Answer

HCPCS code J1560 is "Gamma globulin > 10 cc inj". Injection, gamma globulin, intramuscular, over 10 cc

Question 2

What category is J1560 in?

Accepted Answer

J1560 belongs to HCPCS Category J (Drugs Administered Other Than Oral).

Question 3

When should I use HCPCS code J1560?

Accepted Answer

Use J1560 when billing for gamma globulin > 10 cc inj. 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 J1560?

Accepted Answer

Common ICD-10 diagnosis codes used with J1560 include: B16.1 (Acute hepatitis B with delta-agent without hepatic coma), B16.2 (Acute hepatitis B without delta-agent with hepatic coma), B16.9 (Acute hepatitis B without delta-agent and without hepatic coma), B17.0 (Acute delta-(super) infection of hepatitis B carrier). Always ensure proper medical documentation supports the medical necessity for the HCPCS code being billed.

Question 5

Is J1560 covered by Medicare?

Accepted Answer

Coverage for J1560 (Gamma globulin > 10 cc inj) 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 J1560?

Accepted Answer

Documentation for J1560 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).