Question 1

What is HCPCS code J1568?

Accepted Answer

HCPCS code J1568 is "Octagam injection". Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg

Question 2

What category is J1568 in?

Accepted Answer

J1568 belongs to HCPCS Category J (Drugs Administered Other Than Oral).

Question 3

When should I use HCPCS code J1568?

Accepted Answer

Use J1568 when billing for octagam 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 J1568?

Accepted Answer

Common ICD-10 diagnosis codes used with J1568 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 J1568 covered by Medicare?

Accepted Answer

Coverage for J1568 (Octagam 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 J1568?

Accepted Answer

Documentation for J1568 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).