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Billing Code Reference & Medicare
Payment Allowance |
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Payment Allowance Limits for Medicare Part B
Drugs
Effective October 1, 2008 - December 31, 2008 |
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CMS IVIG Administration Codes 2008
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| HCPCS Code |
Description |
HCPCS Code Dosage |
Payment Limit |
| 90371 |
Hep b Ig, im |
1ml |
$123.870 |
| 90385 |
Rh ig, minidose, im |
50 mcg |
$25.991 |
| J2788 |
Rho d immune globulin 50 mcg |
50 mcg |
$26.859 |
| J2790 |
Rho d immune globulin inj |
300 mcg |
$84.546 |
| J2792 |
Rho(D) immune globulin h, sd |
100 iu |
$16.807 |
| J7189 |
Factor VIIa recombinant |
1 mcg |
$1.235 |
| J7190 |
Factor VIII |
1iu |
$0.830 |
| J7191 |
Factor VIII (porcine) |
1iu |
$1.860 |
| J7192 |
Factor VIII recombinant |
1iu |
$1.080 |
| J7193 |
Factor IX non-recombinant |
1iu |
$0.895 |
| J7194 |
Factor IX complex |
1iu |
$0.819 |
| J7195 |
Factor IX recombinant |
1iu |
$1.065 |
| J7197 |
Antithrombin III injection |
1iu |
$2.204 |
| J7187 |
Inj Von Willebrand Factor Complex |
1 iu |
$0.882 |
| J7198 |
Anti-Inibitor |
1iu |
$1.483 |
| P9041 |
Albumin (human), 5% |
50ml |
$35.342 |
| P9043 |
Plasma Protein Fraction, 5% |
50ml |
$22.344 |
| P9045 |
Albumin (human), 5% |
250ml |
$54.682 |
| P9046 |
Albumin (human) 25% |
20ml |
$25.593 |
| P9047 |
Albumin (human) 25% |
50ml |
$51.196 |
| P9048 |
Plasma Protein Fraction 5% |
250ml |
$41.211 |
| J1568 |
Octagam Injection |
500mg |
$35.915 |
| J1569 |
Gammagard Liquid Injection |
500mg |
$35.006 |
| J2791 |
Rhophylac Injection |
100iu |
$5.245 |
| J1571 |
Hepagam B IM Injection |
0.5ml |
$43.921 |
| J1572 |
Flebogamma Injection |
500mg |
$35.699 |
| J1561 |
Gamunex Injection |
500mg |
$34.798 |
| J1566 |
IVIG lyophiized |
500 mg |
$29.236 |
| J1460 |
Gamma globulin 1CC inj |
1CC |
$12.090 |
| J1470 |
Gamma globulin 2CC inj |
2CC |
$24.179 |
| J1480 |
Gamma globulin 3CC inj |
3CC |
$36.267 |
| J1490 |
Gamma globulin 4CC inj |
4CC |
$48.358 |
| J1500 |
Gamma globulin 5CC inj |
5CC |
$60.448 |
| J1510 |
Gamma globulin 6CC inj |
6CC |
$72.544 |
| J1520 |
Gamma globulin 7CC inj |
7CC |
$84.587 |
| J1530 |
Gamma globulin 8CC inj |
8CC |
$96.716 |
| J1540 |
Gamma globulin 9CC inj |
9CC |
$108.840 |
| J1550 |
Gamma globulin 10CC inj |
10CC |
$120.895 |
| J1560 |
Gamma globulin >10CC inj |
10CC |
$120.895 |
| J1562 |
Vivaglobulin, injection |
100MG |
$7.075 |
| J1566 |
immune globulin. powder |
500MG |
$29.236 |
| J1640 |
Hemin, 1mg |
1MG |
$7.588 |
| 90375 |
Rabies ig, im / sc |
150 IU |
$90.895 |
| 90376 |
Rabies ig, heat treated |
150 iu |
$98.077 |
| 90675 |
Rabies Vaccine, im |
1 ml |
$146.881 |
| J0850 |
Cytomegalovirus imm IV / vial |
per vial |
$878.825 |
| J9045 |
Carboplatin Injection |
50 mg |
$9.607 |
| J9100 |
Cytarabine hcl 100MG inj |
100 mg |
$1.683 |
| J9110 |
Cytarabine hcl 500MG inj |
500 mg |
$8.416 |
| J9130 |
Dacarbazine 100 MG inj |
100 mg |
$4.455 |
| J9140 |
Dacarbazine 200 MG inj |
200 mg |
$8.774 |
| J9206 |
Irinotecan injection |
20 MG |
$36.997 |
| J9250 |
Methotrexate sodium inj |
5 MG |
$0.226 |
| J9260 |
Methotreate soium inj |
50 MG |
$2.357 |
| J9264 |
Paclitaxel protein bound |
1 MG |
$8.792 |
| J9265 |
Paclitaxel injection |
30 MG |
$11.038 |
| J9293 |
Mitoxantron hydrochl / 5 MG |
5 MG |
$87.192 |
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Note 1: Payment allowance limits subject to the ASP methodology are based on 2Q08 ASP data.
Note 2: The absence or presence of a HCPCS code and the payment allowance limits in this table does not indicate Medicare coverage of the drug. Similarly, the inclusion of a payment allowance limit within a specific column does not indicate Medicare coverage of the drug in that specific category. These determinations shall be made by the local Medicare contractor processing the claim. |
| For a more complete listing of Payment Allowance limits for 2008 Click here. |
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