Home Drug Codes J Codes J1572 · FLEBOGAMMA 10% DIF
Updated July 1st, 2026

FLEBOGAMMA 10% DIF J Code: J1572

Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg

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Medicare Payment Limit ?
Not published
CMS publishes none for Q3 2026
APC Payment Limit ?
$90.74
/ HCPCS billing unit · APC 0947
ASP ?
No current ASP
Not available for Q3 2026
WAC · AWP ?
$•••.••
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NDCs Crosswalked ?
7
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Drug & Product Overview

HCPCS Descriptor Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg
HCPCS Added Date January 1, 2008
Manufacturer Grifols
Route of Administration Intravenous
Generic Status Single-Source; Branded
Dosage Form Injection, Solution

About FLEBOGAMMA 10% DIF

Flebogamma 10% DIF is a medication aligned to the HCPCS J Code: J1572 for billing, pricing, and reimbursement purposes in the United States. This Immunoglobulin medication is administered via the intravenous route and manufactured by Grifols.

Manufacturers, reach out to us to add more information.

NDC Code Information

7 NDC packages are crosswalked to J1572. Package detail is available to logged-in subscribers.

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FLEBOGAMMA 10% DIF Pricing & Reimbursement

J1572 Private Payer Reimbursement
$55.35 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

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UnitedHealthcare, BlueCross BlueShield, Aetna, Cigna

FLEBOGAMMA 10% DIF CPT Administration Codes

The below list of CPT codes is intended for informational purposes only and may not be exhaustive. CPT® codes and descriptions are copyright American Medical Association (AMA). All rights reserved.

CPT Code Description
96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour
96366 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)
Not on the CMS JW / JZ list

CMS does not include Flebogamma 10% DIF (J1572) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing J1572. Wastage billing guide →

FLEBOGAMMA 10% DIF Medically Unlikely Edits (MUE)

The most billing units of J1572 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 500 mg.

Practitioner Office & Hospital Outpatient
180 units / day
= 90,000 mg per day

MAI 3 · Date of Service Edit: Clinical. Per-day limit based on clinical expectations; excess units are denied but may be appealed with documentation of medical necessity. See all MUE limits →

mg Enter a dose to see how many billing units it is and whether it is under the limit.

FLEBOGAMMA 10% DIF Clinical Information

Indications and drug classification.

Treated Diseases & Conditions

This list of indications is not exhaustive and may be subject to errors. The information on BuyandBill.com is intended for informational purposes only and should not be used for medical advice.

Primary immunodeficiency
Drug Class
Antigen Neutralization [MoA]Human Immunoglobulin G [EPC]Immunoglobulins [CS]Passively Acquired Immunity [PE]

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Frequently Asked Questions

Is there an available Flebogamma 10% Dif billing and coding guide?
We have not yet identified a manufacturer source of Flebogamma 10% Dif billing and coding information.
Are there any available Flebogamma 10% Dif patient assistance programs?
Our team did not identify a source for Flebogamma 10% Dif patient assistance information. Please reach out to our team if you feel that this is a mistake.
Where can I find Flebogamma 10% Dif prescribing information?
FLEBOGAMMA 10% DIF prescribing information can be found at the link below: Visit Here →
Where can I find Flebogamma 10% Dif side effect information?
Our team has not yet identified a source of side effects information for FLEBOGAMMA 10% DIF. Please check back in a few weeks.
Does billing FLEBOGAMMA 10% DIF require JZ/JW wastage modifiers?
CMS does not include FLEBOGAMMA 10% DIF (J1572) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing J1572. For more information, visit the link below.

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