Home Drug Codes J Codes J1568 · OCTAGAM
Updated July 1st, 2026

OCTAGAM J Code: J1568

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

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Q4 2026 Medicare Payment Limit for J1568, effective October 1, 2026: $47.133 per HCPCS billing unit, up 0.2% from $47.056. From CMS's final file.

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Medicare Payment Limit ?
$47.056
/ HCPCS billing unit · Q3 2026
APC Payment Limit ?
$47.056
/ HCPCS billing unit · APC 0943
ASP ?
$•••.••
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WAC · AWP ?
$•••.••
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NDCs Crosswalked ?
28
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Drug & Product Overview

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

About OCTAGAM

Octagam is a medication aligned to the HCPCS J Code: J1568 for billing, pricing, and reimbursement purposes in the United States. Classified under Immunoglobulin, it is administered via the intravenous route and manufactured by Pfizer.

According to CMS Drug Use Information: This medication is used to strengthen the body's natural defense system (immune system) to lower the risk of infection in persons with a weakened immune system. This medication is made from healthy human blood that has a high level of certain defensive substances (antibodies), which help fight infections. It is also used to increase the blood count (platelets) in persons with a certain blood disorder (idiopathic thrombocytopenia purpura-ITP). Platelets are needed to stop bleeding and form blood clots. Some immune globulin products may also be used to treat certain types of muscle weakness problem (multifocal motor neuropathy, dermatomyositis) or a certain nerve disorder (chronic inflammatory demyelinating polyneuropathy-CIDP). Some products may also be used to prevent certain blood vessel disorders in people with Kawasaki syndrome.

Disclaimer: This is a summary and does not contain all possible information about this product. For complete information about this product or your specific health needs, ask your healthcare professional.

NDC Code Information

Based on publicly available CMS files. Showing 5 of 28 NDCs — log in for the full crosswalk.

NDC Code Drug Manufacturer Billing Units / Pkg Package Size
00069-6002-02 Octagam Immune Globulin (Human) Pfizer Laboratories Div Pfizer Inc 4 2000 MG / 20 ML
00069-6111-02 Octagam Immune Globulin (Human) Pfizer Laboratories Div Pfizer Inc 20 10000 MG / 100 ML
00069-6237-02 Octagam Immune Globulin (Human) Pfizer Laboratories Div Pfizer Inc 40 20000 MG / 200 ML
00069-6339-02 Octagam Immune Globulin (Human) Pfizer Laboratories Div Pfizer Inc 60 30000 MG / 300 ML
68982-0840-01 Octagam Immune Globulin (Human) Octapharma USA Inc 2 1000 MG / 20 ML
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OCTAGAM Pricing & Reimbursement

J1568 Private Payer Reimbursement
$49.20 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

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UnitedHealthcare, BlueCross BlueShield, Aetna, Cigna

Historical Graphing and Billing Calculator

per HCPCS unit
As of Q3 2026

OCTAGAM 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)
JW / JZ modifiers apply

CMS has identified Octagam (J1568) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →

OCTAGAM Medically Unlikely Edits (MUE)

The most billing units of J1568 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 500 mg.

Practitioner Office & Hospital Outpatient
300 units / day
= 150,000 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.

OCTAGAM 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.

Chronic Immune Thrombocytopenic Purpura Dermatomyositis Primary Humoral Immunodeficiency Diseases Primary Humoral Immunodeficiency Diseases (PI)
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 Octagam billing and coding guide?
Billing and coding information for OCTAGAM can be found through Pfizer. Visit Here →
Are there any available Octagam patient assistance programs?
OCTAGAM patient assistance information can be found through Pfizer. Visit Here →
Where can I find Octagam prescribing information?
OCTAGAM prescribing information can be found at the link below: Visit Here →
Where can I find Octagam side effect information?
Our team has not yet identified a source of side effects information for OCTAGAM. Please check back in a few weeks.
Does billing OCTAGAM require JZ/JW wastage modifiers?
CMS has identified OCTAGAM(J1568) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. See CMS guidelines on use of the JZ and JW wastage modifiers below.

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