HCPCS J1557 (Gammaplex) Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Drugs Administered Other than Oral Method • Drugs, Administered by Injection |
| Common Place of Service | • None • 99 - Other POS • 11 - Office |
| Complexity Level | Low |
| Medicare Payment Limit | $63.683  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
| Related NDC Codes | • 64208-8234-02 - GAMMAPLEX (1X100ML,SINGLE USE) 5 GM/ 100 ML • 64208-8234-03 - GAMMAPLEX (1X200ML,SINGLE USE) 10 GM/ 200 ML • 64208-8234-06 - GAMMAPLEX (1X100ML,SINGLE USE) 5 GM/100ML • 64208-8234-07 - GAMMAPLEX (1X200ML,SINGLE USE) 10 GM/200ML • 64208-8235-01 - GAMMAPLEX 10% (INNER PACK NDC,PF) 100 MG/1 ML |
National average reimbursement for HCPCS J1557 by major payers:
$63.83
$63.78
$65.43
$62.32
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS J1557 | ||||||
United | J1557 | $63.85 | 1851491757 - CYNTHIA COTTON | 813193170 - VILLAGEMD OF SOUTHEAST TEXAS, PA | TX | Gastroenterology Physician (207RG0100X) |
United | J1557 | $54.01 | 1235439605 - BNO ENTERPRISES, INCORPORATED | 273818490 - BNO ENTERPRISES INCORPORATED | TX | Multi-Specialty Group (193200000X) |
United | J1557 | $63.85 | 1033101829 - TIMOTHY HUGGINS | 760423386 - REGIONAL EMPLOYEE ASSISTANCE PROGRA M | TX | Gastroenterology Physician (207RG0100X) |
United | J1557 | $59.48 | 1154490191 - TOTH ENTERPRISES II | 742876350 - TOTH ENTERPRISES II, P.A. DBA VICTORY MEDICAL CENTER PHARMACY | TX | Family Medicine Physician (207Q00000X) |
United | J1557 | $57.18 | 1437461258 - BRUNDHA BALARAMAN | 881819222 - ALLUSTRA DERMATOLOGY PLLC | TX | Dermatology Physician (207N00000X) |
United | J1557 | $63.85 | 1083979322 - ANKIT PATEL | 752656723 - PREMIER FAMILY CARE I, INC. | TX | Neurology Physician (2084N0400X) |
United | J1557 | $63.85 | 1750562211 - ECJ INTERNAL MEDICINE, PA DBA WESTSIDE MEDICAL CARE CENTER | 742844745 - ECJ INTERNAL MEDICINE PA DBA WESTSIDE MEDICAL CARE CENTER | TX | Multi-Specialty Group (193200000X) |
United | J1557 | $63.85 | 1710959762 - TERRY PEERY | 742710396 - CENTRAL TEXAS NEUROLOGY CONSULTANTS | TX | Neurology Physician (2084N0400X) |
United | J1557 | $66.62 | 1679024384 - CHAO AND YI EYE ASSOCIATES, PC | 813046655 - CHAO AND YI EYE ASSOCIATES PC | TX | Multi-Specialty Group (193200000X) |
United | J1557 | $57.01 | 1457890402 - TOWN SQUARE EMERGENCY ASSOCIATES PLLC | 815214395 - TOWN SQUARE EMERGENCY ASSOCIATES PLLC | TX | Multi-Specialty Group (193200000X) |
United | J1557 | $62.71 | 1073773867 - MOLLY WARTHAN | 474405014 - MOLLY M WARTHAN MD | TX | Dermatology Physician (207N00000X) |
United | J1557 | $60.49 | 1114906278 - WAYNE GREEN | 271619835 - KNAPP MEDICAL GROUP | TX | Gastroenterology Physician (207RG0100X) |
United | J1557 | $55.24 | 1811238454 - HOUSTON GASTRO INSTITUTE PLLC | 461804857 - HOUSTON GASTRO INSTITUTE | TX | Single Specialty Group (193400000X) |
United | J1557 | $194.46 | 1932774080 - CEPAMERICA TEXAS PA | 260525357 | TX | Critical Care Medicine (Internal Medicine) Physician (207RC0200X) |
United | J1557 | $63.85 | 1467988352 - TYLER ENOS | 751477242 - HIGH PLAINS DERMATOLOGY CENTER | TX | Dermatology Physician (207N00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS J1557 vs. Other Drugs, Administered by Injection Codes
The HCPCS J1557 code is part of the Drugs Administered Other than Oral Method services used for Drugs, Administered by Injection. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS J1557 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 64208-8234-02-NDC | Moderate | GAMMAPLEX (1X100ML,SINGLE USE) 5 GM/ 100 ML |
| J1556-HCPCS | Low | Injection, immune globulin (bivigam), 500 mg |
| J1557-HCPCS | Low | Injection, immune globulin, (Gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg |
| J1558-HCPCS | Low | Injection, immune globulin (xembify), 100 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J1557. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J1557 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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