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    HCPCS Details

    HCPC J1558
    Short Description Inj. xembify, 100 mg
    Long Description Injection, immune globulin (xembify), 100 mg
    Pricing indicator 51
    Coverage code C
    ASC payment group code YY
    BETOS2 code O1E
    Action code N
    Type of service 1
    Effective date 2020-07-01
    Date Added 2020-07-01

    HCPCS/NDC Cross-Walk

    NDC HCPC Description Drug Name Labeler Name HCPCS Dosage PKG Size PKG QTY Bill Units Bill Units PKG
    13533081005 J1558 Inj. xembify, 100 mg Xembify GRIFOLS USA, LLC 100 MG 5 1 10 10
    13533081010 J1558 Inj. xembify, 100 mg Xembify GRIFOLS USA, LLC 100 MG 10 1 20 20
    13533081020 J1558 Inj. xembify, 100 mg Xembify GRIFOLS USA, LLC 100 MG 20 1 40 40
    13533081050 J1558 Inj. xembify, 100 mg Xembify GRIFOLS USA, LLC 100 MG 50 1 100 100
    The ASP crosswalks are maintained by the Division of Data Analysis and Market Based Pricing to support ASP-based Medicare Part B payments only. The crosswalks are intended to help the public (including entities that submit manufacturer ASP data and providers who bill for drugs) understand which drug products (identified by NDCs) are assigned to which HCPCS billing codes. The crosswalks are not intended to be a comprehensive list of all drugs/NDCs available in the United States. The NDC to HCPCS Crosswalk also includes information on the NDC package size and the number of billable units (as defined by the HCPCS code descriptor). Comments on the file may be sent to [email protected].

    HCPCS Billing Calculator

    Dosage given to patient (per dose)
    HCPCS Dosage 100 MG
    HCPCS/CPT Billing Units 0.01
    Total doses ordered
    Billing Units 0.01