J1561
J1561 – Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 9 NDCs crosswalked per 500 MG $49.014/unit ASP+6%
📋 J1561 summary
J1561 is a HCPCS Level II J-code used to bill immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg, billed per 500 MG. The number of billing units to report depends on the dose administered and the NDC/package billed — use the calculator below.
Brand names associated with J1561: Gammaked*, Gamunex-C, Gammaked
Code J1561
Billing unit 500 MG Payment limit $49.014/unit NDC-Crosswalk 9
Quarter Q3 2026
RxCUI Atlas Trace the drug concept →
⚠ An NDC↔HCPCS crosswalk and a published payment limit do not guarantee payer coverage or payment. Always verify the current payer policy and claim format before billing.
🗂️ Key billing facts
HCPCS codeJ1561
DescriptorInjection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg
Billing unit500 MG
Payment limit / unit$49.014
Est. ASP / unit$46.240 est.
Mapped NDCs9
Data periodQ3 2026
Last updated2026-08-20
🧾 Billing & reimbursement HCPCS · CMS · EFF. Q3 2026
📅 Payment limits effective Q3 2026 — from the CMS Medicare Part B Payment Limit File (revised quarterly).
Medicare payment limit / unit
$49.014
Est. ASP / unit
$46.240 est.
Est. after 2% sequester
$48.034
HCPCS dosage
500 MG
The CMS payment limit is the Medicare Part B drug allowance (ASP + 6%, statutory). After the 2% federal sequester the effective payment is ≈ ASP + 4.3%; estimated ASP = payment limit ÷ 1.06. Source: CMS Medicare Part B Payment Limit File (quarterly), Q3 2026.
Full HCPCS code details (official CMS record)
Long descriptionInjection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg
CoverageD — Special coverage instructions apply
Pricing indicator51 — Drug — priced under the ASP methodology
Type of service1 — Medical care
BETOS-2O1E
ASC payment groupYY
Action codeN — No maintenance this year
Effective date2013-01-01
Date added2008-01-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J1561 = 500 mg. Enter a regimen to convert dose → billing units and project a full course.
Billing units = dose ÷ HCPCS unit size. Most payers require whole units — round per the payer's policy. “Est. Medicare pay” uses the current payment limit. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (JZ when none is discarded) where allowed. Always verify payer-specific rounding before billing.
🔁 NDCs that bill under J1561 WITH EST. MEDICARE PAY
9 NDCs map to J1561. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($49.014/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 13533-0800-12 | Gamunex-C Immune Globulin (Human) 10 g/100mL INJECTION | GRIFOLS | 1 VIAL, GLASS in 1 CARTON (13533-800-12)... | 10 g/100mL | 2 | $98.03 | — | ● Active | CMS + PDAC |
| 13533-0800-15 | Gamunex-C Immune Globulin (Human) 10 g/100mL INJECTION | GRIFOLS | 1 VIAL, GLASS in 1 CARTON (13533-800-15)... | 10 g/100mL | 5 | $245.07 | — | ● Active | CMS + PDAC |
| 13533-0800-20 | Gamunex-C Immune Globulin (Human) 10 g/100mL INJECTION | GRIFOLS | 1 VIAL, GLASS in 1 CARTON (13533-800-20)... | 10 g/100mL | 10 | $490.14 | — | ● Active | CMS + PDAC |
| 13533-0800-24 | Gamunex-C Immune Globulin (Human) 10 g/100mL INJECTION | GRIFOLS | 1 VIAL, GLASS in 1 CARTON (13533-800-24)... | 10 g/100mL | 40 | $1,960.56 | — | ● Active | CMS + PDAC |
| 13533-0800-40 | Gamunex-C Immune Globulin (Human) 10 g/100mL INJECTION | GRIFOLS | 1 VIAL, GLASS in 1 CARTON (13533-800-40)... | 10 g/100mL | 80 | $3,921.12 | — | ● Active | CMS + PDAC |
| 13533-0800-71 | Gamunex-C Immune Globulin (Human) 10 g/100mL INJECTION | GRIFOLS | 1 VIAL, GLASS in 1 CARTON (13533-800-71)... | 10 g/100mL | 20 | $980.28 | — | ● Active | CMS + PDAC |
| 76125-0900-10 | GAMMAKED Immune Globulin (Human) 10 g/100mL INJECTION | KEDRION | 1 VIAL, GLASS in 1 CARTON (76125-900-10)... | 10 g/100mL | 20 | $980.28 | — | ● Active | CMS ASP |
| 76125-0900-20 | GAMMAKED Immune Globulin (Human) 10 g/100mL INJECTION | KEDRION | 1 VIAL, GLASS in 1 CARTON (76125-900-20)... | 10 g/100mL | 40 | $1,960.56 | — | ● Active | CMS ASP |
| 76125-0900-50 | GAMMAKED Immune Globulin (Human) 10 g/100mL INJECTION | KEDRION | 1 VIAL, GLASS in 1 CARTON (76125-900-50)... | 10 g/100mL | 10 | $490.14 | — | ● Active | CMS + PDAC |
NDC→HCPCS mappings come from the CMS ASP NDC-HCPCS crosswalk; additional DME MAC / DMEPOS mappings come from PDAC and are labeled separately. NADAC from CMS (weekly). “Status” reflects the product's marketing / obsolete flag in the NDC directory. Presence or absence here does not determine Medicare coverage. Linked NDCs open the full product page.
📊 Medicare utilization & spend CMS · PART B · 2026 (Q1)
Period
Total Part B spend
$164.01M
Claims
40,877
Beneficiaries
14,913
Spend / beneficiary
$10,997.47
Spend / claim
$4,012.17
Trend by period
Where J1561 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #19 of 824
#14
PADCEV J9177
$215.91M
#15
ENHERTU J9358
$209.39M
#16
GAMMAGARD LIQUID J1569
$182.71M
#17
ENTYVIO J3380
$180.78M
#18
ULTOMIRIS J1303
$178.93M
#19
GAMMAKED* J1561
$164.01M
#20
TECENTRIQ J9022
$153.47M
#21
OCREVUS J2350
$143.97M
#22
YERVOY J9228
$137.56M
#23
LEQVIO J1306
$137.07M
#24
BOTOX COSMETIC* J0585
$126.15M
Total claims — #60 of 824
#55
ONDANSETRON HCL(J240... J2405
43,411
#56
CINVANTI J0185
42,275
#57
PALONOSETRON HCL J2469
41,742
#58
SYFOVRE J2781
41,654
#59
IZERVAY J2782
41,264
#60
GAMMAKED* J1561
40,877
#61
XOLAIR J2357
40,450
#62
SODIUM CHLORIDE(J704... J7040
40,325
#63
LEQVIO J1306
38,806
#64
ARFORMOTEROL TARTRAT... J7605
38,654
#65
SIMPONI ARIA J1602
38,495
Top Medicare Part B drugs by the selected metric. Click any drug to open its J-code page. Source: CMS Medicare Quarterly Part B Spending by Drug.
Full breakdown by period (2)
| Period | Total spend | Beneficiaries | Claims | $/beneficiary | $/claim |
|---|---|---|---|---|---|
| 2026 (Q1) | $164.01M | 14,913 | 40,877 | $10,997.47 | $4,012.17 |
| 2025 (Q1-Q4) | $648.78M | 19,889 | 158,429 | $32,619.99 | $4,095.08 |
Provider-administered (Part B) spend, calculated for the whole HCPCS code (CMS does not publish Medicare spend per individual NDC). Self-administered use is covered under Part D instead. A blank patient count means fewer than 11 people — CMS hides counts that small to protect privacy. Source: CMS Medicare Quarterly Part B Spending by Drug (data.cms.gov), updated quarterly.
📈 Medicare Part B claims detail CMS PSPS · 2024
Calendar-year 2024 Medicare Part B fee-for-service activity for this HCPCS code, summed across all carriers, localities and specialties (CMS Physician/Supplier Procedure Summary). A “service” is one billed line/unit — not one claim — so counts run higher than claim counts.
Allowed charges
$242.18M
Medicare paid
$187.54M
Submitted services
6,002,601
Denial rate
16.0%
Allowed / service
$48.04
Submitted charges
$998.81M
Source: CMS Physician/Supplier Procedure Summary (PSPS), CY2024 — Medicare Part B carrier + DME fee-for-service claims (excludes Medicare Advantage). Figures are for the whole HCPCS code, which may cover uses beyond this drug. ⚠ CMS hides any figure covering fewer than 11 patients (a privacy rule), so totals — especially denials and low-volume codes — run a little low.
🗺️ Where J1561 is utilized CMS · BY PROVIDER · 2024
Medicare Part B services for this code by the rendering provider's state — 1,819,367 services across 24 states & territories in 2024 (CMS reports include DC and U.S. territories). Switch to per 100k to compare states fairly regardless of population. Hover or tap a state for its top ZIP codes.
Hover or tap a state to see its numbers + top ZIP codes.
Per-capita = services ÷ 2023 state population × 100,000 (so high-population states aren't automatically "hotter"). Counts reflect the provider's location, not the patient's. Providers with fewer than 11 patients are hidden by CMS for privacy, so totals run low and per-100k can be noisy in small states — read this as relative geography, not exact counts. Source: CMS Medicare Physician & Other Practitioners — by Provider and Service, 2024.
📊 What bills under J1561
J-codes are billing codes often used for drugs billed under the medical benefit. This connects the billing code to the NDC package records it covers, by ingredient and labeler.
NDC products by ingredient
NDC products by labeler
🗃️ Data sources & freshness
Every figure on this page is computed from public datasets. Here's what each section draws on and how current it is.
HCPCS code & descriptor
CMS HCPCS Level II code file
Loaded
Payment limit & billing unit
CMS Medicare Part B ASP Pricing File (quarterly)
Q3 2026 · as of 2026-08-20
NDC ↔ HCPCS crosswalk
CMS ASP NDC-HCPCS crosswalk + DMEPDAC (PDAC)
9 NDCs mapped
NADAC acquisition cost
CMS National Average Drug Acquisition Cost (weekly)
Not available for mapped NDCs
Utilization & spend
CMS Part B Spending by Drug · PSPS · Physician & Other Practitioners
Latest data year 2026
Figures are estimates for reference and may lag the source files. Always verify against the current CMS files and your payer's policy before submitting claims.
⚠️ Practical billing caveats
- A crosswalk is not coverage. An NDC mapping or a published payment limit does not guarantee a payer will cover or pay this code. Check the specific plan's policy.
- Units ≠ milligrams. Bill the number of HCPCS units (dose ÷ the code's unit size), not the milligram dose. Use the calculator above.
- Discarded drug. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (and JZ when nothing is discarded) where the payer allows.
- Rounding & partial units. Many payers require whole units; round per the payer's policy, not automatically up.
- The code can cover more than this drug. Some HCPCS codes span multiple products or strengths — confirm the exact code for the product administered.
- Figures lag. ASP limits change quarterly and utilization data are released with a delay. Verify against the current CMS files before billing.
❓ J1561 billing FAQ
What is HCPCS code J1561?
J1561 is a HCPCS Level II J-code used to bill Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J1561?
One unit of J1561 represents 500 MG. Report the number of units equal to the dose administered divided by 500 MG.
How many units of J1561 should I bill?
Divide the dose administered by the code's unit size (500 MG) to get the number of billing units, then round per your payer's policy. The calculator on this page converts a dose into billing units and projects a full course.
How much does Medicare pay for J1561?
The Medicare Part B payment limit is $49.014 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $48.034 per unit. Payment limits are revised quarterly.
Which NDCs bill under J1561?
9 NDCs currently map to J1561 in the CMS ASP NDC-HCPCS crosswalk. See the NDC crosswalk table above for each product, package, billing units and estimated reimbursement.
Does a crosswalk mean J1561 is covered?
No. An NDC-to-HCPCS crosswalk and a published payment limit do not guarantee coverage or payment. Coverage depends on the payer, the diagnosis and the site of care — always verify the current policy before billing.
For professional billing reference only — verify against the current CMS files before submitting claims.