Access and
Billing codes
Confidence in coverage
Hizentra for the treatment of CIDP is covered for 97% of US commercially insured patients.1* Plus, with the Copay Program, most people with commercial insurance pay $0 out of pocket.†
- The Hizentra Copay Program provides eligible patients with commercial insurance up to $20,000 in copay assistance per calendar year
coverage for patients with Medicare Part B and qualifying Medigap plan, after Part B annual deductible is met.2
*As of July 2025. Prior authorization or step therapy may be required.
†Subject to terms and conditions of the Copay Support Program, available here.
This resource provides information from a complex and evolving medical coding system. The treating physician is solely responsible for diagnosis coding and determination of the appropriate ICD-10-CM codes that describe the patient’s condition and are supported by the medical record. All codes listed in this guide are for informational purposes and are not an exhaustive list. The CPT®, HCPCS, and ICD-10-CM codes provided are based on AMA or CMS guidelines. The billing party is solely responsible for coding of services (eg, CPT coding). Because government and other third-party payer coding requirements change periodically, please verify current coding requirements directly with the payer being billed.
G61* Inflammatory Polyneuropathy
G61.81† Chronic inflammatory demyelinating polyneuritis
*G61 code should not be used for reimbursement purposes.
†Coverage for maintenance treatment of CIDP with subcutaneous immunoglobulin is only eligible for coverage under Medicare Part B. Claims for Part D coverage will be denied.
The following HCPCS codes describe supplies (including drugs) rendered by the billing provider. CMS publishes and maintains the HCPCS code set.
These codes are entered to paper claim form CMS-1500 in Field 24 or to electronic claim form ASC 837P in Loop 2400, Segment SV101-2, with the Qualifier “HC” entered to Segment SV101-1, unless otherwise directed by the payer.
Hizentra: Immune Globulin Subcutaneous (Human), 20% liquid
HCPCS Code
J1559
Description
Injection, immune globulin (Hizentra), 100 mg
Ready-to-use Hizentra prefilled syringe sizes
Certain payers may require the entry of NDC information to the claim form, as directed by the payer.
| Grams protein | Fill size | Carton NDC number* |
|---|---|---|
| 1 g | 5 mL | 44206-0456-21 |
| 2 g | 10 mL | 44206-0457-22 |
| 4 g | 20 mL | 44206-0458-24 |
| 10 g | 50 mL | 44206-0455-25 |
*For billing requiring an 11-digit NDC, add the preceding 0 as shown above. Component NDC numbers can be found in the Prescribing Information.
If the billing provider performs administration services in conjunction with a patient’s infusion, the following administration codes may be used to bill for this service if the service meets the requirements of the code description.
| CPT Code† | Description |
|---|---|
| 96369 | Subcutaneous injection for therapy or prophylaxis; initial, up to 1 hour, including pump setup and establishment of subcutaneous infusion site(s) |
| 96370 | Each additional hour |
| 96371 | Additional pump setup with establishment of new subcutaneous infusion site(s) |
| S9338 | Home infusion therapy, immunotherapy, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
†CPT Copyright 2024 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.
| G-Code | Description |
|---|---|
| G0089 | Subcutaneous immunotherapy and other certain subcutaneous infusion drugs, initial encounter |
| G0069 | Subcutaneous immunotherapy and other certain subcutaneous infusion drugs, subsequent encounter |
Providers must be a qualified HIT supplier to bill for professional services.
Section 1861(iii)(3)(C) of the Act defines a “home infusion drug” as a parenteral drug or biological administered intravenously, or subcutaneously for an administration period of 15 minutes or more, in the home of an individual through a pump that is an item of durable medical equipment (as defined in section 1861(n) of the Act).
The professional visit G-code claim will recycle three times (with a 30-day look-back period) for a total of 15 business days. After 15 business days, if no J-code claim is found in claims history, the G-code claim will be denied.
The Medicare benefit for subcutaneous immune globulin administered by DME MACs applies only to those products that are specifically labeled as subcutaneous administration products.
Billing for External Pumps and Supplies
When the billing provider furnishes an external infusion pump for patient use, the following code may be used to bill for the pump if it meets the requirements of the code description.
External infusion pump
| HCPCS Code | Description |
|---|---|
| E0779* | Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater |
| E0781 | Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient |
| E0791 | Parenteral infusion pump, stationary, single or multichannel |
When the billing provider furnishes supplies for the patient’s use with the external infusion pump, the following codes may be appropriate for the supplies if they meet the requirements of the code description and payer coverage policies.
*This is the only payable pump code under Medicare Part B for delivery of Hizentra.
Professional services for drug infusion
| HCPCS Code | Description |
|---|---|
| G0069 | Professional services for the administration of subcutaneous immunotherapy for each infusion drug administration calendar day in the individual’s home, each 15 minutes |
External infusion pump supplies†
| HCPCS Code | Description |
|---|---|
| K0552 | Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each |
| A4221 | Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
| A4222 | Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
†For E0779, E0780, E0781, E0791 and K0455 pumps, either A4222 and/or K0552 may be billed.
Modifier -JB for Medicare billing
Medicare requires the addition of Modifier -JB (administered subcutaneously) to the HCPCS code for Hizentra (J1559) to confirm SC administration. Example: J1559-JB.
Commercial and Medicaid plans may require the use of the JB modifier. If required, JB should also be added to the HCPCS code for the covered infusion pump (E0779) following the modifier that indicates whether the pump is being rented (RR) or purchased (NU). Example: E0779-RR-JB or E0779-NU-JB. Always check with the plan to see if the modifier code is required.
Abbreviations: AMA, American Medical Association; CMS, Centers for Medicare & Medicaid Services; CIDP, chronic inflammatory demyelinating polyneuropathy; DME MACs, Durable Medical Equipment Medicare Administrative Contractors; HIT, home infusion therapy; HCPCS, Healthcare Common Procedure Coding System; ICD-10-CM, International Classification of Diseases, 10th Revision, Clinical Modification; IVIg, intravenous immunoglobulin; NDC, National Drug Code; PI, primary immunodeficiency; SCIg, subcutaneous immunoglobulin.
References: 1. Data on File. Available from CSL Behring as DOF HIZ-019. 2. GBS|CIDP Foundation International. Published July 16, 2021. Accessed September 10, 2026. https://www.gbs-cidp.org/2021/07/medicare-b-will-cover-an-immunoglobulin-therapy-for-patients-with-cidp-starting-july-18-2021/ 3. CSL Behring LLC. Guide to Insurance Coverage and Coding for Hizentra. Accessed July 29, 2026. https://www.Hizentra.com
IMPORTANT SAFETY INFORMATION
WARNING: Thrombosis may occur with immune globulin products, including Hizentra. Risk factors may include: advanced age, prolonged immobilization, hypercoagulable conditions, history of venous or arterial thrombosis, use of estrogens, indwelling vascular catheters, hyperviscosity, and cardiovascular risk factors.
For patients at risk of thrombosis, administer Hizentra at the minimum dose and infusion rate practicable. Ensure adequate hydration in patients before administration. Monitor for signs and symptoms of thrombosis and assess blood viscosity in patients at risk for hyperviscosity.
Hizentra is contraindicated in patients with a history of anaphylactic or severe systemic reaction to human immune globulin (Ig) or components of Hizentra (eg, polysorbate 80), as well as in patients with immunoglobulin A deficiency with antibodies against IgA and a history of hypersensitivity. Because Hizentra contains L-proline as stabilizer, use in patients with hyperprolinemia is contraindicated.
IgA-deficient patients with anti-IgA antibodies are at greater risk of severe hypersensitivity and anaphylactic reactions. Thrombosis may occur following treatment with Ig products, including Hizentra.
Monitor patients for aseptic meningitis syndrome (AMS), which may occur following treatment with Ig products, including Hizentra. In patients at risk of acute renal failure, monitor renal function, including blood urea nitrogen, serum creatinine and urine output. In addition, monitor patients for clinical signs of hemolysis or pulmonary adverse reactions (eg, transfusion-related acute lung injury [TRALI]).
Hizentra is derived from human blood. The risk of transmission of infectious agents, including viruses and, theoretically, the Creutzfeldt-Jakob disease (CJD) agent and its variant (vCJD), cannot be completely eliminated.
The most common adverse reactions (observed in ≥5% of study subjects) were local infusion-site reactions, as well as headache, diarrhea, fatigue, back pain, nausea, extremity pain, cough, upper respiratory tract infection, rash, pruritus, vomiting, upper abdominal pain, migraine, arthralgia, pain, fall, and nasopharyngitis.
The passive transfer of antibodies can interfere with response to live virus vaccines and lead to misinterpretation of serologic test results.
Indications
Hizentra®, Immune Globulin Subcutaneous (Human), 20% Liquid, is indicated for:
- Treatment of primary immunodeficiency (PI) in adults and pediatric patients 2 years and older.
- Maintenance therapy in adults with chronic inflammatory demyelinating polyneuropathy (CIDP) to prevent relapse of neuromuscular disability and impairment.
- Limitation of Use: Maintenance therapy in CIDP has been systematically studied for 6 months and for a further 12 months in a follow-up study. Continued maintenance beyond these periods should be individualized based on patient response and need for continued therapy.
For subcutaneous infusion only.
Please see full Prescribing Information for Hizentra including boxed warning.
To report SUSPECTED ADVERSE REACTIONS, contact the CSL Behring Pharmacovigilance Department at 1-866-915-6958 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
Hizentra is manufactured by CSL Behring AG and distributed by CSL Behring LLC.
Hizentra® is a registered trademark of CSL Behring AG.
Hizentra Connect℠ is a service mark of CSL Behring LLC.