Hizentra (SCIG 20%) — HCPCS J1559
CareCost Estimate · Billing Cheat Sheet
CSL Behring
20% (200 mg/mL) liquid · 1g, 2g, 4g, 10g vials
Subcutaneous pump (NOT IV)
Reviewed: May 3, 2026
ASP: Q2 2026
HCPCS
J1559
1 unit = 100 mg (NOT 500)
PI Weekly
~70 units
100 mg/kg/wk (70 kg)
Modifier
JZ
Single-dose vial
Admin CPT
96369+96370
SCIG pump (not 96365)
Medicare ASP+6%
$14.515
/100 mg unit · $145/g
BILLER TRAPS: (1) J1559 = 100 mg per unit (different from IVIG codes which use 500 mg). (2) SCIG admin codes are 96369/96370/96371 (pump infusion) — NOT 96365/96366 (IV) and NOT 96372 (SC injection).
Codes & NDC
| HCPCS | J1559 — "Hizentra injection" (1 unit = 100 mg) |
|---|
| Concentration | 20% liquid (200 mg/mL) — 2× the IgG/mL of IVIG 10% |
|---|
| Vial sizes | 1 g/5 mL, 2 g/10 mL, 4 g/20 mL, 10 g/50 mL |
|---|
| Storage | Refrigerate 2-8°C; room temp up to 30 mo per current label |
|---|
SCIG admin codes (CRITICAL)
| Code | When |
|---|
96369 | SC infusion via mechanical pump, initial up to 1 hr |
96370 | Each additional hr |
96371 | Add'l pump set-up (e.g., 2nd site, 2nd pump) |
NOT 96372 (that's manual SC injection, not pump). NOT 96365/96366 (IV). Most billers initially miscode SCIG with IV codes — 96369-96371 are SCIG-specific.
Indication-specific dosing
| Indication | Dose | Schedule |
|---|
| PI conversion from IVIG | 1.37 × IVIG monthly ÷ 4 | Weekly |
| PI maint. | 100-200 mg/kg/wk | Weekly typical |
| CIDP maint. | 200-400 mg/kg/wk | Weekly (after IVIG induction) |
| Frequency | weekly / biweekly / daily push | Patient preference |
Hizentra: 1st SCIG with FDA-approved CIDP maintenance indication (2018).
SCIG vs IVIG comparison
| Factor | SCIG (Hizentra) | IVIG |
|---|
| Frequency | Weekly | q3-4wk |
| Trough variation | Low (steady state) | High (peak/trough) |
| Side effects | Local (site rxn) | Systemic (HA, infusion rxn) |
| Setting | Home (POS 12) | Office/AIC/home |
| Per-mg cost | $0.145/mg | ~$0.099/mg |
ICD-10
| Code | For |
|---|
D80.x | PI — antibody defects |
D81.x | PI — combined |
D82.x | PI — other |
G61.81 | CIDP (Hizentra maintenance indication) |
Home self-administration (the norm)
- Patient training required (typically 1-3 sessions with infusion nurse)
- Multiple infusion sites per session (abdomen, thighs)
- 60-120 min per session via mechanical pump
- Major billing impact: home health vs office (POS 12 most common)
- Some plans: DME benefit (pump) + medical benefit (drug)
SCIG brand interchangeability
| Brand | HCPCS | Mfr |
|---|
| Hizentra 20% | J1559 | CSL Behring |
| Cuvitru 20% | J1555 | Takeda |
| Cutaquig 16.5% | J1551 | Octapharma |
| Xembify 20% | J1558 | Grifols |
| Gamunex-C SC | J1561 | Grifols (also IV) |
Payer requirements (May 2026)
| Payer | PA | Requirements |
|---|
| UnitedHealthcare | Yes | PI/CIDP dx + IgG levels + training docs; SCIG often preferred over IVIG for stable patients |
| Aetna | Yes | Same + step from IVIG attempt may apply |
| Cigna | Yes | Home infusion vendor |
| Medicare LCD | Yes | FDA-approved indication; DME pump benefit separate |
Medicare reimbursement (Q2 2026)
| Field | Value |
|---|
| ASP + 6% | $14.515 / 100 mg unit = $145.15/g |
| 7 g weekly (70 kg, 100 mg/kg) | $1,016.05 |
| 14 g weekly (CIDP 200 mg/kg) | $2,032.10 |
| Annual (PI, weekly) | ~$52,835 |
Patient assistance — CSL Behring
- Phone: 1-877-355-IGIV (1-877-355-4448) AssureSupport
- Hizentra Co-pay Assistance Program (commercial)
- CSL patient assistance for uninsured / Medicare income-tested
Pending SME review. Verify against current CSL label, UHC SCIG LCD, and CMS ASP file at billing time.