Octagam (immune globulin IV) — HCPCS J1568
CareCost Estimate · Billing Cheat Sheet
Octapharma USA
Octagam 5% liquid + Octagam 10% liquid (single-dose bottles)
IV infusion (non-chemo)
Reviewed: May 2, 2026
ASP: Q2 2026
UNIT TRAP — J1568 = 1 unit per 500 mg (NOT per mg). A 30 g (30,000 mg) dose = 60 units, not 30,000. Always divide total mg by 500.
HCPCS
J1568
1 unit = 500 mg
PI dose (typical)
56 units
28 g · 70 kg × 400 mg/kg
Modifier
JZ
JW for partial-bottle waste
Admin CPT
96365
+ 96366 (each addl. hr) · non-chemo
Medicare ASP+6%
$47.035
/500 mg unit · $0.094/mg
LOWEST-COST MAJOR IVIG on Q2 2026 ASP+6% — Octagam $47.035 vs Privigen $49.533, Gammagard Liquid $49.081, Gamunex-C $49.726 (per 500 mg unit).
Octagam 5% vs Octagam 10% — both bill J1568
| 5% liquid | 10% liquid |
|---|
| Conc. | 50 mg/mL | 100 mg/mL |
| PI | Yes | Yes |
| ITP | Yes (chronic) | Per label |
| Dermatomyositis | NO | YES (Aug 2021, first IVIG) |
| Rate (init.) | 0.01 mL/kg/min | 0.5 mg/kg/min |
| Rate (max) | 0.04 mL/kg/min | 12 mg/kg/min |
| Bottles | 1g, 2.5g, 5g, 10g, 25g | 1g, 2g, 5g, 10g, 20g, 30g |
| FDA approval | 2004 | 2014 PI/ITP; 2021 DM |
Indication-specific dosing
| Indication | Form. | Dose |
|---|
| Primary humoral immunodeficiency (PI) | 5% | 300–600 mg/kg q3–4 wk (target IgG trough 500–1000 mg/dL) |
| Chronic ITP | 5% | 1 g/kg/day × 1–2 days |
| Adult dermatomyositis | 10% | 2 g/kg per cycle, divided over 2–5 days, q4 weeks |
DM cycle math: 70 kg × 2 g/kg = 140 g = 280 units per cycle (split across 2–5 infusion days; bill per-day).
Unit conversion cheat sheet
| Dose | = mg | = units |
|---|
| 5 g | 5,000 | 10 |
| 10 g | 10,000 | 20 |
| 20 g | 20,000 | 40 |
| 28 g (PI 70 kg × 400 mg/kg) | 28,000 | 56 |
| 70 g (ITP 70 kg × 1 g/kg) | 70,000 | 140 |
| 140 g (DM 70 kg × 2 g/kg) | 140,000 | 280 |
Common error: Billing mg as units = 1,000× overbill. Always divide by 500.
Administration & modifiers
| Code | When |
|---|
96365 | Therapeutic IV, initial hour (primary) — non-chemo |
96366 | Each additional hour (typical IVIG runs 2–6 hr) |
96413/96415 | NOT appropriate — IVIG is non-chemo |
| Multi-day DM cycles: Bill 96365 + 96366 + J1568 each infusion day separately |
JZ/JW: JZ on every adult claim with no waste; JW on the discarded portion when partial-bottle remainder. Required since 7/1/2023.
ICD-10
| Code | For |
|---|
D80.x / D81.x / D82.x / D83.x | Primary humoral immunodeficiency (PI) |
D69.3 | Chronic ITP |
M33.10–M33.19 | Other dermatomyositis (most adult DM, Octagam 10%) |
M33.00–M33.09 | Juvenile dermatomyositis |
M33.20–M33.29 | Polymyositis with myopathy |
M33.90–M33.99 | Dermatopolymyositis, unspecified |
Brand interchangeability — Q2 2026 ASP+6%
| Brand | HCPCS | ASP+6% / 500 mg | DM? |
|---|
| Octagam (5%/10%) | J1568 | $47.035 (lowest) | 10% — first IVIG (2021) |
| Privigen (10%) | J1459 | ~$49.533 | Yes (added later) |
| Gammagard Liquid | J1569 | ~$49.081 | No |
| Gamunex-C / Gammaked | J1561 | ~$49.726 | No |
| Flebogamma DIF | J1572 | ~$48.5 | No |
Payer overrides common: Many commercials mandate Privigen / Gammagard / Gamunex-C per contract. Verify formulary before infusing.
Payer requirements (May 2026)
| Payer | PA | Brand / Site |
|---|
| UnitedHealthcare | Yes | Brand-agnostic; DM requires FDA-labeled IVIG; aggressive HOPD→home/AIC steerage (Optum) |
| Aetna | Yes | CPB 0206; site-of-care policy → AIC/home |
| Cigna | Yes | Coverage Policy 1206; Carelon site-of-care UM |
| BCBS plans | Yes | Plan-specific; FDA-labeled brand for DM commonly required |
Site of care
| Setting | POS | Notes |
|---|
| Home infusion | 12 | Preferred for stable PI |
| Ambulatory infusion (AIC) | 49 | Preferred for ITP, DM cycles |
| Physician office | 11 | Common (rheum, immuno) |
| Hospital outpatient | 22/19 | Disfavored after first 1–3 cycles |
Medicare reimbursement (Q2 2026)
| Field | Value |
|---|
| ASP + 6% per unit | $47.035 / 500 mg unit (= $0.094 / mg) |
| PI dose (28 g = 56 units) | $2,633.96 |
| ITP day (70 g = 140 units) | $6,584.90 |
| DM cycle (140 g = 280 units) | $13,169.80 |
| PI annual (728 units, 13 doses) | ~$34,242 |
Patient assistance — Octapharma OneSource
- Phone: 1-888-429-4535 (Octapharma OneSource)
- Benefits investigation, PA assistance, appeal support
- Commercial copay assistance for eligible patients
- Free drug program for uninsured / underinsured
- Foundations (Medicare): PAN, HealthWell, PAF — verify open IVIG funds quarterly
BOXED WARNING — thrombosis, renal dysfunction, acute renal failure (class warning all IVIG). Hydrate adequately. Slow infusion in elderly, renal impairment, thrombotic risk. Monitor renal function baseline + during therapy.
Pending SME review. Staff-authored from FDA, CMS, Octapharma, payer policies. Final review review in progress.