HCPCS J1573 is officially defined as "Injection, hepatitis b immune globulin (hepagam b), intravenous, 0.5 ml." HCPCS J1573 is referenced in 3 tracked payer policy changes from Texas Medicaid and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS J1573 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Starting April 1, 2026, Texas Medicaid's CSHCN Services Program will only reimburse one of the three immune globulin procedure codes (J1571, J1573, or 90371) when billed on the same date of service by any provider. This prevents duplicate billing for immune globulin treatments.
Aetna considers immune globulins medically necessary for hepatitis B, cytomegalovirus, Rho-D, rabies, varicella zoster, tetanus, vaccinia, botulism, hepatitis A, measles (rubeola) and rubella exposures or conditions, and considers all other indications experimental, investigational, or unproven. Each product has its own initial criteria, such as hepatitis B immune globulin for members who had contact with an individual diagnosed with hepatitis B virus, Rho-D immune globulin for unsensitized Rh-negative women at 24 to 28 weeks gestation unless the father is known to be Rh-negative, and varicella zoster immune globulin for high-risk individuals with significant exposure to varicella. Continuation of therapy for each product is considered medically necessary for all members, including new members, who meet all initial medical necessity criteria.
Reviewed 2025-12-23, Aetna Clinical Policy Bulletin 0544 covers immune globulin products for post-exposure prophylaxis and treatment, including hepatitis B, cytomegalovirus, Rho(D), rabies, varicella zoster, tetanus, measles, rubella, vaccinia, and botulism immune globulins. For each product the policy lists the indications it considers medically necessary and states that all other indications are experimental, investigational, or unproven. Continuation of therapy is considered medically necessary for all members, including new members, who meet the initial criteria. Immune globulin intramuscular injection (GamaSTAN) requires precertification.
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