HCPCS Level II › J codes J2792 Rho(d) immune globulin h, sdInjection, rho d immune globulin, intravenous, human, solvent detergent, 100 iu
Medicare coverage: Special coverage instructions apply Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 450 units per day (clinical), rationale: Prescribing Information Outpatient hospital: max 450 units per day (clinical), rationale: Prescribing Information DME supplier: max 0 units per day (clinical), rationale: CMS Policy Medicare pricing for J2792 Medicare Part B drug payment limit (ASP, October 2026) J2792 payment limit: $35.395 per 100 IU, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.
NDCs that bill under J2792 (CMS ASP NDC-HCPCS crosswalk, October 2026) 49591-0300-51 Winrho SDF, Kamada Ltd.: 150 billing units per package49591-0330-51 Winrho SDF, Kamada Ltd.: 15 billing units per package (1 VIAL, GLASS in 1 CARTON / 1.3 mL in 1 VIAL, GLASS)49591-0350-51 Winrho SDF, Kamada Ltd.: 25 billing units per package70257-0310-51 Winrho SDF, Kamada Ltd.: 50 billing units per package70257-0330-51 Winrho SDF, Kamada Ltd.: 15 billing units per package70257-0350-51 Winrho SDF, Kamada Ltd.: 25 billing units per packagePhysician Fee Schedule (CY 2026, RVU26D) Status E: excluded from the PFS by regulation.
Payer policies and prior authorization for J2792 Payer coverage policies that name J2792 J2792 appears in 4 coverage policies from Aetna, Premera Blue Cross.
Payer Policy Role in policy Reviewed Document Aetna Graves' Ophthalmopathy Treatments (0419)Celecoxib, Gypenosides, Pioglitazone not covered Apr 23, 2026 payer document Aetna Immune Globulins for Post-Exposure Prophylaxis (0544) covered if criteria are met Oct 7, 2026 payer document Aetna Injectable Medications (0020) listed, no stance (range J2550-J3520) Mar 5, 2026 payer document Premera Blue Cross Pharmacotherapy of Thrombocytopenia (5.01.566) listed, no stance May 25, 2026 payer document
Medicaid fee-for-service AZ: $32.21 (asc), effective Oct 1, 2026 FL: $450.00 (physician_administered_drugs), effective Jan 1, 2026 IL: $34.26 (practitioner), effective Apr 1, 2026 IN: $34.24 (professional, Advanced Practice Nurse (85%), non-facility), effective Apr 1, 2026 KS: $35.40 (default), effective Oct 1, 2026 KY: $33.91 (asc), effective Jan 1, 2026 LA: $35.79 (professional), effective Jul 1, 2026 MS: $24.62 (comprehensive, facility), effective Oct 1, 2025 NE: $35.79 (injectables), effective Jul 1, 2026 OH: $34.26 (provider_administered_drugs), effective Jul 1, 2026 OK: $35.79 (physician, non-facility), effective Jul 1, 2026 TX: $33.91 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Sep 1, 2026 VA: $35.79 (medical), effective Jul 1, 2026 VT: $19.35 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $35.79 (professional_administered_drugs), effective Jul 1, 2026 WY: $14.83 (outpatient_hospital_apc, Ambulatory Surgical Centers), effective Apr 1, 2026 From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.