Does 96372 require prior authorization?

No, 96372 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 96372?

Medicare facility rate: $15.36. Non-facility rate: $15.36. Work RVU: 0.17.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.17

Facility

$15.36

Non-Facility

$15.36

Medical records must document the indication(s) supporting use of IVIG for each claim.
For indications where routine IVIG use is not indicated, the medical record must document prior interventions that were unsuccessful or reasons those interventions were not tolerated.
Documentation must support objective clinical response to IVIG for continued coverage.
Medical records must be made available to the Contractor upon request to substantiate coverage and payment.

IVIG is covered only for indications specified as covered in the related Local Coverage Determination (LCD) and when medical necessity criteria in that LCD are met.
Pegfilgrastim (J2506) is indicated to decrease the incidence of infection manifested by febrile neutropenia in patients with nonmyeloid malignancies receiving myelosuppressive chemotherapy associated with a clinically significant incidence of febrile neutropenia.
Pegfilgrastim may be administered via prefilled syringe or via an on-body injector (e.g., Neulasta Onpro or UDENYCA ONBODY) as approved delivery methods.
Same‑day administration (on the day of chemotherapy) may be allowed when patient or caregiver circumstances create a significant barrier to returning for next‑day dosing (for example, lack of transportation).
Intramuscular immune globulin (gamma globulin) is indicated for post-exposure prophylaxis to hepatitis A.
IG is indicated for measles (rubeola) post-exposure prophylaxis in susceptible patients exposed less than 3 days prior to treatment.

L34771 — Immune Globulins

J05

A57554 — Billing and Coding: Immune Globulins

J05

WPS-L34771 — Immune Globulins

J8 MAC Part B

NORIDIAN-L36538 — Treatment of Males with Low Testosterone

JF Part B

PALMETTO-L39086 — Treatment of Males with Low Testosterone

Ask Verity about documentation requirements, denial risks, or coverage in your state.