J1552, Injection, immune globulin (alyglo), 500 mg
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Documentation Required
- Claims should reference and be supported by LCD L34580 and follow the billing/coding guidelines in this article; specific documentation requirements (e.g., medical records, prior authorization) are those detailed in LCD L34580.
- Claims missing required NOC narrative information or with incorrect unit reporting will be rejected as unprocessable and may show remark code M123.
- All documentation must be maintained in the patient's medical record, be legible, include complete patient identification and dates of service, and be produced upon contractor request.
- Medical records must include the legible signature of the physician or non-physician practitioner responsible for the care.
- The submitted medical record must support the ICD-10-CM code(s), the CPT/HCPCS code(s) billed, and the medical necessity of services as stated in the applicable NCD and LCD.
- Records should include relevant diagnostic laboratory studies, prior history of bleeding or infection, disease progression, prior medical/surgical therapies, vaccination response, and any other information essential to establish that the patient meets NCD/LCD coverage indications.
Key Coverage Criteria
- Billing and coding for intravenous immunoglobulin (IVIG) should follow the Local Coverage Determination (LCD) L34580 and the billing/coding guidelines in this article as a complement to that LCD.
- Billing and coding guidance in this article applies when immune globulin use meets the reasonable and necessary coverage criteria established in LCD L35093.
- IVIg (intravenous immune globulin) is covered when medically necessary as determined and documented by the treating physician, consistent with the associated Local Coverage Determination (LCD).
- 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.
- Coverage requires documentation that the immune globulin therapy is reasonable and necessary in accordance with LCD L34007 and applicable NCDs.
- IVIG is covered when the product is eligible under a Medicare benefit category, is reasonable and necessary for diagnosis or treatment per Social Security Act §1862(a)(1)(A), and meets all other applicable Medicare statutory and regulatory requirements and related LCD/Policy Article rules.
20 Active Policies
A57554, Billing and Coding: Immune Globulins
J5
WPS-L34771, Immune Globulins
J8
A57778, Billing and Coding: Immune Globulin
J9
FIRST_COAST-L34007, Immune Globulin
J9
NOVITAS-L35093, Immune Globulin
JH
PALMETTO-JJ-L34580, Intravenous Immunoglobulin (IVIG)
JJ
A56786, Billing and Coding: Immune Globulin
JL
PALMETTO-JM-L34580, Intravenous Immunoglobulin(IVIG)
JM
BCBSMT-ADM1001.034, Specialty Medication Administration Site of Care
A56718, Billing and Coding: Intravenous Immunoglobulin (IVIG)
BCBSNM-ADM1001.034, Specialty Medication Administration Site of Care
BCBSOK-RX504.003, Immunoglobulin Therapy
BCBSOK-ADM1001.034, Specialty Medication Administration Site of Care
UMR-POL-UMR-immune-globulin-ivig-scig, Immune Globulin (IVIG and SCIG)
UMR-POL-UMR-provider-administered-drugs-soc, Provider Administered Drugs – Site of Care
SUREST-POL-SUREST-immune-globulin-ivig-scig, Immune Globulin (IVIG and SCIG)
BCBSNM-RX504.003, Immunoglobulin Therapy
A57187, Billing and Coding: Immune Globulin Intravenous (IVIg)
L33610, Intravenous Immune Globulin
UHC-POL-immune-globulin-ivig-scig, Immune Globulin (IVIG and SCIG)
Related Codes
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