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
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
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.
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
L34771 — Immune Globulins
J05
A57554 — Billing and Coding: Immune Globulins
J05
A57778 — Billing and Coding: Immune Globulin
J09
L34007 — Immune Globulin
J09
A56786 — Billing and Coding: Immune Globulin
Related Codes
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