J1554, Injection, immune globulin (asceniv), 500 mg
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Documentation Required
- 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.
- Accurate patient weight in kilograms must be documented prior to infusion because immune globulin dosing is mg/kg based.
Key Coverage Criteria
- 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.
- Off-label IVIG use may be billed when supported by the applicable Local Coverage Determination (LCD) and by documentation of medical necessity; off-label is defined as not in Medicare-approved compendia or the FDA label.
- IVIG may be used in bone marrow/stem cell transplantation when the recipient was CMV seropositive before transplantation, or after allogeneic transplantation for hematologic neoplasm when both donor and recipient were CMV seronegative.
20 Active Policies
A57554, Billing and Coding: Immune Globulins
J5
A59105, Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)
J6
WPS-L34771, Immune Globulins
J8
A57778, Billing and Coding: Immune Globulin
J9
FIRST_COAST-L34007, Immune Globulin
J9
NORIDIAN-L34314, Immune Globulin Intravenous (IVIg)
JF
NOVITAS-L35093, Immune Globulin
JH
PALMETTO-JJ-L34580, Intravenous Immunoglobulin (IVIG)
JJ
NGS-L40181, Off-Label Use of Intravenous Immune Globulin (IVIG)
JK
NGS-L39314, Off-Label Use of Intravenous Immune Globulin (IVIG)
JK
A56786, Billing and Coding: Immune Globulin
JL
PALMETTO-JM-L34580, Intravenous Immunoglobulin(IVIG)
JM
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-ADM1001.034, Specialty Medication Administration Site of Care
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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