J1560 — Injection, gamma globulin, intramuscular, over 10 cc
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
- Signed and dated office visit records and operative reports are required; all services ordered or rendered to Medicare beneficiaries must be signed.
- For services requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
- The patient's medical record must include the ordering provider's assessment related to the patient's complaint for that visit and relevant medical history.
- Document results of pertinent tests/procedures; for diagnostic tests report the test result if known, otherwise report the symptoms that prompted the test.
Key Coverage Criteria
- 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.
- 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.
- IG is indicated for rubella prophylaxis in a woman in early pregnancy who is exposed and lacks immunity.
- IVIG may be used for post-transfusion purpura and can be considered first-line for severely affected patients.
- Varicella-zoster immune globulin is indicated for passive immunization of immunosuppressed, exposed susceptible individuals when varicella zoster immunoglobulin is not available.
6 Active Policies
A57554 — Billing and Coding: Immune Globulins
J05
L34771 — Immune Globulins
J05
CGS-L38268 — Immune Thrombocytopenia (ITP) Therapy
J18 MAC Part B
WPS-L34771 — Immune Globulins
J8 MAC Part B
A57160 — Billing and Coding: Immune Thrombocytopenia (ITP) Therapy
Related Codes
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