J1573 — Injection, hepatitis b immune globulin (hepagam b), intravenous, 0.5 ml
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
- 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.
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.
- 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.
- IVIG may be covered only when dispensed and billed to Medicare by the same entity that actually dispenses the drug to the Medicare beneficiary and that entity is licensed to dispense drugs in the state where it is physically located.
- 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.
3 Active Policies
A57554 — Billing and Coding: Immune Globulins
J05
L34771 — Immune Globulins
J05
L33610 — Intravenous Immune Globulin
J19
Related Codes
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