J1599 — Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 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.
- 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.
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.
- 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.
- 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.
- IVIG may be used in solid organ transplantation when the donor was CMV seropositive and the recipient was CMV seronegative prior to transplantation.
- IVIG may be used for recurrent severe infections when there is documented severe or absent IgG subclass deficiency or clinically significant functional humoral immunity deficiency (failure to produce specific antibodies) with a history of recurrent infections.
20 Active Policies
A57554 — Billing and Coding: Immune Globulins
J05
L34771 — Immune Globulins
J05
L40181 — Off-Label Use of Intravenous Immune Globulin (IVIG)
J06
L39314 — Off-Label Use of Intravenous Immune Globulin (IVIG)
J06
A60187 — Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)
Related Codes
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