J1599, Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
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.
- Document results of pertinent tests/procedures; for diagnostic tests report the test result if known, otherwise report the symptoms that prompted the test.
- When using modifier -GA, an ABN (Form CMS-R-131) should be signed by the beneficiary to indicate acceptance of payment responsibility, and for claims submitted to the Part A MAC occurrence code 32 and the date of the ABN are required.
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 (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.
- 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.
20 Active Policies
CGS-L38268, Immune Thrombocytopenia (ITP) Therapy
J15
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
NORIDIAN-L34314, Immune Globulin Intravenous (IVIg)
JF
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
PALMETTO-JM-L34580, Intravenous Immunoglobulin(IVIG)
JM
BCBSMT-ADM1001.034, Specialty Medication Administration Site of Care
BCBSNM-RX504.003, Immunoglobulin Therapy
A56718, Billing and Coding: Intravenous Immunoglobulin (IVIG)
BCBSOK-RX504.003, Immunoglobulin Therapy
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
A57160, Billing and Coding: Immune Thrombocytopenia (ITP) Therapy
A57187, Billing and Coding: Immune Globulin Intravenous (IVIg)
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.