J2791 — Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or intravenous, 100 iu
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 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.
- IVIG is covered for hyperimmunoglobulinemia E (hyper-IgE) syndrome.
- IVIG is covered for Lambert-Eaton myasthenic syndrome (LEMS).
- IVIG is covered for multifocal motor neuropathy (MMN).
7 Active Policies
CGS-L38268 — Immune Thrombocytopenia (ITP) Therapy
J18 MAC Part B
L33610 — Intravenous Immune Globulin
J19
PALMETTO-L34580 — Intravenous Immunoglobulin (IVIG)
JJ Part B
L34580 — Intravenous Immunoglobulin (IVIG)
A57160 — Billing and Coding: Immune Thrombocytopenia (ITP) Therapy
Related Codes
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