Billing and Coding: Intravenous Immune Globulin

Intravenous immune globulin (IVIG) is covered when treating physicians document medical necessity with required clinical data (history and physical, recent physician rationale, orders ≤30 days specifying dose/frequency/route/duration, weight in kg, labs and response to prior infusions). Specific covered indications include CVID with documented IgG levels and vaccine/titer nonresponse, HIV with ITP and platelet count <30,000 with active bleeding, immunodeficient patients with well-documented recurrent or chronic bacterial sinusitis, and stiff-man syndrome meeting diagnostic criteria and failed conservative therapy; IVIG is explicitly not covered for simple rhinosinusitis. Additional billing and documentation rules apply (valid ICD-10 diagnosis codes, ordering provider NPI, ABN modifiers GA/GX/GY/GZ and CMS-R-131 when applicable), and stiff-man syndrome initial dosing is limited to 2 g/kg per month.

"IVIG is covered for patients with common variable immunodeficiency (CVID) when initial presenting IgG levels, evidence of Pneumovax vaccination, and pre- and post-vaccine pneumococcal antibody tite..."