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Billing and Coding: Immune Globulin Intravenous (IVIg)
A57187
Effective: October 1, 2025
Updated: December 31, 2025
Policy Summary
This billing and coding guidance requires clear physician documentation of medical necessity to initiate and continue IVIg therapy and must be used with the associated Local Coverage Determination (LCD). Required documentation includes history and physical, office/progress notes, test results with interpretation, and an accurate weight in kilograms prior to infusion; specific coverage criteria, exclusions, and frequency limits are defined in the LCD.
Coverage Criteria Preview
Key requirements from the full policy
"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)."
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