Billing and Coding: Immune Globulin

Billing for immune globulin must follow LCD L34007 and applicable NCDs with medical-record documentation supporting ICD-10 and CPT/HCPCS coding and medical necessity. Specific billing rules include JA/JB modifiers for IV vs subcutaneous formulations (e.g., J1561/J1569), required narrative information and a single unit when billing NOC drugs (SV101-7 or CMS-1500 Item 19), and JW/JZ modifiers to report drug wastage or attest no wastage for Part B separately payable single-dose drugs, with defined exceptions for packaged or non-separately payable drugs.

"Coverage requires documentation that the immune globulin therapy is reasonable and necessary in accordance with LCD L34007 and applicable NCDs."

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