Parenteral Immunoglobulins

Aetna covers IVIG and SCIG (the policy's listed products) for specified primary antibody deficiencies — e.g., SCID or congenital agammaglobulinemia with genetic/molecular confirmation or low IgG (<200 mg/dL for SCID), CVID (age ≥2) with IgG <500 mg/dL or ≥2 SD below mean, and other antibody deficiencies — only when diagnostic criteria and lab thresholds are met (history of recurrent bacterial infections and impaired antibody response to pneumococcal polysaccharide vaccine, as specified). Precertification with Statement of Medical Necessity and Site of Care Utilization Management requirements apply for the listed products; IVIG/SCIG are investigational for any unlisted conditions, magnesium pre-medication (J3475) is not covered, and IM immunoglobulins are addressed under a separate policy.

"Chronic fatigue syndrome"

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