Local Coverage Article Billing and Coding

Billing and Coding: Intravenous Immunoglobulin (IVIG)

A56718

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Contractor Information

Article Information

General Information

Article ID
A56718
Article Title
Billing and Coding: Intravenous Immunoglobulin (IVIG)
Article Type
Billing and Coding
Original Effective Date
07/25/2019
Revision Effective Date
10/01/2022
Revision Ending Date
N/A
Retirement Date
N/A
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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) states that no payment shall be made to any provider for any claim which lacks the necessary information to process the claim.

Title XVIII of the Social Security Act, §1842(b)(18)(C) and (p)(1), describes payment for services that may be furnished by a practitioner. Requests for payment, or bills submitted shall include the appropriate diagnosis code(s).

CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 17, §80.6 Intravenous Immune Globulin.

CMS Internet-Only Manual, Pub. 100-08, Medicare Program Integrity Manual, Chapter 3, §3.4.1.3, Diagnosis Code Requirements.

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Intravenous Immunoglobulin (IVIG) L34580.

Note: With respect to HCPCS codes J2792 Injection, Rho D immune globulin (human), solvent detergent (WINRho) and J2791 Injection immune globulin (human), (Rhophylac), this article only addresses their use intravenously.

Coding Information

CPT/HCPCS Codes

Group 1

(12 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
J1459 INJECTION, IMMUNE GLOBULIN (PRIVIGEN), INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), 500 MG
J1554 INJECTION, IMMUNE GLOBULIN (ASCENIV), 500 MG
J1556 INJECTION, IMMUNE GLOBULIN (BIVIGAM), 500 MG
J1557 INJECTION, IMMUNE GLOBULIN, (GAMMAPLEX), INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), 500 MG
J1561 INJECTION, IMMUNE GLOBULIN, (GAMUNEX-C/GAMMAKED), NON-LYOPHILIZED (E.G., LIQUID), 500 MG
J1566 INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G., POWDER), NOT OTHERWISE SPECIFIED, 500 MG
J1568 INJECTION, IMMUNE GLOBULIN, (OCTAGAM), INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), 500 MG
J1569 INJECTION, IMMUNE GLOBULIN, (GAMMAGARD LIQUID), NON-LYOPHILIZED, (E.G., LIQUID), 500 MG
J1572 INJECTION, IMMUNE GLOBULIN, (FLEBOGAMMA/FLEBOGAMMA DIF), INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), 500 MG
J1599 INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), NOT OTHERWISE SPECIFIED, 500 MG
J2791 INJECTION, RHO(D) IMMUNE GLOBULIN (HUMAN), (RHOPHYLAC), INTRAMUSCULAR OR INTRAVENOUS, 100 IU
J2792 INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN, SOLVENT DETERGENT, 100 IU

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(198 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
A85.8 Other specified viral encephalitis
B08.3 Erythema infectiosum [fifth disease]
B20 Human immunodeficiency virus [HIV] disease
B25.0 Cytomegaloviral pneumonitis
B25.1 Cytomegaloviral hepatitis
B25.2 Cytomegaloviral pancreatitis
B25.8 Other cytomegaloviral diseases
B25.9 Cytomegaloviral disease, unspecified
C88.0 Waldenstrom macroglobulinemia
C90.00 Multiple myeloma not having achieved remission
C90.02 Multiple myeloma in relapse
C91.10 Chronic lymphocytic leukemia of B-cell type not having achieved remission
C91.11 Chronic lymphocytic leukemia of B-cell type in remission
C91.12 Chronic lymphocytic leukemia of B-cell type in relapse
D47.3 Essential (hemorrhagic) thrombocythemia
D55.0 Anemia due to glucose-6-phosphate dehydrogenase [G6PD] deficiency
D55.1 Anemia due to other disorders of glutathione metabolism
D55.21 Anemia due to pyruvate kinase deficiency
D55.29 Anemia due to other disorders of glycolytic enzymes
D55.3 Anemia due to disorders of nucleotide metabolism
D55.8 Other anemias due to enzyme disorders
D55.9 Anemia due to enzyme disorder, unspecified
D56.0 Alpha thalassemia
D56.1 Beta thalassemia
D56.2 Delta-beta thalassemia
D56.3 Thalassemia minor
D56.4 Hereditary persistence of fetal hemoglobin [HPFH]
D56.5 Hemoglobin E-beta thalassemia
D56.8 Other thalassemias
D56.9 Thalassemia, unspecified
D57.00 Hb-SS disease with crisis, unspecified
D57.01 Hb-SS disease with acute chest syndrome
D57.02 Hb-SS disease with splenic sequestration
D57.03 Hb-SS disease with cerebral vascular involvement
D57.09 Hb-SS disease with crisis with other specified complication
D57.1 Sickle-cell disease without crisis
D57.20 Sickle-cell/Hb-C disease without crisis
D57.211 Sickle-cell/Hb-C disease with acute chest syndrome
D57.212 Sickle-cell/Hb-C disease with splenic sequestration
D57.213 Sickle-cell/Hb-C disease with cerebral vascular involvement
D57.218 Sickle-cell/Hb-C disease with crisis with other specified complication
D57.219 Sickle-cell/Hb-C disease with crisis, unspecified
D57.3 Sickle-cell trait
D57.80 Other sickle-cell disorders without crisis
D57.811 Other sickle-cell disorders with acute chest syndrome
D57.812 Other sickle-cell disorders with splenic sequestration
D57.813 Other sickle-cell disorders with cerebral vascular involvement
D57.818 Other sickle-cell disorders with crisis with other specified complication
D57.819 Other sickle-cell disorders with crisis, unspecified
D58.0 Hereditary spherocytosis
D58.1 Hereditary elliptocytosis
D58.2 Other hemoglobinopathies
D58.8 Other specified hereditary hemolytic anemias
D58.9 Hereditary hemolytic anemia, unspecified
D59.0 Drug-induced autoimmune hemolytic anemia
D59.11 Warm autoimmune hemolytic anemia
D59.12 Cold autoimmune hemolytic anemia
D59.13 Mixed type autoimmune hemolytic anemia
D59.9 Acquired hemolytic anemia, unspecified
D61.01 Constitutional (pure) red blood cell aplasia
D61.810 Antineoplastic chemotherapy induced pancytopenia
D61.811 Other drug-induced pancytopenia
D61.818 Other pancytopenia
D69.0 Allergic purpura
D69.3 Immune thrombocytopenic purpura
D69.41 Evans syndrome
D69.42 Congenital and hereditary thrombocytopenia purpura
D69.49 Other primary thrombocytopenia
D80.0 Hereditary hypogammaglobulinemia
D80.1 Nonfamilial hypogammaglobulinemia
D80.3 Selective deficiency of immunoglobulin G [IgG] subclasses
D80.5 Immunodeficiency with increased immunoglobulin M [IgM]
D80.6 Antibody deficiency with near-normal immunoglobulins or with hyperimmunoglobulinemia
D80.7 Transient hypogammaglobulinemia of infancy
D80.8 Other immunodeficiencies with predominantly antibody defects
D80.9 Immunodeficiency with predominantly antibody defects, unspecified
D81.0 Severe combined immunodeficiency [SCID] with reticular dysgenesis
D81.1 Severe combined immunodeficiency [SCID] with low T- and B-cell numbers
D81.2 Severe combined immunodeficiency [SCID] with low or normal B-cell numbers
D81.4 Nezelof's syndrome
D81.6 Major histocompatibility complex class I deficiency
D81.7 Major histocompatibility complex class II deficiency
D81.82 Activated Phosphoinositide 3-kinase Delta Syndrome [APDS]
D81.89 Other combined immunodeficiencies
D81.9 Combined immunodeficiency, unspecified
D82.0 Wiskott-Aldrich syndrome
D82.1 Di George's syndrome
D82.2 Immunodeficiency with short-limbed stature
D82.3 Immunodeficiency following hereditary defective response to Epstein-Barr virus
D82.4 Hyperimmunoglobulin E [IgE] syndrome
D82.8 Immunodeficiency associated with other specified major defects
D82.9 Immunodeficiency associated with major defect, unspecified
D83.0 Common variable immunodeficiency with predominant abnormalities of B-cell numbers and function
D83.1 Common variable immunodeficiency with predominant immunoregulatory T-cell disorders
D83.2 Common variable immunodeficiency with autoantibodies to B- or T-cells
D83.8 Other common variable immunodeficiencies
D83.9 Common variable immunodeficiency, unspecified
D84.0 Lymphocyte function antigen-1 [LFA-1] defect
D84.1 Defects in the complement system
D84.9 Immunodeficiency, unspecified
D89.3 Immune reconstitution syndrome
D89.810 Acute graft-versus-host disease
D89.811 Chronic graft-versus-host disease
D89.812 Acute on chronic graft-versus-host disease
D89.813 Graft-versus-host disease, unspecified
D89.82 Autoimmune lymphoproliferative syndrome [ALPS]
D89.831 Cytokine release syndrome, grade 1
D89.832 Cytokine release syndrome, grade 2
D89.833 Cytokine release syndrome, grade 3
D89.834 Cytokine release syndrome, grade 4
D89.835 Cytokine release syndrome, grade 5
D89.839 Cytokine release syndrome, grade unspecified
D89.89 Other specified disorders involving the immune mechanism, not elsewhere classified
D89.9 Disorder involving the immune mechanism, unspecified
G04.81 Other encephalitis and encephalomyelitis
G13.0 Paraneoplastic neuromyopathy and neuropathy
G13.1 Other systemic atrophy primarily affecting central nervous system in neoplastic disease
G25.82 Stiff-man syndrome
G35 Multiple sclerosis
G60.3 Idiopathic progressive neuropathy
G61.0 Guillain-Barre syndrome
G61.81 Chronic inflammatory demyelinating polyneuritis
G61.82 Multifocal motor neuropathy
G61.89 Other inflammatory polyneuropathies
G62.81 Critical illness polyneuropathy
G62.89 Other specified polyneuropathies
G64 Other disorders of peripheral nervous system
G70.00 Myasthenia gravis without (acute) exacerbation
G70.01 Myasthenia gravis with (acute) exacerbation
G70.80 Lambert-Eaton syndrome, unspecified
G70.81 Lambert-Eaton syndrome in disease classified elsewhere
G70.9 Myoneural disorder, unspecified
G72.49 Other inflammatory and immune myopathies, not elsewhere classified
G72.81 Critical illness myopathy
G73.1 Lambert-Eaton syndrome in neoplastic disease
G73.3 Myasthenic syndromes in other diseases classified elsewhere
H54.7 Unspecified visual loss
L10.0 Pemphigus vulgaris
L10.1 Pemphigus vegetans
L10.2 Pemphigus foliaceous
L10.3 Brazilian pemphigus [fogo selvagem]
L10.4 Pemphigus erythematosus
L10.5 Drug-induced pemphigus
L10.81 Paraneoplastic pemphigus
L10.89 Other pemphigus
L10.9 Pemphigus, unspecified
L12.0 Bullous pemphigoid
L12.1 Cicatricial pemphigoid
L12.8 Other pemphigoid
L12.9 Pemphigoid, unspecified
L13.8 Other specified bullous disorders
L95.0 Livedoid vasculitis
L95.9 Vasculitis limited to the skin, unspecified
M30.3 Mucocutaneous lymph node syndrome [Kawasaki]
M33.00 Juvenile dermatomyositis, organ involvement unspecified
M33.01 Juvenile dermatomyositis with respiratory involvement
M33.02 Juvenile dermatomyositis with myopathy
M33.03 Juvenile dermatomyositis without myopathy
M33.09 Juvenile dermatomyositis with other organ involvement
M33.10 Other dermatomyositis, organ involvement unspecified
M33.11 Other dermatomyositis with respiratory involvement
M33.12 Other dermatomyositis with myopathy
M33.13 Other dermatomyositis without myopathy
M33.19 Other dermatomyositis with other organ involvement
M33.20 Polymyositis, organ involvement unspecified
M33.21 Polymyositis with respiratory involvement
M33.22 Polymyositis with myopathy
M33.29 Polymyositis with other organ involvement
M33.90 Dermatopolymyositis, unspecified, organ involvement unspecified
M33.91 Dermatopolymyositis, unspecified with respiratory involvement
M33.92 Dermatopolymyositis, unspecified with myopathy
M33.93 Dermatopolymyositis, unspecified without myopathy
M33.99 Dermatopolymyositis, unspecified with other organ involvement
M36.0 Dermato(poly)myositis in neoplastic disease
R78.81 Bacteremia
T86.10 Unspecified complication of kidney transplant
T86.11 Kidney transplant rejection
T86.12 Kidney transplant failure
T86.13 Kidney transplant infection
T86.19 Other complication of kidney transplant
T86.21 Heart transplant rejection
T86.22 Heart transplant failure
T86.23 Heart transplant infection
T86.298 Other complications of heart transplant
T86.5 Complications of stem cell transplant
Z41.8 Encounter for other procedures for purposes other than remedying health state
Z48.21 Encounter for aftercare following heart transplant
Z48.22 Encounter for aftercare following kidney transplant
Z48.23 Encounter for aftercare following liver transplant
Z48.24 Encounter for aftercare following lung transplant
Z48.280 Encounter for aftercare following heart-lung transplant
Z48.288 Encounter for aftercare following multiple organ transplant
Z48.290 Encounter for aftercare following bone marrow transplant
Z48.298 Encounter for aftercare following other organ transplant
Z94.0 Kidney transplant status
Z94.1 Heart transplant status
Z94.81 Bone marrow transplant status
Z94.84 Stem cells transplant status

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

N/A

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
10/01/2022 R13

Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes added D81.82. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/1/22.

07/07/2022 R12

Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes added code G72.49.

10/01/2021 R11

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added codes A85.8 and G04.81.

This revision has a retroactive effective date of 10/1/2020.

10/01/2021 R10

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes deleted code D55.2 and added codes D55.21 and D55.29. This revision is due to the Annual ICD-10 update and is effective on 10/1/21.

08/05/2021 R9

Under CPT/HCPCS Codes Group 1: Codes added code J1554. This revision has a retro-effective date of 4/1/21.

07/15/2021 R8

Under ICD-10 Codes that Support Medical Necessity – Group 1: Codes added codes D59.11, D59.12 and D59.13.

This revision has a retro-effective date of 10/1/20.

07/01/2021 R7

Under CMS National Coverage Policy removed regulation CMS Internet-Only Manual, Pub. 100-20, One-Time Notification, Change Request 6337, Transmittal 477, dated April 24, 2009.

10/04/2020 R6

Under ICD-10 Codes that Support Medical Necessity – Group 1: Codes added code G72.81. This revision has a retro-effective date of 10/4/20.

10/04/2020 R5

With Revision #4, ICD-10 codes C90.00, C90.02, D61.01 and T86.5 were added under ICD-10 Codes that Support Medical Necessity Group 1: Codes. This revision is effective 10/4/20.

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added C88.0. This revision is effective 10/4/20.

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes deleted D59.1 and D84.8 and added D57.03, D57.09, D57.213, D57.218, D57.813, D57.818, D89.831, D89.832, D89.833, D89.834, D89.835 and D89.839. This revision is due to the Annual ICD-10 Code Update and is effective on 10/1/20.

10/04/2020 R4

The related Intravenous Immunoglobulin (IVIG) L34580 LCD is being presented for notice. No comments were received during the comment period; therefore, no changes have been made.

01/31/2020 R3

Under Article Text added the verbiage “(IVIG)” to the first sentence. Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added G70.80, G70.81, G73.1, T86.21, T86.22, T86.23, T86.298 and Z94.1.

10/10/2019 R2

This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of the related Intravenous Immunoglobulin (IVIG) L34580 LCD and placed in this article.

07/25/2019 R1

All coding located in the Coding Information section has been removed from the related Intravenous Immunoglobulin (IVIG) L34580 LCD and added to this article.

Associated Documents

Related Local Coverage Documents
LCDs
L34580 - Intravenous Immunoglobulin (IVIG)
Related National Coverage Documents
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Statutory Requirements URLs
N/A
Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
08/26/2022 10/01/2022 - N/A Currently in Effect You are here
05/25/2022 07/07/2022 - 09/30/2022 Superseded View
10/01/2021 10/01/2021 - 07/06/2022 Superseded View
08/23/2021 10/01/2021 - N/A Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • IVIG
  • Intravenous Immunoglobulin