Does J0850 require prior authorization?

Yes, J0850 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

What is the Medicare reimbursement rate for J0850?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

Backwork Sign up free

`J0850`, Injection, cytomegalovirus immune globulin intravenous (human), per vial

HCPCS/CPT

Prior Authorization

Prior Auth Required

Conditional coverage; review criteria to confirm PA need (medium confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Medical records must document the indication(s) supporting use of IVIG for each claim.
For indications where routine IVIG use is not indicated, the medical record must document prior interventions that were unsuccessful or reasons those interventions were not tolerated.

For varicella prophylaxis, progress notes must document one of: personal history of leukemia/lymphoma, HIV infection, current immunosuppressive therapy, or a newborn exposure with documentation why newborn is at increased risk (e.g., maternal exposure within 5 days of delivery).

For tetanus immune serum, progress notes must identify that the wound is other than a clean minor wound and the date of injury, and must document that active tetanus immunization is unknown/uncertain, or <2 prior tetanus doses, or a ≥24-hour delay between injury and initiation of prophylaxis.

Key Coverage Criteria

IVIG is covered only for indications specified as covered in the related Local Coverage Determination (LCD) and when medical necessity criteria in that LCD are met.
IVIG may be indicated for pure red cell aplasia–related anemia.
Intramuscular immune globulin (gamma globulin) is indicated for post-exposure prophylaxis to hepatitis A.
IG is indicated for measles (rubeola) post-exposure prophylaxis in susceptible patients exposed less than 3 days prior to treatment.
IG is indicated for rubella prophylaxis in a woman in early pregnancy who is exposed and lacks immunity.
IVIG may be used for post-transfusion purpura and can be considered first-line for severely affected patients.

4 Active Policies

WPS-J5-L34771, Immune Globulins

A57554, Billing and Coding: Immune Globulins

WPS-J8-L34771, Immune Globulins

HEALTHNET_OR-HNOR-CYTOMEGALOVIRUS-IMMUNE-GLOBULIN-CYTOGAM-CP-PHAR-277-C8B3352344, Cytomegalovirus Immune Globulin (CytoGam); CP.PHAR.277

Have a follow-up question?

Ask Backwork about documentation requirements, denial risks, or coverage in your state.

Ask Backwork about J0850 Sign up free

J0850, Injection, cytomegalovirus immune globulin intravenous (human), per vial