Does J1599 require prior authorization?

No, J1599 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for J1599?

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

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`J1599`, Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Treating physician must clearly document medical necessity to initiate IVIg therapy and the continued need for ongoing therapy in the medical record.
Include a History and Physical (H&P) in the medical record supporting IVIg therapy.
Include office and/or progress notes that document clinical status, response, and ongoing need for IVIg.
Provide relevant test results with written interpretation supporting the indication for IVIg.
Record an accurate patient weight in kilograms prior to each infusion because IVIg dosing is calculated in mg/kg.
Medical records must document the indication(s) supporting use of IVIG for each claim.

Key Coverage Criteria

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).
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.
Off-label IVIG use may be billed when supported by the applicable Local Coverage Determination (LCD) and by documentation of medical necessity; off-label is defined as not in Medicare-approved compendia or the FDA label.
IVIG may be used in bone marrow/stem cell transplantation when the recipient was CMV seropositive before transplantation, or after allogeneic transplantation for hematologic neoplasm when both donor and recipient were CMV seronegative.
IVIG may be used in solid organ transplantation when the donor was CMV seropositive and the recipient was CMV seronegative prior to transplantation.
IVIG may be used for recurrent severe infections when there is documented severe or absent IgG subclass deficiency or clinically significant functional humoral immunity deficiency (failure to produce specific antibodies) with a history of recurrent infections.

20 Active Policies

CGS-J15-L38268, Immune Thrombocytopenia (ITP) Therapy

J15

CGS-J18-L38268, Immune Thrombocytopenia (ITP) Therapy

J18

A57554, Billing and Coding: Immune Globulins

WPS-J5-L34771, Immune Globulins

A59105, Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)

NGS-J6-L39314, Off-Label Use of Intravenous Immune Globulin (IVIG)

WPS-J8-L34771, Immune Globulins

NORIDIAN-JE-L34314, Immune Globulin Intravenous (IVIg)

NORIDIAN-JF-L34314, Immune Globulin Intravenous (IVIg)

PALMETTO-JJ-L34580, Intravenous Immunoglobulin (IVIG)

NGS-JK-L39314, Off-Label Use of Intravenous Immune Globulin (IVIG)

PALMETTO-JM-L34580, Intravenous Immunoglobulin(IVIG)

L33610, Intravenous Immune Globulin

UHC-POL-immune-globulin-ivig-scig, Immune Globulin (IVIG and SCIG)

UHC-POL-provider-administered-drugs-soc, Provider Administered Drugs – Site of Care

BCBSIL-RX504.003, Immunoglobulin Therapy

BCBSIL-ADM1001.034, Specialty Medication Administration Site of Care

BCBSMT-RX504.003, Immunoglobulin Therapy

BCBSMT-ADM1001.034, Specialty Medication Administration Site of Care

A57187, Billing and Coding: Immune Globulin Intravenous (IVIg)

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J1599, Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Treating physician must clearly document medical necessity to initiate IVIg therapy and the continued need for ongoing therapy in the medical record.
Include a History and Physical (H&P) in the medical record supporting IVIg therapy.
Include office and/or progress notes that document clinical status, response, and ongoing need for IVIg.
Provide relevant test results with written interpretation supporting the indication for IVIg.
Record an accurate patient weight in kilograms prior to each infusion because IVIg dosing is calculated in mg/kg.
Medical records must document the indication(s) supporting use of IVIG for each claim.

Key Coverage Criteria

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).
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.
Off-label IVIG use may be billed when supported by the applicable Local Coverage Determination (LCD) and by documentation of medical necessity; off-label is defined as not in Medicare-approved compendia or the FDA label.
IVIG may be used in bone marrow/stem cell transplantation when the recipient was CMV seropositive before transplantation, or after allogeneic transplantation for hematologic neoplasm when both donor and recipient were CMV seronegative.
IVIG may be used in solid organ transplantation when the donor was CMV seropositive and the recipient was CMV seronegative prior to transplantation.
IVIG may be used for recurrent severe infections when there is documented severe or absent IgG subclass deficiency or clinically significant functional humoral immunity deficiency (failure to produce specific antibodies) with a history of recurrent infections.

20 Active Policies

CGS-J15-L38268, Immune Thrombocytopenia (ITP) Therapy

J15

CGS-J18-L38268, Immune Thrombocytopenia (ITP) Therapy

J18

A57554, Billing and Coding: Immune Globulins

WPS-J5-L34771, Immune Globulins

A59105, Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)

NGS-J6-L39314, Off-Label Use of Intravenous Immune Globulin (IVIG)

WPS-J8-L34771, Immune Globulins

NORIDIAN-JE-L34314, Immune Globulin Intravenous (IVIg)

NORIDIAN-JF-L34314, Immune Globulin Intravenous (IVIg)

PALMETTO-JJ-L34580, Intravenous Immunoglobulin (IVIG)

NGS-JK-L39314, Off-Label Use of Intravenous Immune Globulin (IVIG)

PALMETTO-JM-L34580, Intravenous Immunoglobulin(IVIG)

L33610, Intravenous Immune Globulin

UHC-POL-immune-globulin-ivig-scig, Immune Globulin (IVIG and SCIG)

UHC-POL-provider-administered-drugs-soc, Provider Administered Drugs – Site of Care

BCBSIL-RX504.003, Immunoglobulin Therapy

BCBSIL-ADM1001.034, Specialty Medication Administration Site of Care

BCBSMT-RX504.003, Immunoglobulin Therapy

BCBSMT-ADM1001.034, Specialty Medication Administration Site of Care

A57187, Billing and Coding: Immune Globulin Intravenous (IVIg)

Have a follow-up question?

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

Ask Backwork about J1599 Sign up free

`J1599`, Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J1599`, Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J1599, Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J1599, Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J1599`, Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not

`J1599`, Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not