About this policy
This article describes CMS national coverage effective on/after October 1, 2001. Please see the Noridian Local Coverage Determination for additional indications. Patient must meet at least one of the following criteria: Failed conventional therapy. Contractors have the discretion to define what constitutes failure of conventional therapy; Conventional therapy is contraindicated. Contractors have the discretion to define what constitutes contraindications to conventional therapy; or Have rapidly progressive disease in which a clinical response could not be affected quickly enough using conventional agents. In these situations, IVIg therapy would be give along with conventional treatment(s) and the IVIg would be used only until conventional therapy could take effect. Note: In addition, IVIg for the treatment of autoimmune mucocutaneous blistering disease must be used only for short term therapy and not as a maintenance therapy. Again, contractors have the discretion to decide what constitutes short-term therapy.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| L10.0 | ICD10CM | Covered |
| L10.1 | ICD10CM | Covered |
| L10.2 | ICD10CM | Covered |
| L10.3 | ICD10CM | Covered |
| L10.4 | ICD10CM | Covered |
| L10.5 | ICD10CM | Covered |
| L10.81 | ICD10CM | Covered |
| L10.89 | ICD10CM | Covered |
| L10.9 | ICD10CM | Covered |
| L12.0 | ICD10CM | Covered |
| L12.1 | ICD10CM | Covered |
| L12.8 | ICD10CM | Covered |
| L12.9 | ICD10CM | Covered |
| L13.8 | ICD10CM |