About this policy
The following billing coding and guidance is to be used with its associated Local Coverage Determination. Medical record documentation maintained by the treating physician must clearly document the medical necessity to initiate IVIg therapy and the continued need thereof. Required documentation of medical necessity could include: • History and physical; • Office/progress note(s); • Test results with written interpretation; and An accurate weight in kilograms should be documented prior to the infusion since the dosage is based mg/kg/dosage.
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 |
|---|---|---|
| J1459 | HCPCS | Covered |
| J1552 | HCPCS | Covered |
| J1553 | HCPCS | Covered |
| J1554 | HCPCS | Covered |
| J1556 | HCPCS | Covered |
| J1557 | HCPCS | Covered |
| J1561 | HCPCS | Covered |
| J1566 | HCPCS | Covered |
| J1568 | HCPCS | Covered |
| J1569 | HCPCS | Covered |
| J1576 | HCPCS | Covered |
| J1577 | HCPCS | Covered |
| J1599 | HCPCS | Covered |
| B20 | ICD10CM | Covered |
| B25.0 | ICD10CM | Covered |
| B25.1 |