External Infusion Pumps
National · Effective Jan 25, 2026
23 active Medicare policies list J1569, and 26 commercial payer policies list it. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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National · Effective Jan 25, 2026
J9 · Effective Oct 1, 2015
JH · Effective Oct 1, 2015
JL · Effective Oct 1, 2015
JE · Effective Oct 1, 2015
JF · Effective Oct 1, 2015
J5 · Effective Oct 1, 2015
J8 · Effective Oct 1, 2015
J15 · Effective Apr 1, 2020
J15 · Effective Oct 1, 2015
26 policies from 12 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
Codes labeled “Inferred from policy title” are not listed in the policy document; Backwork attached them because the policy title names the drug.
| Policy | Effective | Status of J1569 |
|---|---|---|
| Intravenous Immune Globulins (Alyglo, Asceniv, Bivigam, Flebogamma DIF, Gammagard Liquid, Gammagard S/D, Gammaked, Gammaplex, Gamunex-C, Octagam, Panzyga, Privigen, Yimmugo)Effective 12/01/2024 - 11/30/2025 | Dec 1, 2024 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Intravenous Immune Globulins (Alyglo, Asceniv, Bivigam, Flebogamma DIF, Gammagard Liquid, Gammagard S/D, Gammaked, Gammaplex, Gamunex-C, Octagam, Panzyga, Privigen, Yimmugo)Effective 12/01/2025 - 04/30/2026 | Dec 1, 2025 |
National · Effective Apr 1, 2026
JJ · Effective Oct 1, 2015
JM · Effective Oct 1, 2015
J6 · Effective Nov 1, 2022
JK · Effective Nov 1, 2022
JL · Effective Apr 1, 2026
J9 · Effective Apr 1, 2026
National · Effective Apr 1, 2026
J5 · Effective Apr 9, 2026
National · Effective Apr 16, 2026
National · Effective Apr 23, 2026
National · Effective Jan 1, 2026
J6 · Effective Jan 1, 2026
| Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Intravenous Immune Globulins (Alyglo, Asceniv, Bivigam, Flebogamma, Gammagard Liquid, Gammagard Liquid ERC, Gammagard S/D, Gammaked, Gammaplex, Gamunex-C, Octagam, Panzyga, Privigen, Qivigy, Yimmugo) | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Subcutaneous Immune Globulins (Cutaquig, Cuvitru, Gammagard Liquid, Gammagard Liquid ERC, Gammaked, Gamunex-C, Hizentra, HyQvia, Xembify) | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Subcutaneous Immune Globulins (Cutaquig, Cuvitru, Gammagard Liquid, Gammaked, Gamunex-C, Hizentra, HyQvia, Xembify)Effective 12/01/2025 - 04/30/2026 | Dec 1, 2025 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Subcutaneous Immune Globulins (Cutaquig, Cuvitru, Hizentra, HyQvia, Xembify, Gammagard Liquid, Gammaked, Gamunex-C)Effective 12/01/2024 - 11/30/2025 | Dec 1, 2024 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Policy | Effective | Status of J1569 |
|---|---|---|
| Alzheimer's Disease: Experimental, Investigational, or Unproven Treatments | Feb 20, 2024 | Covered |
| Guillain-Barre Syndrome Treatments | Sep 22, 2023 | Covered |
| Infertility | Feb 15, 2024 | Covered |
| Policy | Effective | Status of J1569 |
|---|---|---|
| Immunoglobulin Therapy | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1569 |
|---|---|---|
| Immunoglobulin Therapy | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1569 |
|---|---|---|
| Immunoglobulin Therapy | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1569 |
|---|---|---|
| Immunoglobulin Therapy | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1569 |
|---|---|---|
| IVIG (immune globulin IV): Asceniv; Alyglo; Bivigam; Flebogamma; Gamunex-C; Gammagard Liquid; Gammagard S/D; Gammagard Liquid ERC; Gammaked; Gammaplex; Octagam; Privigen; Panzyga; Yimmugo | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| SCIG (immune globulin SQ): Hizentra, Gammagard Liquid, Gamunex-C, Gammaked, HyQvia, Cuvitru, Cutaquig, Xembify | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1569 |
|---|---|---|
| Immune Globulin (IVIG and SCIG) | Oct 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Policy | Effective | Status of J1569 |
|---|---|---|
| Immune Globulin (IVIG and SCIG) | Oct 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Policy | Effective | Status of J1569 |
|---|---|---|
| Autism Spectrum Disorders/Pervasive Developmental Disorders: Assessment and Treatment | May 15, 2026 | Not covered |
| Policy | Effective | Status of J1569 |
|---|---|---|
| Immune Globulin Subcutaneous (Hizentra, Gammagard Liquid, Gamunex-C/Gammaked, HyQvia, Cuvitru, Cutaquig, and Xembify for Subcutaneous Administration) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1569 |
|---|---|---|
| Immune Globulin (IVIG and SCIG) | Oct 1, 2026 | Covered |