Specialized IVIG Services
Neurological Diseases
in which IVIG is an effective treatment include:
- Multiple Sclerosis (MS)
- Guillain – Barre (GB) Syndrome
- CIDPN
- Idiopathic Thrombocytopenia
- Multifocal Motor Neuropathy (MMN)
Clinical Expertise
- Clinical staff including pharmacist and registered nurse, with extensive experience with IVIG
- Patient education provided for each patient
- Screening for drug interactions
- Communication with physician for the best treatment plan possible
- Comprehensive care plan developed for each patient
- Complete inventory of all IVIG brands
- 24 hour, 7 day a week on call pharmacist
Reimbursement Expertise:
- Facilitate reimbursement providing maximum financial protection to patients
- Aggressively engage insurers in obtaining approval for treatments provided
The staff at Reeves-Sain is committed to making the patient referral process as efficient as possible. We are dedicated and experienced professionals who will coordinate all necessary homecare services. Thank you for allowing us the opportunity to serve you.
Intravenous Immune Globulin – New Benefit
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 provides a new benefit for intravenous immune globulin (IVIG) administered in the home setting effective for dates of service on or after January 1, 2004. In order for the IVIG to be covered, all of the following criteria must be met:
- It is an approved pooled plasma derivative for the treatment of primary immune deficiency disease; and
- The patient has a diagnosis of primary immune deficiency disease (ICD-9 codes 279.04, 279.05, 279.06, 279.12, 279.2); and
- The IVIG is administered in the home; and
- The treating physician has determined that administration of the IVIG in the patient’s home is medically appropriate.
If all of the criteria are not met and the IVIG is not administered with an infusion pump, the IVIG will be denied as non-covered– no benefit category. If the criteria are not met and the IVIG is administered with an infusion pump, the general criteria in the External Infusion Pump LMRP will be applied. If it is determined that the criteria for an infusion pump are not met, the pump, related supplies and the IVIG will be denied as not medically necessary.
Coverage under this benefit is limited to the IVIG itself, not to related supplies and services. If the IVIG is not administered with an infusion pump, related supplies will be denied as non-covered– no benefit category.
The IVIG must be dispensed and billed by a pharmacy or other entity licensed to dispense drugs. If the IVIG meets the coverage criteria for this benefit but it is not dispensed by an entity licensed to dispense drugs, it will be denied as not medically necessary. Suppliers must bill as an assigned claim. Beneficiaries are ineligible to receive payment for the drug.
HCPCS cods for IVIG are J1563 (Injection, immune globulin, intravenous, 1 gram) or J1564 (Injection, immune globulin, 10mg). If the dose administered is 500 mg or more, HCPCS code J1563 must be used. If the IVIG is not administered through an infusion pump and if supplies are billed, HCPCS code A9270 (non-covered item or service) must be used for the supplies. If the IVIG is administered through an infusion pump, the HCPCS codes A4221 and A4222 are used for the related supplies.
Claims for IVIG administered in the home are DMERC jurisdiction with the following exception. Home health agencies dispensing IVIG would bill the fiscal intermediary.
Because of the need to make system changes, claims that qualify for coverage cannot be processed until on or after April 5, 2004. Claims received on or after April 5 for dates of service on or after January 1, 2004 will be process based on the new coverage criteria.
