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IVIG Commonly Asked Beneficiary Questions - IVIG

IVIG Commonly Asked Beneficiary Questions

Below are two common questions received from beneficiaries calling the IVIG demonstration phone line, along with the answers. Both are good reminders about the IVIG demonstration.

Q1. I thought that Medicare covered IVIG treatment at 100% and therefore I don't have any out-of-pocket expenses. Why am I getting a bill or MSN that shows I'm partially responsible for these services?

A1. IVIG coverage is similar to many other Medicare Part B covered services; it is subject to coinsurance and deductible, which is the beneficiary's responsibility. Some beneficiaries may have a Medicare supplemental insurance that covers these costs. This coverage also is only payable in certain places of service and the beneficiary must have a covered diagnosis for the IVIG drug (and administration) to be paid by Medicare.

Q2. Why is the supplier questioning my PIDD diagnosis when I've been approved for the IVIG demonstration?  

A2. Medicare only covers IVIG medication in the home for non-home-bound patients, when a patient has certain primary immune deficiency diseases (PIDD) as outlined for coverage in the Medicare IVIG coverage determination. The IVIG demonstration application form does not ask for the specific PIDD diagnosis, but only requires a treating physician signature, stating that the beneficiary has PIDD. Since only certain PIDD diagnoses are covered for IVIG, suppliers may request more specific documentation about the patient's diagnosis before providing services covered under the demonstration.  If you have further questions about your PIDD diagnosis, contact your treating physician. 

Last Updated Wed, 02 Nov 2016 11:17:09 +0000