Provider and Supplier
Treating physicians have the key role in determining whether IVIG can safely be administered in the home for an individual Medicare beneficiary. If so and the beneficiary meets other demonstration criteria, the physician will then be asked to sign the beneficiary application form attesting that you are treating the patient, that the patient has primary immune deficiency disease and is a candidate for home IVIG.
Once a beneficiary has been approved for the IVIG demonstration, the supplier that provides the drug may also bill for the in-home administration services, either that the supplier provided directly or through an entity that the suppliers contracts with for the administration services. For more information on the supplier role in this demonstration, see below and also reference CMS Medicare Learning Network (MLN) Matters Special Edition (SE)1424
Ways to Avoid Common Billing Errors Made on Demonstration Claims
Proper Billing for Dates of Service
When billing any of the IVIG drugs covered under the demonstration for a beneficiary with PIDD, a date span must not be used. The drug must be submitted with the same from and to date on the claim.
Q2052, the administration code, must be billed as a separate claim line on the same claim for the same place of service as the IVIG drug. When Q2052 is billed alone, the claim will be denied.
In cases where the drug is mailed or delivered to the patient prior to administration, suppliers should not bill the drug until the administration (the "Q2052" claim line) has been performed. Both services should be billed on the same claim and the date of service for the administration of the drug (the "Q2052" claim line) may be no more than 30 calendar days after the date of service on the drug claim line and must be within the same calendar year.
No more than one unit of Q2052 shall be billed per claim line.
Q2052 shall only be billed for beneficiaries enrolled in the IVIG demonstration.
If a provider is billing for multiple administrations of the IVIG on a single claim, then the provider shall bill the "Q2052" code for each date of service on a separate claim line. Multiple administrations on a claim are payable but they should be for different dates of service. While the usual administration of IVIG drugs for PIDD is approximately monthly, it may more or less frequent depending upon a patient's medical need. Thus, there may be situations in which multiple units of the drug are shipped to the patient and billed on a single "J" code claim line followed by more than one "Q2052" administration claim line, each with the date of service on which the IVIG was administered.
End of the Year Billing
Services under the IVIG Demonstration that claims for the Q2052 and IVIG drugs must be billed within the same calendar year.
Example: The administration (Q2052) dates are 12/15/15 and 01/05/16 which are two different calendar years. There must be separate shipments for the IVIG drugs that will be administered for each calendar year.
The shipment for the drugs that will be administered on 01/05/2016 must also have a service date in 2016.
Drugs Covered Under IVIG Demonstration
The following drugs are covered under the demonstration for a beneficiary with Primary Immune Deficiency Disease (PIDD):
- Bivigam, J1556
- Flebogamma, J1572
- Gammagard liquid, J1569
- Gammaplex, J1557
- Gamunex, J1561
- IVIG, NOS (lyophilized), J1566
- IVIG, NOS (non lyophilized), J1599
- Octagam, J1568
- Privigen, J1459
- 2014 $300.00
- 2015 $319.23
- 2016 $336.05
- 2017 $354.60
Educational tutorials and other multimedia education opportunities are available. View the Educational Opportunities webpage for details.
Last Updated Nov 16, 2016