Intravenous Immune Globulin (IVIG)

Coverage

Documentation

Tips

Eligibility

  • For dates of service on or after January 1, 2024, the beneficiary must be enrolled in Medicare Part B and must meet the coverage criteria outlined in the IVIG LCD.
  • Suppliers must be eligible to dispense IVIG and meet all statutory and regulatory requirements for the administration of IVIG.
    • Nursing services may be subcontracted

Billing

  • Q2052 established for "services, supplies, and accessories used in the home for administration of IVIG"
    • Billed in 15-minute increments (refer to the LCD for a table)
    • Billed each time the drug is administered
    • Services are paid as a bundled charge and should not be "unbundled"
    • Subject to deductible and co-insurance
    • 2024 fee schedule amount $420.48
  • Q2052 may be billed separately from the drug but when the drug is mailed or delivered to the beneficiary and not administered on the same day, the date of service for the administration must be within 30 days of the date of service of the drug.
    • If the Q2052 is billed without the J-code, the claim will be recycled for 15 days and will be denied if no associated J-code is located in the system.
    • A narrative is recommended (not required) for claims processing of the Q2052 when not billed on the same claim as the IVIG.
      Narrative example: drug del Feb 1, admin Feb 3
  • Suppliers should report the infusion visit length in 15-minute increments (15 minutes=1 unit) when billing for Q2052 in accordance with rounding rules below. The units are for informational purposes only and a maximum of one unit of service of Q2052 per infusion date will be paid regardless of the units of service billed.
    Unit Time
    1 <23 minutes
    2 = 23 minutes to <38 minutes
    3 = 38 minutes to <53 minutes
    4 = 53 minutes to <68 minutes
    5 = 68 minutes to <83 minutes
    6 = 83 minutes to <98 minutes
    7 = 98 minutes to <113 minutes
    8 = 113 minutes to <128 minutes
    9 = 128 minutes to <143 minutes
    10 = 143 minutes to <158 minutes
  • The same place of service (POS) must be billed for the drug and Q2052 and must reflect an appropriate home or other home-like setting:
    • 04 - Homeless Shelter
    • 12 - Home
    • 13 - Assisted Living Facility
    • 14 - Group Home
    • 32 - Nursing Facility
    • 33 - Custodial Care Facility
    • 54 - Intermediate Care Facility/Mentally Retarded
    • 55 - Residential Substance Abuse Treatment Facility
    • 56 - Psychiatric Residential Treatment Center

Documentation

  • Documentation must support the level of care provided
  • Nursing visits must be documented and signed by the nurse
  • An order is not required for the nursing visit

Resources

Last Updated Sep 04 , 2024