Immune Globulin Intravenous (IVIg) (L34074) - R12 - Effective February 1, 2020

Date Posted: January 29, 2026

This Local Coverage Determination (LCD) has been revised under contractor numbers: 02101 (AK), 02201 (ID), 02301 (OR), 02401 (WA), 03101 (AZ), 03201 (MT), 03301 (ND), 03401 (SD), 03501 (UT), and 03601 (WY).

Effective Date: February 1, 2020

Summary of Changes:

Policy was updated to correct typographical errors. Under Coverage Indications, Limitations and/or Medical Necessity, corrected 'nonresponsiveness' to 'non-responsiveness.' Under Associated Information, corrected 'and An' to 'and an.'

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Last Updated Jan 28 , 2026