Immune Globulin Intravenous (IVIg) LCD - R8

The following JF 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), 03601 (WY). 

Medicare Coverage Database (MCD) Number: L34074
LCD Title: Immune Globulin Intravenous (IVIg)
Effective Date: August 13, 2019
Summary of Changes: LCD is revised to add the following ICD-10-CM codes per Change Request (CR)11295

  • D80.2, Selective deficiency of immunoglobulin A [IgA]
  • D80.3, Selective deficiency of immunoglobulin G [IgG] subclasses
  • D80.4, Selective deficiency of immunoglobulin M [IgM]
  • D80.6, Antibody deficiency with near-normal immunoglobulins or with hyperimmunoglobulinemia
  • D80.7, Transient hypogammaglobulinemia of infancy
  • D81.5, Purine nucleoside phosphorylase [PNP] deficiency
  • D82.1, Di George's syndrome
  • D82.4, Hyperimmunoglobulin E [IgE] syndrome
  • D83.1, Common variable immunodeficiency with predominant immunoregulatory T-cell disorders
  • G11.3, Cerebellar ataxia with defective DNA repair

View the locally hosted Noridian Active LCD.  

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Last Updated Jul 29, 2019