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Urgent Customer Alert: Providers
Must Switch to New
"Lyophilized" and
"Non-Lyophilized" IVIG Billing
Codes April 1
Effective for dates of service on or after April 1, 2005, the IVIG billing codes J1563 and J1564 will no longer be paid by Medicare. This applies to ALL treatment settings under Medicare Part A and Part B.
Physicians. Starting April 1, 2005, you should bill Medicare using one of the four new "Q" codes that separately define lyophilized
and non-lyophilized (liquid)
IVIG products.
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Old Code
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New Code
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Description
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Unit
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J1563
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Q9941
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IVIG lyophilized
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1 gram
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Q9943
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IVIG
non-lyophilized
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1 gram
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J1564
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Q9942
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IVIG lyophilized
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10 mg
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Q9944
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IVIG
non-lyophilized
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10 mg
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Separate
Medicare Part B payment
allowance limits have been
established for IVIG billed with
each of these four codes,
effective from April 1 through
June 30:
New Code |
Description |
Payment Limit |
Q9941 |
IVIG
lyophilized, 1
gram |
$39.138 |
Q9943 |
IVIG
non-lyophilized,
1 gram |
$56.355 |
Q9942 |
IVIG lyophilized 10
mg |
$0.391 |
Q9944 |
IVIG
non-lyophilized,
10 mg |
$0.564 |
Hospitals. On and after April 1, IVIG billed using these new "Q" codes will be paid under the Hospital Outpatient Prospective Payment System (HOPPS). Again, claims which identify IVIG with "J1563" or "J1564" will not be paid on or after April 1. To the best of our ability, we have confirmed the following hospital outpatient payment rates:
New Code |
Description |
Payment Limit |
Q9941 |
IVIG
lyophilized, 1
gram |
$80.68 |
Q9943 |
IVIG
non-lyophilized,
1 gram |
$80.68 |
Q9942 |
IVIG lyophilized 10
mg |
$0.806 |
Q9944 |
IVIG
non-lyophilized,
10 mg |
$0.806 |
Your billing staff should check with other applicable insurers to determine whether to use the old "J" codes or the new "Q" codes for billing IVIG.
If you have any questions, please email us.
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