The Centers for Medicare & Medicaid Services (CMS) has established new product-specific HCPCS Codes
(Healthcare Common Procedure Coding System) for filing claims for reimbursement for liquid intravenous immune globulin
(IVIG) products, to go into effect July 1, 2007. This change in codes for IVIG comes two years after a decision in
April 2005 to create two separate codes, one for liquid IVIG and one for lyophilized (powder) IVIG.
By further specifying codes to each liquid IVIG product, providers are more likely to be reimbursed accurately for the specific
products they administer to patients. The formula for calculating reimbursement
rates for Medicare patients receiving IVIG infusions will remain the same: average selling price
(ASP) plus 6%. However, each manufacturer will report its IVIG product ASP to CMS, which will be the
quarterly benchmark reimbursement for each individual IVIG product, instead of the previously-used weighted
aggregate number. This reporting brings a new level of transparency to each manufacturer’s actual IVIG pricing structure.
The new codes are as follows:
|
Octagam injection |
(500
mg) |
Q4087 |
|
Gammagard
injection (liquid) |
(500
mg) |
Q4088 |
|
Flebogamma
injection |
(500
mg) |
Q4091 |
|
Gamunex
injection |
(500
mg) |
Q4092 |
The HCPCS code for all lyophilized IVIG products remains the same:
|
Carimune NF |
(500
mg) |
Q9941 |
|
Gammagard S/D |
(500
mg) |
Q9941 |
|
Panglobulin |
(500
mg) |
Q9941 |
The HCPCS code for pre-administration related services for IVIG infusion is G0332 and should
be billed in conjunction with administration of IVIG. Providers can bill for only one IVIG
pre-administration per patient per day of IVIG administration.
