Q. Will an external infusion pump be reimbursed with IVIG?
A. No, the recently created benefit for IVIG, announced in March 2004, only allows for payment of the drug when specific criteria are met. Coverage under this benefit is limited to the IVIG itself, not to related supplies and services.
All of the following criteria must be met for coverage of IVIG:
1. It is an approved pooled plasma derivative for the treatment of primary immune deficiency disease; and
2. The patient has a diagnosis of primary immune deficiency disease (ICD-9 codes 279.04, 279.05, 279.06, 279.12, 279.2); and
3. The IVIG is administered in the home; and
4. The treating physician has determined that administration of the IVIG in the patient’s home is medically appropriate.
In addition, IVIG must be dispensed and billed by a pharmacy or other entity licensed to dispense drugs.
Refer to the previously published article (March 2004) for further information about this benefit.