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Billing
Billing Changes for Intravenous Immune Globulin (IVIG)
The Centers for Medicare & Medicaid Services (CMS) has revised the billing rules in Medicare Claims Processing Manual, Chapter 20 – Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS), Section 213 – Billing for Home IVIG Items and Services.
2024 IVIG Payment Rate
IVIG will be remained payable under Medicare as a separate bundled payment, reported with HCPCS Level II code (Q2052 Services, supplies, and accessories used in the home for the administration of intravenous immune globulin). After being adjusted for inflation, the 2024 payment rate is now $420.48, valid from January 1 to December 31. This bundled payment covers supplies and nurse services, including tubing and an infusion set.
Billing Rule and Requirements for Q2052
Similar to the presentation, a medication code needs to be billed using Q2502. Though it is ideal, the necessary medication code is no longer required to be on the same claim. CMS directs Medicare Administrative Contractors (MACs) to recycle IVIG claims up to three times for a total of 15 business days until the proper J code is located in history. The MAC will reject the claim if no J code is reported within 30 days prior to the date of service.
Multiple IVIG services may be billed by suppliers on a single claim, but not on a single claim line. That would suggest that IVIG was used more than once on each service date, which is not permitted. Charge for several service dates on different claim lines. Multiple units of the drug may be billed on a single claim line.
Medicare will only pay for IVIG therapies provided in the following services: 12, 13, 14, 32, and 33. 04 Refuge for the homeless; 54 Facility for intermediate care/mentally retarded; 55 Residential Treatment Center for Substance Abuse; and 56 Residential Treatment Center for Psychiatry.
