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| Jurisdiction B News: Gammagard Liquid (J1569) Added as Covered Subcutaneous |
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Having trouble reading this email? View it in your browser. Gammagard Liquid® (J1569) Added as Covered Subcutaneous Immune Globulin Gammagard Liquid® (J1569) is added to the External Infusion Pump Local Coverage Determination (LCD) as covered subcutaneous immune globulin effective for dates of service on or after July 22, 2011. The existing Healthcare Common Procedure Coding System (HCPCS) code for Gammagard Liquid® must be used: J1569 - INJECTION, IMMUNE GLOBULIN, (GAMMAGARD LIQUID), INTRAVENOUS, NONLYOPHILIZED, (E.G. LIQUID), 500 MG For J1569 and associated infusion pump (E0779) claims where the route of administration is subcutaneous, a JB modifier must be added to each HCPCS code. For other methods of administration, no modifier should be added. One (1) unit of service (UOS) is 500mg. Gammagard liquid is distributed in multiple package sizes from one (1)-gram (1000mg) to thirty (30)-grams (30,000mg). Suppliers must choose the package size that is appropriate for the dosage being administered to minimize waste. For example, 1500mg is prescribed (3 UOS). Gammagard liquid is available in 1-gram (2UOS) and 2.5-gram (5 UOS) sizes. Two 1-gram vials (4 UOS) must be used rather than one 2.5-gram vial (5 UOS). Excess wastage due to non-optimal vial sizes will be denied as not reasonable and necessary As a reminder, below are the coverage criteria from the External Infusion Pump LCD: Subcutaneous immune globulin (J1559, J1561, J1562) is covered only if criteria 1 and 2 are met:The subcutaneous immune globulin preparation is a pooled plasma derivative which is approved for the treatment of primary immune deficiency disease; andThe patient has a diagnosis of primary immune deficiency disease (International Classification of Diseases 9th revision [ICD-9] codes 279.04, 279.05, 279.06, 279.12, 279.2).Coverage of subcutaneous immune globulin applies only to those products that are specifically labeled as subcutaneous administration products. Intravenous immune globulin products are not covered under this LCD. Only an E0779 infusion pump is covered for the administration of subcutaneous immune globulin. If a different pump is used, it will be denied as not reasonable and necessary. Gammagard Liquid will be added in a future revision of the LCD. Refer to the LCD, Policy Article and Supplier manual for additional information. Remember! National Government Services' Jurisdiction B DME MAC List serv is for out going messages only. Please do not respond back to messages as your response will not be answered, as this is not an authorized mode of communication at this time, Thank You! National Government Services encourages all Web site users to provide feedback regarding ways to improve our Web site. The ForeSee Results (pop-up) survey is an easy mechanism for providers to use to let us know how we can best serve you. Your comments play a large role in the enhancements that are made to the National Government Services Web site. CONFIDENTIALITY NOTICE: This E-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply E-mail and destroy all copies of the original message. National Government Services Inc. 8115 Knue Road Indianapolis, Indiana 46250 This email was sent to: This e-mail address is being protected from spambots. You need JavaScript enabled to view it Unsubscribe powered byMailerMailer |
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