IVIG Administration–Medicare Payment for Pre-administration-Related Services

Provider Types Affected
Physicians and hospitals that bill Medicare carriers, Fiscal Intermediaries (FIs), or Part A/B Medicare Administrative Contractors (A/B MACs) for Intravenous Immune Globulin (IVIG) administration.

Provider Action Needed
You may bill for pre-administration-related services associated with Intravenous Immune Globulin (IVIG) administration (HCPCS code G0332) during calendar year 2007. The pre-administration-related service must be billed on the same claim and have the same date of service, as the claim for the IVIG itself (codes J1566 and/or J1567) and the drug administration service.

CR 5428, from which this article was taken, extends payment of the pre-administration-related service for IVIG through CY 2007 but only when submitted on the same claim as the IVIG and its administration.

Make sure that your billing staff is aware that they must include your claim for the IVIG pre-administration-related services on the same claim (and with the same date of service) as the IVIG and its administration.

Background
Under Section 1861(s)(1) and 1861(s)(2), Medicare Part B covers Intravenous Immune Globulin (IVIG) administered by physicians in physician offices and by hospital outpatient departments. More specifically, when you administer IVIG to a Medicare beneficiary in the physician office or hospital outpatient department, Medicare makes separate payments to the physician or hospital for both the IVIG product itself and for its administration via intravenous infusion.

In addition, for 2006, CMS established a temporary pre-administration-related service payment, for physicians and hospital outpatient departments that administer IVIG to Medicare beneficiaries, to cover the effort required to locate and acquire adequate IVIG product and to prepare for an infusion of IVIG during this current period where there may be potential market issues. CR 5428, from which this article was taken, announces the extension of this temporary payment for the IVIG pre-administration-related service through CY 2007.

As a reminder, here are some important details that you should know:

• The policy and billing requirements concerning the IVIG pre-administration-related services payment are the same in 2007 as they were in 2006



• This IVIG pre-administration service payment is in addition to Medicare’s payments to the physician or hospital for the IVIG product itself and for its administration by intravenous infusion.



• Medicare Carriers, FIs, or A/B MACs will pay for these services, that are provided in a physician office, under the physician fee schedule; and FIs or A/B MACs will pay for them under the Outpatient Prospective Payment System (OPPS), for hospitals subject to OPPS (bill types: 12x, 13x) or under current payment methodologies for all non-OPPS hospitals (bill types: 12x, 13x, 85x).



• You need to use HCPCS code G0332 –Pre-administration-Related Services for Intravenous Infusion of Immunoglobulin, (this service is to be billed in conjunction with administration of immunoglobulin) to bill for this service.



• You can bill for this only one IVIG pre-administration per patient per day of IVIG administration.



• The service must be billed on the same claim form as the IVIG product (HCPCS codes J1566 (Injection, immune globulin, intravenous, lyophilized (E.G. powder), 500 mg) and/or J1567 (Injection, immune globulin, intravenous, non-lyophilized (E.G. liquid), 500 mg), and have the same date of service as the IVIG product and a drug administration service.



• Your claims for pre-administration-related services will be returned/rejected by your FI, carrier, or A/B MAC if more than 1 unit of service of G0332 is indicated on the same claim for the same date of service. They will use the appropriate reason/remark code such as:



• M80-“Not covered when performed during the same session/date as a previously processed service for the patient;”



• B5-“Payment adjusted because coverage/program guidelines were not met or were exceeded;”



• M67-“Missing other procedure codes;” and/or



• 16-“Claim/service lacks information which is needed for adjudication.”

Additional Information
You can find the official instruction, CR 5428, issued to your FI, carrier, or A/B MAC by visiting http://www.cms.hhs.gov/Transmittals/downloads/R1140CP.pdf\ on the CMS website.

If you have any questions, please contact your state's Provider Contact Center.

MLN Matters MM5428