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External Infusion Pump LCD: Immune Globulin Subcutaneous (Human), 20% Liquid (Hizentra™)

A new SCIG preparation, Immune Globulin Subcutaneous (Human), 20% Liquid (Hizentra™), has been approved for use by the FDA. This preparation meets the requirements necessary for inclusion in the DME MAC LCD for External Infusion Pumps (L27215) as a covered SCIG when used for the treatment of primary immune deficiency disease. Coverage is effective for claims with dates of service on or after March 4, 2010.

Claims for Hizentra™ administered with a DME infusion pump should be submitted using HCPCS code:

  • J7799 – NOC drugs, other than inhalation drugs, administered through DME

Hizentra™ is supplied in 5 ml (1g protein), 10 ml (2g protein), and 20 ml (4g protein) vials. One unit of service equals 5 ml (1g protein). Since the amount of SCIG for each patient is individualized, each dose must be prepared using the combination of vial sizes that result in the least amount of wastage for the dosage amount being administered.

An E0779 infusion pump is covered for the administration of subcutaneous immune globulin.

Refer to the LCD for External Infusion Pumps (L27215) for additional information about the coverage of SCIG. Hizentra™ will be added to a future revision of the LCD.

External Infusion Pump LCD: Immune Globulin Subcutaneous (Human), 20% Liquid (Hizentra™)
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