Tagged: Medicare Hizentra
April 8, 2019 at 2:10 pm #116329
Hi, I’m new to the forum and was recently diagnosed with CIDP. My Part D Medicare insurance has denied the IVIG treatment. I am wondering if there are others on Medicare who have been successful in getting this treatment covered, and what insurance you have, i.e., Original Medicare with supplement and Part D OR Medicare Advantage Plans. Any information would be appreciated.
April 8, 2019 at 3:11 pm #116330Jim-LAModerator
Hello Ron and welcome to the forums!
IVIg/SCIg and related infusion treatments (Rituximab, etc.) are normally covered under Part B. Perhaps your provider is using the incorrect CPT billing codes; or, you are having IVIg through home infusions, which aren’t normally covered under Part B? The typical CPT codes used are 99601 and 99602.
April 9, 2019 at 12:21 pm #116331
Thank you for the info. We spoke with the doctor today, and they are going to try to get it done in the hospital outpatient dept. I’ll post the results when we find out if it will be covered there. I appreciate your giving me the CPT codes.
April 10, 2019 at 10:56 am #116332dsfritz1Participant
I am on Medicare original and have received IVIG for about 18 months. When i was first diagnosed my doctor set up my treatment to be at my home. At that point i needed to understand my costs so i did my research not until that time. In my case i found out that if i had home treatment Medicare would cover it under part D not B. This was too expensive for me so i had my doctor change treatment to an infusion center which is covered under part B. Before treatment started i was able to sign up for a supplemental [because i had just turned 65 3 months prior and was still withing the 6 month signup period for supplemental]. All costs have been covered by Medicare and the supplemental. So is short for Medicare original if you have infusion done at hospital or infusion center [and maybe doctor’s – not 100% sure] it is covered under part B. It is important that you infusion center or hospital outpatient provider know the correct coding so there is not trouble with coverage.
April 10, 2019 at 1:11 pm #116333
Thank you DSfritz1 for the info. That confirms what I’ve been thinking that infusion at home would leave a lot of out-of-pocket cost since Part D doesn’t usually cover the full cost of meds. It’s good to hear that Part B does cover it, and I do have a supplement policy as well, which should cover the balance. I’m curious if you don’t mind telling me, what Part D company did you have a policy with? My Part D is Humana Enhanced; they denied coverage initially and the subsequent appeal as well. Thank you for the info about Part B.
April 10, 2019 at 2:49 pm #116334dsfritz1Participant
I have United Healthcare through AARP. I had just started the approval process when I found out that home infusion would be covered by part D. I had a special signup period for Medicare since I did not have employee covered insurance at that time and was paying very high premium for my individual policy. When i switched to Medicare my insurance screwed up and claimed i was still covered by them [that is what Medicare told me]. it took a lot of phone calls and a month or so to get that straightened out. During that time is when I researched home vs hospital outpatient or infusion center coverage. After the research i told the contact person for my Part D that i was going to have my neurologist change my orders to an infusion center, that I was no longer interested in home infusion, so the approval process for that was not totally completed.
Besides a bunch of tests during initial and followup examinations my neurologist tested two nerves in one foot/leg for my nephropathy.I forget what test he called it but it involved a lot of shocks! I had slow response in both and one had infrequent F-wave readings [only registered an F-wave one in 5 times]. Although i had some issues with my hands as well he felt no further testing was needed in other foot/leg or hands. Then, after ALL the blood work he ordered came back normal he then diagnosed me with CIDP…started treatment…and here i am today….doing great.
April 11, 2019 at 4:06 pm #116335
A friend has United Healthcare Medicare Advantage as a retiree from the State of Georgia. He gets home infusion through Part D, but I think there is a copay. I think the hospital or infusion center is a better option so that Part B and the supplement will take care of the cost. The test you’re referring to, I believe, is called an EMG. That was the first test I had, plus a lot of blood work and then a lumbar puncture to diagnose the CIPD. I’m scheduled to have my first infusion next Monday at the hospital as an outpatient. It’s good to know that your treatment is working.
June 6, 2020 at 8:24 pm #117621DavidHParticipant
First post on the forum. I was diagnosed with CIDP in August 2017. Essentially only sensory effects, loss of feeling in feet, lower legs, hands, loss of balance, etc. Currently on Hizentra, (subcutaneous infusion) and am about to retire and go on Medicare. Has there been any changes in covering at home infusions by Medicare? How are others handling this cost?
June 6, 2020 at 10:43 pm #117623Jim-LAModerator
If you have a primary immunodeficiency disease with the ICD-9 diagnosis codes 279.04, 279.05, 279.06, 279.12, or 279.2, your IVIg/SCIg treatment is reimbursed under Medicare Part B. If you or your provider submits the IVIg/SCIg service claim under Part D, it will most likely be denied.
The center for medicare services has transitioned to ICD-10 codes. A converter is here:
ICD-10 code G61.0 may be the code to use when requesting Medicare pay for the treatment. More details here:
June 12, 2020 at 2:44 pm #117647DavidHParticipant
Thanks Jim. I know you had some recent upsets in your life, hope you are recovering well. You sure seem to have the answers.
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