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CY2005 Medicare Changes for IVIG Payment Rates
Medicare has issued a revision to the January 2005 Quarterly Average Sales Price (ASP) for Medicare Part B drugs. Specifically, Medicare has increased the payment limit for IVIG (Intravenous Immune Globulin) therapies for the first quarter of 2005. The implementation date is January 18, 2005, and will be retroactive back to January 1, 2005. Medicare’s Transmittal of these changes has been sent to all Medicare Contractors who process IVIG claims. It’s important to note that the carriers WILL NOT search and adjust claims that have already been processed unless brought to their attention.
Medicare has adjusted the payment rate for IVIG therapies based upon additional data that they have collected. Keep in mind that this change is only for the first Quarter of 2005. The Centers for Medicare and Medicaid Services (CMS) will be updating the payment limit every quarter based on data submitted by IVIG manufacturers. So it remains to be seen if this rate will continue for the remaining calendar quarter calculations. ZLBBehring will keep on top of this issue and report on any changes going forward. The chart below reflects the old payment rate and the newly revised for the first quarter of 2005:
HCPCS Code |
Description |
HCPCS Code Dosage |
Old Q1 2005 Payment Limit |
Revised Q1 2005 Payment Limit |
| J1563 |
IV Immune Globulin |
1 Gram |
$40.02 |
$56.72 |
| J1564 |
IV Immune Globulin |
10 MG |
$0.38 |
$0.57 |
ZLB Behring’s Reimbursement Answer line is available to answer any questions regarding the changes to Medicare reimbursement for IVIG. You can call our Toll-Free Answerline at 1-800-676-4266. For a direct link to the Medicare Transmittal, please visit
www.cms.hhs.gov .
ZLB Behring assumes no responsibility for the individual interpretation of any material, facts, or references provided within the context of its publication of Reimbursement alert.
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