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CIDP and PI Access and Billing Codes

Hizentra is covered under Medicare Part B for both PI and CIDP*

The convenience of self-infused Hizentra—covered under the same benefit category as IVIg.†

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  • Lower patient out-of-pocket costs than with Part D
    • Coverage includes infusion pump, ancillary supplies, medication, and nurse training
  • No prior authorization required‡

For updated coverage and comprehensive support, call Hizentra ConnectSM at 1-877-355-4447
Monday-Friday, 8 AM to 8 PM ET.

*100% coverage for patients with Medicare Part B and a Medigap plan after Part B annual deductible is met. †Coverage of IVIg when administered in a clinical setting. ‡Chart notes must be up to date and include diagnostic criteria.

Diagnostic and billing codes for Hizentra therapy

All codes provided here are for informational purposes and are not an exhaustive list. The CPT, HCPCS, and ICD-10-CM codes provided are based on AMA or CMS guidelines. The treating physician is solely responsible for diagnosis coding and determination of the appropriate ICD-10-CM codes that describe the patient's condition and are supported by the medical record. The billing party is solely responsible for coding of services (eg, CPT Coding). Because government and other third-party payer coding requirements change periodically, please verify current coding requirements directly with the payer being billed.

Hizentra Connect, the comprehensive resource center for CSL Behring's Immune globulin (lg) therapies, is there to answer any additional questions you might have about diagnostic or billing codes for Hizentra.

To get the guidance and support you need, call 1-877-355-4447 Monday–Friday, 8 AM to 8 PM ET.

ICD-10-CM Diagnosis Codes10

D80

Immunodeficiency with predominantly antibody defects
D80.0* Hereditary hypogammaglobulinemia

Autosomal recessive agammaglobulinemia (Swiss type)

X-linked agammaglobulinemia [Bruton] (with growth hormone deficiency)
D80.1 Nonfamilial hypogammaglobulinemia

Agammaglobulinemia with immunoglobulin-bearing B-lymphocytes

Common variable agammaglobulinemia [CVAgamma]

Hypogammaglobulinemia NOS
D80.2* Selective deficiency of immunoglobulin A [IgA]
D80.3* Selective deficiency of immunoglobulin G [IgG] subclasses
D80.4* Selective deficiency of immunoglobulin M [IgM]
D80.5* Immunodeficiency with increased immunoglobulin M [IgM]
D80.6* Antibody deficiency with near-normal immunoglobulins or with hyperimmunoglobulinemia
D80.7* Transient hypogammaglobulinemia of infancy
D80.8 Other immunodeficiencies with predominantly antibody defects

Kappa light chain deficiency
D80.9 Immunodeficiency with predominantly antibody defects, unspecified

D81

Combined immunodeficiencies
D81.0* Severe combined immunodeficiency [SCID] with reticular dysgenesis
D81.1* Severe combined immunodeficiency [SCID] with low T- and B-cell numbers
D81.2* Severe combined immunodeficiency [SCID] with low or normal B-cell numbers
D81.4 Nezelof's syndrome
D81.5* Purine nucleoside phosphorylase [PNP] deficiency
D81.6* Major histocompatibility complex class I deficiency

Bare lymphocyte syndrome
D81.7* Major histocompatibility complex class II deficiency
D81.82* Activated Phosphoinositide 3-kinase Delta Syndrome [APDS]
D81.89* Other combined immunodeficiencies
D81.9* Combined immunodeficiency, unspecified

Severe combined immunodeficiency disorder [SCID] NOS

D82

 

Immunodeficiency associated with other major defects

Excludes: ataxia telangiectasia [Louis-Bar] (G11.3)
D82.0* Wiskott-Aldrich syndrome

Immunodeficiency with thrombocytopenia and eczema
D82.1* Di George's Syndrome

Pharyngeal pouch syndrome

Thymic alymphoplasia

Thymic aplasia or hypoplasia with immunodeficiency
D82.2 Immunodeficiency with short-limbed stature
D82.3 Immunodeficiency following hereditary defective response to Epstein-Barr virus

X-linked lymphoproliferative disease
D82.4* Hyperimmunoglobulin E [IgE] syndrome
D82.8 Immunodeficiency associated with other specified major defects
D82.9 Immunodeficiency associated with major defect, unspecified

D83

Common variable immunodeficiency
D83.0* Common variable immunodeficiency with predominant abnormalities of B-cell numbers and function
D83.1* Common variable immunodeficiency with predominant immunoregulatory T-cell disorders
D83.2* Common variable immunodeficiency with autoantibodies to B- or T-cells
D83.8* Other common variable immunodeficiencies
D83.9* Common variable immunodeficiency, unspecified

D84

Immunodeficiency, unspecified
D84.9 Immunodeficiency, unspecified

G11

Hereditary Ataxia
G11.3* Cerebellar ataxia with defective DNA repair
Ataxia telangiectasia

G61

Chronic inflammatory demyelinating polyneuritis
G61.81* Chronic Inflammatory demyelinating polyneuritis

Chronic inflammatory demyelinating polyneuropathy

Chronic inflammatory demyelinating polyradiculoneuropathy

Polyneuropathy (multiple nerve disorder)

Polyneuropathy, chronic inflammatory demyelinating

Polyradiculoneuropathy, chronic inflammatory demyelinating

Polyradiculoneuropathy, inflammatory demyelinating
*Medicare Part B–approved diagnosis codes for treatment with Hizentra in the home. All other diagnoses may qualify for coverage under Medicare Part D plans.
Download for a printer-friendly version of this chart.

HCPCS Billing Codes11,12,15-17

The following HCPCS codes describe supplies (including drugs) rendered by the billing provider. CMS publishes and maintains the HCPCS code set.

These codes are entered to paper claim form CMS-1500 in Field 24; or to electronic claim form ASC 837P in Loop 2400, Segment SV101-2, with the Qualifier "HC" entered to Segment SV101-1, unless otherwise directed by the payer.

Hizentra: Immune Globulin Subcutaneous (Human), 20% liquid12
HCPCS Code Description
J1559 Injection, immune globulin (Hizentra), 100 mg

Ready-to-Use Hizentra Vial Sizes

Certain payers may require the entry of NDC information to the claim form, as directed by the payer.
Grams Protein Fill Size NDC Number to Use on All Claim Forms*
1 g 5 mL 44206-0451-01
2 g 10 mL 44206-0452-02
4 g 20 mL 44206-0454-04
10 g 50 mL 44206-0455-10

Ready-to-Use Hizentra Prefilled Syringe Sizes

Certain payers may require the entry of NDC information to the claim form, as directed by the payer.
Grams Protein Fill Size NDC Number to Use on All Claim Forms*
1 g 5 mL 44206-0456-21
2 g 10 mL 44206-0457-22
4 g 20 mL 44206-0458-24
*For billing requiring an 11 digit NDC add the preceding zero as shown above.
CPT Code 11,15-17 Description
If the billing provider performs administration services in conjunction with a patient's infusion, the following administration codes may be used to bill for this service if the service meets the requirements of the code description.
96369 Subcutaneous injection for therapy or prophylaxis; initial, up to 1 hour, including pump setup and establishment of subcutaneous infusion site(s)
96370 Each additional hour
96371 Additional pump setup with establishment of new subcutaneous infusion site(s)
S9338 Home infusion therapy, immunotherapy, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

Medicare Home Infusion Therapy (HIT) Professional Services (G‑Codes)18

G0089 Subcutaneous immunotherapy and other certain subcutaneous infusion drugs, initial encounter
G0069 Subcutaneous immunotherapy and other certain subcutaneous infusion drugs, subsequent encounter

Providers must be a qualified HIT supplier to bill for professional services. Section 1861(iii)(3)(C) of the Act defines a “home infusion drug” as a parenteral drug or biological administered intravenously, or subcutaneously for an administration period of 15 minutes or more, in the home of an individual through a pump that is an item of durable medical equipment (as defined in section 1861(n) of the Act). The professional visit G-code claim will recycle three times (with a 30-day look back period) for a total of 15 business days. After 15 business days, if no J-code claim is found in claims history, the G-code claim will be denied.

Billing for Medicare DME MACs12

The Medicare benefit for patients with primary immune deficiency or chronic inflammatory demyelinating polyneuropathy for subcutaneous immune globulin administered by DME MACs applies only to those products that are specifically labeled as subcutaneous administration products. Intravenous immune globulin products administered via the subcutaneous route are not covered by Medicare DME MACs (refer to Local Coverage Decision for External Pumps, effective 2/4/2011).

Billing for External Pumps and Supplies

When the billing provider furnishes an external infusion pump for patient use, the following code may be used to bill for the pump if it meets the requirements of the code description.

External Infusion Pump
HCPCS Code Description
E0779 Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater

E0779 is the only reimbursable pump code for infusion of Hizentra under Medicare Part B.*

Other pump codes may be used to bill other payers, depending on the pump that is used and the payer's pump coverage policy. The codes below are not covered by Medicare. Other pump codes may include:

E0781 Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient
E0791 Parenteral infusion pump, stationary, single or multichannel

When the billing provider furnishes supplies for the patient's use with the external infusion pump, the following codes may be appropriate for the supplies if they meet the requirements of the code description and payer coverage policies.

Professional Services for Drug Infusion
G0069 Professional services for the administration of subcutaneous immunotherapy for each infusion drug administration calendar day in the individual's home, each 15 minutes

External Infusion Pump Supplies*
K0552 Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each
A4221 Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately)
A4222 Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately)

*For E0779 and K0455 pumps, either A4222 or K0552 may be billed, but not both.

Modifier -JB for Medicare Billing

Medicare requires the addition of Modifier -JB (administered subcutaneously) to the HCPCS code for Hizentra (J1559) to confirm subcutaneous administration. Example: J1559-JB.

Commercial and Medicaid plans may require the use of the JB modifier. If required, JB should also be added to the HCPCS code for the covered infusion pump (E0779) following the modifier that indicates whether the pump is being rented (RR) or purchased (NU). Example: E0779-RR-JB or E0779-NU-JB. Always check with the plan to see if the modifier code is required.

ICD=International Classification of Diseases
HCPCS=Healthcare Common Procedure Coding System
CPT=Current Procedural Terminology

Hizentra Coding Information brochure

Hizentra Coding Information

You can download a printable version of the diagnosis and ICD-10-CM billing codes.

Download the diagnoses and billing codes for PI
Download the diagnoses and billing codes for CIDP

CSL Behring makes it easy for your patients to start and stay on Hizentra therapy. The following tools, resources, and guidelines are here to help you with access and reimbursement.

Hizentra Support Programs

Hizentra Connect is a comprehensive resource center to help you and your patients. Through Hizentra Connect, patients can receive in-home nurse training and infusion equipment at no cost. For qualified patients, the Free Trial program provides a month supply of product.

See Hizentra Connect support for more details

Hizentra Referral Form

Download and complete this form to initiate a Benefits Investigation by Hizentra Connect.

Download referral form
Hizentra Referral Form
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