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More PI diagnoses covered for home Ig replacement therapy under Medicare Part B

July 18, 2019

Over the past year, the Immune Deficiency Foundation (IDF) has worked with the Centers for Medicare and Medicaid Services (CMS) to expand access to immunoglobulin (Ig) replacement therapy for Medicare beneficiaries. In particular, IDF has advocated to expand Medicare Part B coverage for in-home Ig replacement therapy to include more PI diagnoses. The agency has been receptive to our concerns and engaged in an effort to review the PI diagnosis codes for expanded Part B coverage.

We are pleased to report that CMS has now published Change Request - 11295 that includes an additional 10 PI diagnoses to be covered under the Part B benefit for Ig replacement therapy in the home setting. The code changes will be implemented on August 13, 2019. The changes will apply to both IVIG (FUTURE Local Coverage Article: Intravenous Immune Globulin - Policy Article (A52509) and SCIG (FUTURE Local Coverage Article: External Infusion Pumps - Policy Article (A52507).These code changes will greatly expand the number of people with PI who will have access to Ig replacement therapy in the home and will benefit current and future Medicare beneficiaries in the PI community.

Below is the full list of the covered codes with the new codes listed in bold:

G11.3 Cerebellar ataxia with defective DNA repair

D80 Immunodeficiency with predominantly antibody defects

  • D80.0 Hereditary hypogammaglobulinemia 
  • 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

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
  •  D81.5 Purine nucleoside phosphorylase [PNP] deficiency
  •  D81.6 Major histocompatibility complex class I deficiency
  •  D81.7 Major histocompatibility complex class II deficiency
  •  D81.89 Other combined immunodeficiencies
  •  D81.9 Combined immunodeficiency, unspecified
  •  D82 Immunodeficiency associated with other major defects
  •  D82.0 Wiskott-Aldrich syndrome
  •  D82.1 Di George's syndrome
  •  D82.4 Hyperimmunoglobulin E [IgE] syndrome

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

This is great news for Medicare beneficiaries with the 10 recently added diagnoses. IDF will continue to advocate to ensure that all individuals with PI have access to the appropriate treatments in the appropriate settings that help improve their quality of life.

Questions? Contact IDF: