CMS Pub. 100-04, ch. 20, § 213

Effective January 1, 2024, Medicare makes a separate bundled payment for home intravenous

immune globulin (IVIG) items and services to DME suppliers. This payment amount covers the

cost of nursing services and supplies including an infusion set and tubing, for the provision of

IVIG administration in the home by a DME supplier.

The items and services payment is made per visit for days on which the IVIG is administered by

a nurse in the patient’s home. The patient must have a diagnosis of Primary Immune Deficiency

Disease (PIDD) as indicated in the Intravenous Immune Globulin Policy Article (A5209).

Payment for home IVIG items and services is only made when the patient is receiving one of the

IVIG products listed on the Local Coverage Determination (LCD) for Intravenous Immune

Globulin (L33610).

A single payment will be made for the items and services provided on the calendar day when

such items and services are furnished in the home. The HCPCS (Q2052) “Services, Supplies,

and Accessories used in the Home for the Administration of Intravenous Immune Globulin”)

will be billed separately from, or on the same claim as, the J-code for the IVIG product. The Q-code should be billed as a separate claim line on the same claim for the same place of service as

the J-code for the IVIG. In cases where the IVIG product is mailed or delivered to the patient

prior to administration, the date of service for the administration of the IVIG (the Q-code) may be

no more than 30 calendar days after the date of service on the IVIG product claim line. No more

than one Q-code should be billed per claim line per date of service.

If a provider is billing for multiple administrations of IVIG on a single claim, then the supplier

would bill the Q-code for each date of service on a separate claim line, which would be payable

per visit (that is, each time the IVIG is administered). There may be situations in which multiple

units of IVIG are shipped to the patient and billed on a single “J” code claim line followed by

more than one Q-code administration claim line, each with the date of service on which the IVIG

was administered. However, only one unit of service (Q-code) shall be paid per infusion date of

service.

Providers should report visit length in 15-minute increments (15 minutes=1 unit) ) when billing

for IVIG (Q2052). See the table below for the rounding of units.

Rounding of Time Units

Unit Time

1 <23 minutes

2 = 23 minutes to <38 minutes

3 = 38 minutes to <53 minutes

4 = 53 minutes to <68 minutes

5 = 68 minutes to <83 minutes

6 = 83 minutes to <98 minutes

7 = 98 minutes to <113 minutes

8 = 113 minutes to <128 minutes

9 = 128 minutes to <143 minutes

10 = 143 minutes to <158 minutes

A submitted claim for home IVIG items and services is subject to a Common Working File (CWF)

edit in the event that an IVIG J-code is not found on the same claim as the IVIG items and services

payment code (Q-code), or in claims history in the previous 30 days. If a J-code is not found on the

same claim as the Q-code, the claims processing system will recycle the Q-code claim for the IVIG

items and services associated with the administration of the IVIG product (J-code), until a claim

containing the J-code for IVIG product is received in the CWF. The home IVIG items and services

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 Q-code claim will be denied.

Suppliers must ensure that an eligible J-code (as indicated on L33610) associated with the visit is

billed with the visit or no more than 30 days prior to the visit. Visits are denied if an eligible J-code

for the visit is not billed. Claims reporting multiple visits on the same line item date of service will

be returned as unprocessable.