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Medical Policy Revision: Immune Globulin Subcutaneous

Effective September 12, 2016, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for immunoglobulin therapy services.

Claims for services provided on and after September 12, 2016 to members enrolled in a Horizon BCBSNJ plan will be processed according to the guidelines of our revised medical policy, Immune Globulin Subcutaneous (Vivaglobin, Hizentra, Gammagard Liquid, Gamunex-C/Gammaked, and HyQvia for subcutaneous administration). Based on updated literature (sources are documented within the policy), our policy includes revised criteria for:

  • Primary immunodeficiency
  • Adjusted body weight dosing for members new to therapy

Review this revised policy in our Medical Policy Manual.

Based on the guidelines of this revised medical policy, effective September 12, 2016, Horizon BCBSNJ, and business partners working on our behalf, may require additional information to determine clinical appropriateness/medical necessity of HCPCS codes J1559, J1561, J1562, and/or J1569.

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been cancelled or postponed, the changes will be applied to claims for dates of service on and after September 12, 2016.

Published on: June 10, 2016, 10:00 a.m. ET
Last updated on: November 25, 2020, 00:26 a.m. ET