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Medical Policy Revision: Intravenous Immunoglobulin Therapy

Effective December 22, 2015, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for Intravenous Immunoglobulin (IVIG) Therapy services.

Claims for IVIG services provided on and after December 22, 2015 to members enrolled in a Horizon BCBSNJ plan will be processed according to the guidelines of our revised medical policy, Intravenous Immunoglobulin (IVIG) Therapy. Based on updated literature (sources are documented within the policy), our policy includes revised criteria for:

  • Primary immunodeficiencies
  • Idiopathic/immune thrombocytopenic purpura (ITP)
  • Kawasaki syndrome
  • Chronic lymphocytic leukemia (CLL) allogeneic bone marrow recipients
  • Chronic inflammatory demyelating polyneuropathy (CIDP)
  • Off-label uses

Effective December 22, 2015, Horizon BCBSNJ, and business partners working on our behalf, may require additional information to determine clinical appropriateness/medical necessity of the above-noted IVIG therapy services.

Review this revised policy in our online Medical Policy Manual.

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 December 22, 2015.

Published on: September 22, 2015, 11:00 a.m. ET
Last updated on: November 24, 2020, 23:44 p.m. ET