Page reviewed Aug 23, 2026 · from CMS Article A56786 (CMS last revised 07/10/2026)
Quick answer
Medicare benefit
Part B (physician-administered)
Covered diagnoses
108 ICD-10 codes
Governing policy
A56786 / L35093
Contractor (MAC)
Novitas Solutions, Inc.
CMS article revised
07/10/2026
Page reviewed
Aug 23, 2026
HCPCS codes covered:
J1459J1551J1552J1553J1554J1555J1556J1557J1558J1559J1561J1566J1568J1569J1572J1575J1576J1577
J1459J1551J1552J1553J1554J1555J1556J1557J1558J1559J1561J1566J1568J1569J1572J1575J1576J1577
Coverage varies by Medicare Administrative Contractor (MAC). This list is Novitas Solutions, Inc.'s policy (Article A56786), which administers Part B in Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma +6 more. In another state? Other MACs may publish a different covered list — find your MAC by state →
What Medicare pays for Immune Globulin (IVIG) (2026 Q4)
2026 Q4 payment limit per billing unit for Immune Globulin (IVIG)’s HCPCS codes (how ASP + 6% works):
| HCPCS | Description | Per unit | Allowed (ASP + 6%) |
|---|---|---|---|
| J1459 | Inj ivig privigen 500 mg | 500 mg | $48.963 |
| J1551 | Inj cutaquig 100 mg | 100 mg | $14.172 |
| J1552 | Inj, alyglo, 500 mg | 500 mg | $120.040 |
| J1553 | Inj yimmugo 100 mg | 100 mg | $21.664 |
| J1554 | Inj. asceniv | 500 mg | $508.454 |
| J1555 | Inj cuvitru, 100 mg | 100 mg | $17.994 |
| J1556 | Inj, imm glob bivigam, 500mg | 500 mg | $80.791 |
| J1557 | Gammaplex injection | 500 mg | $62.299 |
| J1558 | Inj. xembify, 100 mg | 100 mg | $15.200 |
| J1559 | Hizentra injection | 100 mg | $14.786 |
| J1561 | Gamunex-c/gammaked | 500 mg | $48.022 |
| J1566 | Immune globulin, powder | 500 mg | $82.756 |
| J1568 | Octagam injection | 500 mg | $47.133 |
| J1569 | Gammagard liquid/erc inj | 500 mg | $49.495 |
| J1575 | Hyqvia 100mg immuneglobulin | 100 mg | $19.293 |
| J1576 | Inj, panzyga, 500 mg | 500 mg | $70.250 |
| J1577 | Inj, qivigy, 100mg | 100 mg | $29.280 |
CMS ASP Drug Pricing File, 2026 Q4. Immune Globulin (IVIG) patient out-of-pocket estimate →
Immune Globulin (IVIG) (HCPCS J1459, J1561, J1566, J1568, J1569, J1572, J1599) is paid under Part B only when the claim’s ICD-10 code is one Novitas Solutions, Inc. lists in Article A56786; otherwise expect a CO-50 denial. How Part B drug coverage is decided →
Covered ICD-10 diagnoses for Immune Globulin (IVIG)
The 108 codes below are the diagnoses Novitas Solutions, Inc. accepts for J1459 under Article A56786, grouped exactly as CMS groups them and organized by condition category for scanning. CMS lists 30 of these codes under more than one HCPCS group (the count above is distinct diagnoses; the group subtotals count each listing). Use the filter in each group to find a specific code or condition.
Group 1 — 108 covered diagnoses (applies to J1459, J1552, J1553, J1554, J1556, J1557, J1561, J1566, J1568, J1569, J1572, J1576, J1577)
Intravenous Formulations of Immune Globulin It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted. The following ICD-10-CM codes support medical necessity and provide coverage for HCPCS codes: J1459, J1552, J1553, J1554, J1556, J1557, J1561, J1566, J1568, J1569, J1572, J1576, and J1577.  
Blood, blood-forming organs & immune disorders (35)
| ICD-10 | Covered diagnosis |
|---|---|
| D59.0 | Drug-induced autoimmune hemolytic anemia |
| D59.11 | Warm autoimmune hemolytic anemia |
| D59.12 | Cold autoimmune hemolytic anemia |
| D59.13 | Mixed type autoimmune hemolytic anemia |
| D59.19 | Other autoimmune hemolytic anemia |
| D69.3 | Immune thrombocytopenic purpura |
| D69.41 | Evans syndrome |
| D80.0 | Hereditary hypogammaglobulinemia |
| D80.1 | Nonfamilial 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 |
| D80.8 | Other immunodeficiencies with predominantly antibody defects |
| 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 |
| D81.31 | Severe combined immunodeficiency due to adenosine deaminase deficiency |
| D81.4 | Nezelof's syndrome |
| D81.5 | Purine nucleoside phosphorylase [PNP] deficiency |
| D81.6 | Major histocompatibility complex class I deficiency |
| 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 |
| D82.0 | Wiskott-Aldrich syndrome |
| D82.1 | Di George's syndrome |
| D82.4 | Hyperimmunoglobulin E [IgE] syndrome |
| 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 |
Diseases of the skin & subcutaneous tissue (19)
| ICD-10 | Covered diagnosis |
|---|---|
| L10.0 | Pemphigus vulgaris |
| L10.1 | Pemphigus vegetans |
| L10.2 | Pemphigus foliaceous |
| L10.3 | Brazilian pemphigus [fogo selvagem] |
| L10.4 | Pemphigus erythematosus |
| L10.5 | Drug-induced pemphigus |
| L10.81 | Paraneoplastic pemphigus |
| L10.89 | Other pemphigus |
| L10.9 | Pemphigus, unspecified |
| L12.0 | Bullous pemphigoid |
| L12.1 | Cicatricial pemphigoid |
| L12.35 | Other acquired epidermolysis bullosa |
| L12.8 | Other pemphigoid |
| L12.9 | Pemphigoid, unspecified |
| L13.8 | Other specified bullous disorders |
| L51.1 | Stevens-Johnson syndrome |
| L51.2 | Toxic epidermal necrolysis [Lyell] |
| L51.3 | Stevens-Johnson syndrome-toxic epidermal necrolysis overlap syndrome |
| L98.5 | Mucinosis of the skin |
Diseases of the musculoskeletal system & connective tissue (19)
| ICD-10 | Covered diagnosis |
|---|---|
| M30.3 | Mucocutaneous lymph node syndrome [Kawasaki] |
| M32.11 | Endocarditis in systemic lupus erythematosus |
| M32.12 | Pericarditis in systemic lupus erythematosus |
| M32.13 | Lung involvement in systemic lupus erythematosus |
| M32.14 | Glomerular disease in systemic lupus erythematosus |
| M32.15 | Tubulo-interstitial nephropathy in systemic lupus erythematosus |
| M32.19 | Other organ or system involvement in systemic lupus erythematosus |
| M33.01 | Juvenile dermatomyositis with respiratory involvement |
| M33.02 | Juvenile dermatomyositis with myopathy |
| M33.03 | Juvenile dermatomyositis without myopathy |
| M33.09 | Juvenile dermatomyositis with other organ involvement |
| M33.11 | Other dermatomyositis with respiratory involvement |
| M33.12 | Other dermatomyositis with myopathy |
| M33.13 | Other dermatomyositis without myopathy |
| M33.19 | Other dermatomyositis with other organ involvement |
| M33.21 | Polymyositis with respiratory involvement |
| M33.22 | Polymyositis with myopathy |
| M33.29 | Polymyositis with other organ involvement |
| M36.0 | Dermato(poly)myositis in neoplastic disease |
Diseases of the nervous system (18)
| ICD-10 | Covered diagnosis |
|---|---|
| G04.81 | Other encephalitis and encephalomyelitis |
| G11.3 | Cerebellar ataxia with defective DNA repair |
| G25.82 | Stiff-man syndrome |
| G35.A | Relapsing-remitting multiple sclerosis |
| G36.0 | Neuromyelitis optica [Devic] |
| G61.0 | Guillain-Barre syndrome |
| G61.81 | Chronic inflammatory demyelinating polyneuritis |
| G61.82 | Multifocal motor neuropathy |
| G70.00 | Myasthenia gravis without (acute) exacerbation |
| G70.01 | Myasthenia gravis with (acute) exacerbation |
| G70.80 | Lambert-Eaton syndrome, unspecified |
| G70.81 | Lambert-Eaton syndrome in disease classified elsewhere |
| G72.41 | Inclusion body myositis [IBM] |
| G72.81 | Critical illness myopathy |
| G72.89 | Other specified myopathies |
| G73.1 | Lambert-Eaton syndrome in neoplastic disease |
| G73.3 | Myasthenic syndromes in other diseases classified elsewhere |
| G93.49 | Other encephalopathy |
Injury, poisoning & external causes (6)
| ICD-10 | Covered diagnosis |
|---|---|
| T86.01 | Bone marrow transplant rejection |
| T86.11 | Kidney transplant rejection |
| T86.21 | Heart transplant rejection |
| T86.31 | Heart-lung transplant rejection |
| T86.41 | Liver transplant rejection |
| T86.810 | Lung transplant rejection |
Neoplasms (4)
| ICD-10 | Covered diagnosis |
|---|---|
| C90.00 | Multiple myeloma not having achieved remission |
| C90.02 | Multiple myeloma in relapse |
| C91.10 | Chronic lymphocytic leukemia of B-cell type not having achieved remission |
| C91.12 | Chronic lymphocytic leukemia of B-cell type in relapse |
Diseases of the eye & adnexa (3)
| ICD-10 | Covered diagnosis |
|---|---|
| H05.241 | Constant exophthalmos, right eye |
| H05.242 | Constant exophthalmos, left eye |
| H05.243 | Constant exophthalmos, bilateral |
Factors influencing health status (2)
| ICD-10 | Covered diagnosis |
|---|---|
| Z51.11 | Encounter for antineoplastic chemotherapy |
| Z51.12 | Encounter for antineoplastic immunotherapy |
Diseases of the circulatory system (1)
| ICD-10 | Covered diagnosis |
|---|---|
| I78.8 | Other diseases of capillaries |
Diseases of the genitourinary system (1)
| ICD-10 | Covered diagnosis |
|---|---|
| N18.6 | End stage renal disease |
Group 2 — 30 covered diagnoses (applies to J1551, J1555, J1558, J1559, J1561, J1569, J1575)
Subcutaneous Formulations of Immune Globulin It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted. The following ICD-10-CM codes support medical necessity and provide coverage for HCPCS codes: J1551, J1555, J1558, J1559, J1561, J1569, and J1575.  
Blood, blood-forming organs & immune disorders (28)
| ICD-10 | Covered diagnosis |
|---|---|
| D80.0 | Hereditary hypogammaglobulinemia |
| D80.1 | Nonfamilial 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 |
| D80.8 | Other immunodeficiencies with predominantly antibody defects |
| 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 |
| D81.31 | Severe combined immunodeficiency due to adenosine deaminase deficiency |
| D81.4 | Nezelof's syndrome |
| D81.5 | Purine nucleoside phosphorylase [PNP] deficiency |
| D81.6 | Major histocompatibility complex class I deficiency |
| 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 |
| D82.0 | Wiskott-Aldrich syndrome |
| D82.1 | Di George's syndrome |
| D82.4 | Hyperimmunoglobulin E [IgE] syndrome |
| 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 |
Diseases of the nervous system (2)
| ICD-10 | Covered diagnosis |
|---|---|
| G11.3 | Cerebellar ataxia with defective DNA repair |
| G61.81 | Chronic inflammatory demyelinating polyneuritis |
How to bill Immune Globulin (IVIG)
Put the patient's covered ICD-10 diagnosis on the claim line with J1459. Matching codes, units and JZ/JW wastage →
Which policy governs Immune Globulin (IVIG)
The covered code lists live in Article A56786 (tied to LCD L35093) — CMS moved code lists out of LCDs and into Articles, which is why the diagnoses live in the Article. What an LCD, an Article and an NCD each govern →
If a claim for Immune Globulin (IVIG) is denied
The usual cause is a diagnosis outside Article A56786's covered list, or a product code and unit count that do not match what was given. The five denial patterns and how to fix each →
Frequently asked questions
- Is Immune Globulin (IVIG) covered by Medicare?
- Yes. Immune Globulin (IVIG) (J1459) is covered under Medicare Part B as a physician-administered drug when billed for a medically necessary, covered diagnosis. Local coverage is defined by Novitas Solutions, Inc. in Billing & Coding Article A56786, tied to LCD L35093. None of the 8 Medicare Administrative Contractors lists these codes as self-administered.
- What diagnoses are covered for Immune Globulin (IVIG) (J1459)?
- Medicare lists 108 covered ICD-10 diagnosis codes for J1459 under Article A56786. The full list is on this page, grouped by condition category. Coverage can vary by Medicare Administrative Contractor (MAC); confirm against the article that applies in your state.
- Which Medicare policy covers Immune Globulin (IVIG)?
- Billing & Coding Article A56786 (v77), tied to LCD L35093 (“Immune Globulin”), published by Novitas Solutions, Inc. and last updated 07/10/2026.
- Why was my Immune Globulin (IVIG) claim denied as not medically necessary?
- The most common cause is an ICD-10 diagnosis on the claim that is not in the covered list for J1459. Confirm the patient's diagnosis is in the groups below, that documentation supports medical necessity, and that you are using the article for your MAC.
Related references
Covered is only half the answer.
You know the diagnosis is payable. Now quote the patient before the visit and catch underpayments: get Immune Globulin (IVIG)'s exact Medicare allowed amount, your payer's rate vs. ASP+6%, and the patient's out-of-pocket — in about 30 seconds, free.
Estimate Immune Globulin (IVIG) cost & patient owe →Source & verification
- Source
- CMS Medicare Coverage Database — Billing & Coding Article A56786 (v77), LCD L35093 “Immune Globulin” — Novitas Solutions, Inc..
- Primary sources
- DailyMed — Immune Globulin (IVIG) prescribing information · CMS Part B Drug ASP Pricing File — the quarterly payment limit quoted above · CMS Medicare Coverage Database — Article A56786
- CMS article last revised
- 07/10/2026
- Page last reviewed by CareCost
- Aug 23, 2026 (coverage data retrieved 2026-09-21; we re-verify against CMS quarterly).
- Notes
- ICD-10-CM is public domain; CPT® (AMA) is intentionally not listed. Reference, not billing advice — built from the CMS Coverage API per our methodology; corrections to editorial@carecostestimate.com.