Gamunex-C, Privigen, Gammagard, Panzyga, Octagam · Medicare Part B (physician-administered) · 138 covered ICD-10 codes
Medicare pays for Immune Globulin (IVIG) (J1459) under Part B when the claim carries a covered diagnosis. Novitas Solutions, Inc. defines local coverage in Billing & Coding Article A56786 (LCD L35093), which lists 138 covered ICD-10 codes — the complete, current list is below, grouped by condition. CMS last revised this article 04/24/2026; we reviewed it Jun 29, 2026.
Page reviewed Jun 29, 2026 · from CMS Article A56786 (CMS last revised 04/24/2026)
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 Q2)
Once a claim carries a covered diagnosis, Medicare Part B reimburses the drug at the ASP + 6% payment limit. Current allowed amounts per billing unit:
HCPCS
Description
Per unit
Allowed (ASP + 6%)
J1459
Inj ivig privigen 500 mg
500 mg
$49.533
J1551
Inj cutaquig 100 mg
100 mg
$13.927
J1552
Inj, alyglo, 500 mg
500 mg
$123.125
J1553
Inj yimmugo 100 mg
100 mg
$24.323
J1554
Inj. asceniv
500 mg
$500.926
J1555
Inj cuvitru, 100 mg
100 mg
$17.580
J1556
Inj, imm glob bivigam, 500mg
500 mg
$79.441
J1557
Gammaplex injection
500 mg
$64.650
J1558
Inj. xembify, 100 mg
100 mg
$15.367
J1559
Hizentra injection
100 mg
$14.515
J1561
Gamunex-c/gammaked
500 mg
$49.726
J1566
Immune globulin, powder
500 mg
$80.395
J1568
Octagam injection
500 mg
$47.035
J1569
Gammagard liquid injection
500 mg
$49.081
J1575
Hyqvia 100mg immuneglobulin
100 mg
$18.804
J1576
Inj, panzyga, 500 mg
500 mg
$73.830
Source: CMS ASP Drug Pricing File, 2026 Q2. Payment = ASP + 6% per unit; multiply by units billed (watch JZ/JW wastage). Your patient's share is typically 20% after the deductible. Estimate the full cost & patient out-of-pocket →
Immune Globulin (IVIG) is a physician-administered biologic billed under Medicare Part B (not the Part D pharmacy benefit). Under Part B, Medicare pays the practice for the drug (HCPCS J1459, J1561, J1566, J1568, J1569, J1572, J1599) plus its administration — but only when the claim's diagnosis (ICD-10) code supports medical necessity. Each MAC publishes the specific covered diagnoses in a Billing & Coding Article; a claim with a diagnosis outside that list is typically denied as not medically necessary (CO-50).
Covered ICD-10 diagnoses for Immune Globulin (IVIG)
The 138 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. 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)
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, and J1576.  
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.  
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 use this list when billing
Put the patient's covered ICD-10 diagnosis on the claim line with J1459 and confirm your documentation supports medical necessity. Match the right product code (reference vs biosimilar) and units, and check the diagnosis against the article for your MAC, since the list above is Novitas Solutions, Inc. policy.
LCD vs. Billing & Coding Article vs. NCD
An LCD (Local Coverage Determination) is a MAC's policy on whether a service is reasonable and necessary in its region, and its companion Billing & Coding Article holds the covered ICD-10 and HCPCS code lists. A NCD (National Coverage Determination), where one exists, applies nationwide. For Immune Globulin (IVIG), the 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, not the LCD.
Common Immune Globulin (IVIG) denial reasons
What you see
Why
Fix
CO-50 — not medically necessary
Diagnosis not in the covered list for J1459
Bill a covered ICD-10 from the groups above, or document an exception
Diagnosis/units mismatch
Right dx but wrong product code or unit count
Match the J/Q code and units to the drug actually given (check JZ/JW wastage)
Confirm against the Article's non-covered ICD-10 group
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.
What diagnoses are covered for Immune Globulin (IVIG) (J1459)?
Medicare lists 138 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 (v73), tied to LCD L35093 (“Immune Globulin”), published by Novitas Solutions, Inc. and last updated 04/24/2026.
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.
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.
04/24/2026 — the most recent revision CMS has published for this article.
Page last reviewed by CareCost
Jun 29, 2026 (coverage data retrieved 2026-06-28; we re-verify against CMS quarterly).
Code licensing
ICD-10-CM codes are public domain (CMS/CDC). CPT® codes are AMA-copyrighted and are intentionally not listed here — see the administration-code reference for those.
Not advice
This is general billing reference, not legal or billing advice. Always verify against the LCD/Article that applies to your MAC and patient.
How we build this
Compiled programmatically from the CMS Coverage API and reviewed by the CareCost Estimate editorial team against the source article. See our methodology and editorial policy.