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Access and Reimbursement for Hizentra

CSL Behring is committed to making starting and staying on Hizentra therapy easy for both you and your patients. The following tools, resources, and guidelines are here to help you along the way.

Hizentra Sample Program

For qualified patients, the Hizentra Sample program provides a 1-month supply of product, infusion equipment, and training at no cost. Talk to a Hizentra representative to learn how to initiate the process.

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Hizentra Referral Form

Hizentra Referral Form

Download and complete this form to initiate a Benefits Investigation by IgIQSM. IgIQ is our comprehensive resource center for patients and healthcare providers.

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Diagnostic and Billing Codes for Hizentra Therapy

Medicare, Medicaid, and most insurers cover Hizentra for the treatment of patients with primary immunodeficiency disease. All codes provided here are for informational purposes and are not an exhaustive list. The CPT, HCPCS, and ICD-10-CM codes provided are based on AMA or CMS guidelines. The treating physician is solely responsible for diagnosis coding and determination of the appropriate ICD-10-CM codes that describe the patient's condition and are supported by the medical record. The billing party is solely responsible for coding of services (eg, CPT Coding). Because government and other third-party payer coding requirements change periodically, please verify current coding requirements directly with the payer being billed.

Hizentra is covered as a Medicare Part B benefit with claims considered for payment by the four regional Durable Medical Equipment Medicare Administrative Contractors (DME MACs). Medicaid coverage policy varies by state. Coverage by other payers varies by payer and provider contract.

ICD-10-CM Diagnosis Codes5

D80 Immunodeficiency with predominantly antibody defects
D80.0* Hereditary hypogammaglobulinemia
Autosomal recessive agammaglobulinemia (Swiss type)
X-linked agammaglobulinemia [Bruton] (with growth hormone deficiency)
D80.1 Nonfamilial hypogammaglobulinemia
Agammaglobulinemia with immunoglobulin-bearing B-lymphocytes
Common variable agammaglobulinemia [CVAgamma]
Hypogammaglobulinemia NOS
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
Kappa light chain deficiency
D80.9 Immunodeficiency with predominantly antibody defects, unspecified
D81 Combined immunodeficiencies
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
D81.4 Nezelof’s syndrome
D81.6* Major histocompatibility complex class I deficiency
Bare lymphocyte syndrome
D81.7* Major histocompatibility complex class II deficiency
D81.89* Other combined immunodeficiencies
81.9* Combined immunodeficiency, unspecified
Severe combined immunodeficiency disorder [SCID] NOS
D82 Immunodeficiency associated with other major defects
Excludes: ataxia telangiectasia [Louis-Bar] (G11.3)
D82.0* Wiskott-Aldrich syndrome
Immunodeficiency with thrombocytopenia and eczema
D82.1 Di George’s Syndrome
Pharyngeal pouch syndrome
Thymic alymphoplasia
Thymic aplasia or hypoplasia with immunodeficiency
D82.2 Immunodeficiency with short-limbed stature
D82.3 Immunodeficiency following hereditary defective response to Epstein-Barr virus
X-linked lymphoproliferative disease
D82.4 Hyperimmunoglobulin E [IgE] syndrome
D82.8 Immunodeficiency associated with other specified major defects
D82.9 Immunodeficiency associated with major defect, unspecified
D83 Common variable immunodeficiency
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
*Medicare Part B–approved diagnosis codes for treatment with Hizentra in the home.
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HCPCS Billing Codes6,7

The following HCPCS codes describe supplies (including drugs) rendered by the billing provider. CMS publishes and maintains the HCPCS code set.

These codes are entered to paper claim for CMS-1500 in Field 24; or to electronic claim form ASC 837P in Loop 2400, Segment SV101-2, with the Qualifier “HC” entered to Segment SV101-1, unless otherwise directed by the payer.

Hizentra: Immune Globulin Subcutaneous (Human), 20% liquid
HCPCS Code Description
J1559 Injection, immune globulin (Hizentra), 100 mg

Certain payers may require the entry of NDC information to the claim form, as directed by the payer.

Ready-to-Use Hizentra Vial Sizes
Grams Protein Fill Size NDC Number to Use on All Claim Forms
1 g 5 mL 44206-0451-01
2 g 10 mL 44206-0452-02
4 g 20 mL 44206-0454-04
10 g 50 mL 44206-0455-10

If the billing provider performs administration services in conjunction with a patient's infusion, the following administration codes may be used to bill for this service if the service meets the requirements of the code description.

CPT Code Description
96369 Subcutaneous injection for therapy or prophylaxis; initial, up to 1 hour, including pump setup and establishment of subcutaneous infusion site(s)
96370 Each additional hour
96371 Additional pump setup with establishment of new subcutaneous infusion site(s)

Billing for Medicare DME MACs7

The medicare benefit for subcutaneous immune globulin administered by DME MACs applies only to those products that are specifically labeled as subcutaneous administration products. Intravenous immune globulin products administered via the subcutaneous route are not covered by Medicare DME MACs (refer to Local Coverage Decision for External Pumps, effective 2/4/2011).

Billing for External Pumps and Supplies

When the billing provider furnishes an external infusion pump for patient use, the following code may be used to bill for the pump if it meets the requirements of the code description.

External Infusion Pump
HCPCS Code Description
E0779 Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater

Only an E0779 infusion pump is covered by Medicare for the administration of Hizentra.

Other pump codes may be used to bill other payers, depending on the pump that is used and the payer's pump coverage policy. The codes below are not covered by Medicare. Other pump codes may include:

E0781 Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient
E0791 Parenteral infusion pump, stationary, single or multichannel

When the billing provider furnishes supplies for the patient's use with the external infusion pump, the following codes may be appropriate for the supplies if they meet the requirements of the code description and payer coverage policies.

External Infusion Pump Supplies
K0552 Supplies for external drug infusion pump, syringe-type cartridge, sterile, each
A4221 Supplies for maintenance of drug infusion catheter, per week
A4222 Infusion supplies for external drug infusion pump, per cassette or bag

Medicare requires the addition of Modifier -JB (administered subcutaneously) to the HCPCS code for Hizentra (J1559) to confirm subcutaneous administration. Example: J1559-JB. Modifier -JB should also be added to the HCPCS code for the covered infusion pump (E0779) following the modifier that indicates whether the pump is being rented (RR) or purchased (NU). Example: E0779-RR-JB or E0779-NU-JB.

ICD = International Classification of Diseases
HCPCS = Healthcare Common Procedure Coding System
CPT = Current Procedural Terminology

Hizentra Coding Information brochure

Hizentra Coding Information

Download coding information
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