Access and billing codes for PI and CIDP

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Hizentra coding information

You can download a printable version of the diagnosis and ICD-10-CM billing codes.

Download the diagnosis and billing codes for PI & CIDP

Hizentra coding information for PI and CIDP

Hizentra is covered under Medicare Part B for both PI and CIDP*

The convenience of self-infused Hizentra—covered under the same benefit category as IVIg.^†

Lower patient out-of-pocket costs than with Part D
- Coverage includes infusion pump, ancillary supplies, medication, and nurse training
No prior authorization required^‡

For updated coverage and comprehensive support, call Hizentra Connect^SM
1-877-355-4447 Monday–Friday, 8 AM to 8 PM ET

*100% coverage for patients with Medicare Part B and a qualifying Medigap plan after Part B annual deductible is met.

†Coverage of IVIg when administered in a clinical setting.

‡Chart notes must be up to date and include diagnostic criteria.

ICD-10-CM diagnosis codes¹

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
D81.31	Severe combined immunodeficiency [SCID] 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 Bare lymphocyte syndrome
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 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
D84	Immunodeficiency, unspecified
D84.9	Immunodeficiency, unspecified
G11	Hereditary Ataxia
G11.3*	Cerebellar ataxia with defective DNA repair Ataxia telangiectasia
G61	Chronic inflammatory demyelinating polyneuritis
G61.81*	Chronic Inflammatory demyelinating polyneuritis Chronic inflammatory demyelinating polyneuropathy Chronic inflammatory demyelinating polyradiculoneuropathy Polyneuropathy (multiple nerve disorder) Polyneuropathy, chronic inflammatory demyelinating Polyradiculoneuropathy, chronic inflammatory demyelinating Polyradiculoneuropathy, inflammatory demyelinating

*Medicare Part B–approved diagnosis codes for treatment with Hizentra in the home. All other diagnoses may qualify for coverage under Medicare Part D plans.

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HCPCS billing codes^2-6

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 form 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% liquid²
HCPCS Code	Description
J1559	Injection, immune globulin (Hizentra), 100 mg

Ready-to-use Hizentra prefilled syringe sizes Certain payers may require the entry of NDC information to the claim form, as directed by the payer.
Grams Protein	Fill Size	Carton NDC Number^*
1 g	5 mL	44206-0456-21
2 g	10 mL	44206-0457-22
4 g	20 mL	44206-0458-24
10 g	50 mL	44206-0455-25

*For billing requiring an 11 digit NDC add the preceding zero as shown above.
Component NDC numbers can be found in the prescribing information.

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^3-6	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)
S9338	Home infusion therapy, immunotherapy, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

Medicare Home Infusion Therapy (HIT) professional services (G-Codes)⁷

G0089	Subcutaneous immunotherapy and other certain subcutaneous infusion drugs, initial encounter
G0069	Subcutaneous immunotherapy and other certain subcutaneous infusion drugs, subsequent encounter
Providers must be a qualified HIT supplier to bill for professional services. Section 1861(iii)(3)(C) of the Act defines a “home infusion drug” as a parenteral drug or biological administered intravenously, or subcutaneously for an administration period of 15 minutes or more, in the home of an individual through a pump that is an item of durable medical equipment (as defined in section 1861(n) of the Act). The professional visit G-code claim will recycle three times (with a 30-day look back period) for a total of 15 business days. After 15 business days, if no J-code claim is found in claims history, the G-code claim will be denied.

Billing for Medicare DME MACs²

The Medicare benefit for patients with primary immune deficiency or chronic inflammatory demyelinating polyneuropathy 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
	E0779 is the only reimbursable pump code for infusion of Hizentra under Medicare Part B.* 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.

Professional services for drug infusion
HCPCS Code	Description
G0069	Professional services for the administration of subcutaneous immunotherapy for each infusion drug administration calendar day in the individual's home, each 15 minutes

External infusion pump supplies
HCPCS Code	Description
K0552	Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each
A4221	Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately)
A4222	Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately)
*For E0779 and K0455 pumps, either A4222 or K0552 may be billed, but not both.

Modifier -JB for Medicare billing

Medicare requires the addition of Modifier -JB (administered subcutaneously) to the HCPCS code for Hizentra (J1559) to confirm subcutaneous administration. Example: J1559-JB.

Commercial and Medicaid plans may require the use of the JB modifier. If required, 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. Always check with the plan to see if the modifier code is required.

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

Hizentra referral forms and patient support

Download Hizentra referral forms and find additional resources to support your patients throughout their treatment journeys

Patient support resources

Find answers to your questions

More information about helping patients get started and stay on Hizentra may be found in our FAQs section

Frequently asked questions

References: 1. National Center for Health Statistics (US Department of Health and Human Services) International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). 2021 Codes Tables and Index. https://www.cdc.gov/nchs/icd/icd10cm.htm. Accessed June 25, 2021. 2. Centers for Medicare and Medicaid Services (US Department of Health and Human Services). HCPCS Release and Code Sets. https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS-Quarterly-Update. Accessed June 25, 2021. 3. 2021 CPT Code 96369. American Academy of Professional Coders website. https://www.aapc.com/codes/cpt-codes/96369. Accessed June 25, 2021. 4. 2021 CPT Code 96370. American Academy of Professional Coders website. https://www.aapc.com/codes/cpt-codes/96370. Accessed June 25, 2021. 5. 2021 CPT Code 96371. American Academy of Professional Coders website. https://www.aapc.com/codes/cpt-codes/96371. Accessed June 25, 2021. 6. 2021 HCPCS Code S9338. American Academy of Professional Coders website. https://www.aapc.com/codes/hcpcs-codes/S9338. Accessed June 25, 2021. 7. Centers for Medicare and Medicaid Services (US Department of Health and Human Services) Medicare Learning Network. Billing for Home Infusion Therapy Services. https://www.cms.gov/files/document/MM11880.pdf. Accessed June 25, 2021.

Access and billing codes for PI and CIDP

Hizentra coding information

Hizentra is covered under Medicare Part B for both PI and CIDP*

ICD-10-CM diagnosis codes1

D80

Immunodeficiency with predominantly antibody defects

D81

Combined immunodeficiencies

D82

Immunodeficiency associated with other major defects

D83

Common variable immunodeficiency

D84

Immunodeficiency, unspecified

G11

Hereditary Ataxia

G61

Chronic inflammatory demyelinating polyneuritis

HCPCS billing codes2-6

Medicare Home Infusion Therapy (HIT) professional services (G-Codes)7

Billing for Medicare DME MACs2