by Jared Staheli
July 9th, 2015
Beginning for dates of service on or after January 1, 2004, Medicare pays for intravenous immune globulin administered in the home. (See the Medicare Benefit Policy Manual, Chapter 15 for coverage requirements.) Contractors pay for the drug, but not the items or services related to the administration of the drug when administered in the home, if deemed medically appropriate.
Contractors may pay any entity licensed in the State to furnish intravenous immune globulin. Payment will be furnished to the entity with the authority to furnish the drug. Beneficiaries are ineligible to receive payment for the drug.
Pharmacies and hospitals dispensing intravenous immune globulin for home use would bill the DME MAC. If the beneficiary is receiving treatment in an outpatient hospital, the bill must be sent to the A/B MAC (A). If the beneficiary is receiving treatment in a physician’s office, the bill must be sent to the A/B MAC (B). Home Health Agencies dispensing intravenous immune globulin would bill the A/B MAC (HHH). Physicians furnishing intravenous immune globulin for the refilling of an external pump for home infusion would bill the DME MAC.
Effective January 1, 2006, Medicare makes an additional payment once per day per beneficiary for preadministration-related services whenever a beneficiary receives intravenous immune globulin.