Updated Policy Effective Date for Billing Immune Globulins

October 6, 2020

Superseding communication from the Department of Health Care Services (DHCS) in the July 2020 General Bulletin, new changes are introduced for billing and claims submission of various HCPCS Level II and Current Procedural Terminology (CPT®) codes for Physician Administered Drugs (PAD).

As part of ongoing efforts to ensure consistency and accuracy in billing and provider reimbursements, providers must note the following when submitting claims for specific biologicals and drugs.

Preferred Codes for Billing Biologicals With Both CPT and HCPCS Codes:

The biologicals below are billed with both CPT and HCPCS codes. The HCPCS codes are often more specific than the CPT codes. Now effective for dates of service on or after October 1, 2019, for reimbursement, providers must submit claims for the listed CPT codes using the corresponding HCPCS codes as shown in the table below:

Procedure Codes Procedure Descriptions Code(s) to Bill with
90281 Immune globulin (Ig), human, for intramuscular use J1460 or J1560
90283 Immune globulin (IgIV), human, for intravenous use J1459, J1556, J1557, J1561, J1566, J1568, J1569, J1572 or J1599
90284 Immune globulin (SCIg), human, for use in subcutaneous infusions, 100 mg, each Bill J1555 (Cuvitru) & J1559 (Hizentra)

Continue to bill 90284 for all other immune globulins used for subcutaneous infusions
90291 Cytomegalovirus immune globulin (CMV-IgIV), human, for intravenous use J0850
90384 Rho(D) immune globulin (RhIg), human, full-dose, for intramuscular J2790 or J2791
90385 Rho(D) immune globulin (RhIg), human, mini-dose, for intramuscular use J2788
90386 Rho(D) immune globulin (RhIgIV), human, for intravenous use J2791 or J2792
90389 Tetanus immune globulin (TIg), human, for intramuscular use J1670

Providers may continue to bill for Gammagard liquid, Gammaked, Gammunex-C, Cutaquig and Xembify with CPT code 90284.

Cuvitru must be billed with J1555 and Hizentra with J1559.

Processes for Rebilling and Payment Correction of Rho (D) Immune Globulins for Dates of Service On or After October 1, 2019 to August 31, 2020 for Providers Who Billed With CPT Codes and Were Denied or Underpaid:

For providers who previously billed with CPT codes 90384 and 90385 and claims were denied:

  • Rebill with the corresponding J codes as indicated in the table above.

    • It is not necessary to submit a Treatment Authorization Request (TAR).

    • This ensures that providers are reimbursed at the full Medi-Cal rate available.

      • If rebill is submitted beyond the 6-month billing limitation, timeliness of the rebill is waived.

For providers who billed with CPT codes 90384 and 90385 and were reimbursed only the injection administration fee of $4.46:

  1. Submit a Claims Inquiry Form (CIF) to void the claim billed with the CPT code.
    • There is no time restriction on this process.

    • When completing the CIF, providers must enter the information exactly as it appears on the Remittance Advice Details (RAD) to ensure the claim is located within the claims processing system.

  2. Rebill using the corresponding J code as indicated in the table above for appropriate reimbursement following the void of the CPT code.

    • These steps ensure that providers are paid at the full Medi-Cal rate available.

    • It is not necessary to submit a TAR.

      • If rebill is submitted beyond the 6-month billing limitation, timeliness of the rebill is waived.

Instructions regarding the submission of CIF can be found here in the Billing Basics Outreach & Education workbook.

Erroneous Payment Correction (EPC) for Dates of Service from August 1, 2020 to August 31, 2020

  • EPCs are processed for all claims billed with J-codes, which were inappropriately denied for dates of service from August 1, 2020, to August 31, 2020.

    • EPCs are processed automatically. No action is required on the part of providers.