LCD ID Number: L39314 Status: A-Approved
LCD Title: Off-Label Use of Intravenous Immune Globulin (IVIG)
Geographic Jurisdiction: Maine Other Jurisdictions
Original Determination Effective Date:
Original Determination Ending Date:
Revision Effective Date:
Revision End Date:
CMS National Coverage Policy:
Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the LCD Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act.
Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:
Title XVIII of the Social Security Act (SSA):
Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.
Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
CMS Publication Pub 100-02, Medicare Benefit Policy Manual, Chapter 15:
50 - Drugs and Biologicals
50.4.5 - Off-Label Use of Drugs and Biologicals in an Anti-Cancer Chemotherapeutic Regimen
CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 17:
10 - Payment Rules for Drugs and Biologicals
Sorry, you need to login or register to view additional sections of this Medicare policy.
All information on this web site is compiled directly from information obtained from the Center
for Medicare and Medicaid Services (CMS) and from its Contractors.
CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on
this web site. However, the ultimate responsibility for correct coding and claims submission lies with the
provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information
is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims.
Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.
No part of this web page or data displayed may be redistibuted or used without the express written consent of Wheaton Partners, LLC.
06/07/2023 03:10:50 220.127.116.11