Does Medicare Cover IVIG Treatments?

Intravenous Immunoglobulin therapy, also known as IVIG, is a therapy for people with weakened immune systems.

It’s a treatment that is used to treat certain conditions that are related to immune deficiencies. These conditions may include immune thrombocytopenia, Kawasaki disease, and chronic inflammatory demyelinating polyneuropathy.

So, a common question many people have is, “does Medicare cover IVIG treatments?” In this article, we answer that question in clear, plain English. You will also find the average costs of IVIG treatments if you have to pay for them out of pocket and other helpful info.

Does Medicare Cover IVIG Treatments?

The short answer is yes; Medicare will cover the cost of IVIG treatments. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met for Medicare to pay for your IVIG treatments. Below we look at what these are so you know what to expect.

Original Medicare

Medicare Part A and Part B provide coverage for IVIG treatments. Original Medicare provides coverage for your IVIG treatments if it is considered medically necessary. Your healthcare provider must first order the treatment for Original Medicare to provide coverage.

Coverage for IVIG treatments is provided by Medicare Part B. Medicare Part B provides coverage for IVIG treatments for the following medical conditions:

Chronic Inflammatory Demyelinating Polyneuropathy or CIDP
Primary Immunodeficiency or PI

Medicare Part B will provide coverage for IVIG for CIDP as a maintenance treatment. Under the same coverage benefit of IVIG, Medicare Part B will also provide coverage for Hizentra.

Once approved, Medicare Part B covers 80 percent of the costs of IVIG treatments. You will pay for the remaining 20 percent.

Medicare Part B provides coverage for IVIG and treatment for PI under the diagnosis codes 279.04, 279.05, 279.06, 279.12, or 279.2. Part B will provide coverage for IVIG for PI if you are signed up for the demonstration project. Under the demonstration project, Medicare Part B provides coverage for IVIG in-home and nursing homes and 15 different diagnoses.

Medicare Part B provides coverage for IVIG for PI through reimbursement. If you did not qualify for coverage under Medicare Part B, then Medicare Part D may provide coverage for your IVIG for PI.

Part C Coverage for IVIG Treatments

Medicare Advantage plans (Medicare Part C) also provide coverage for IVIG treatments. Advantage plans cover everything Original Medicare covers but also additional benefits as well. However, exactly what a plan covers and the out-of-pocket costs will vary depending on the specifics of your plan.

Medicare Part C plans that include prescription drug plans will also provide coverage for medications your healthcare provider will prescribe.

Medicare Part D plans provide coverage for IVIG treatments if you are not covered by Medicare Part B. Part D is a prescription drug plan, and just like Medicare Part C, Medicare Part D plans are provided by private insurance companies.

How Much Does IVIG Cost?

IVIG costs from $100 to $350 per gram. The total cost depends on the number of infusions needed.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. Always be sure to double-check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.