Most insurers cover Privigen for the medically necessary treatment of primary immunodeficiency disease (PI) and chronic immune thrombocytopenic purpura (ITP). Medicaid coverage varies by state, and coverage by other payers varies by plan and by contract. Download the Prescription Referral Form to confirm insurance coverage options.

Below are the ICD-10-CM22 diagnosis codes that may be used to identify patient medical conditions typically associated with PI and chronic ITP.

D69

Purpura and other hemorrhagic conditions

D69.3
Immune thrombocytopenic purpura Hemorrhagic (thrombocytopenic) purpura Idiopathic thrombocytopenic purpura Tidal platelet dysgenesis
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
D81.4
Nezelof's syndrome
D81.6*
Major histocompatibility complex class I deficiency Bare lymphocyte syndrome
D81.7*
Major histocompatibility complex class II deficiency
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

CPT® and HCPCS Codes (Healthcare Common Procedural Coding System) CPT/HCPCS Code Description23,24

S9338
Home infusion therapy, immunotherapy, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately)
J1459
Injection, immune globulin (Privigen), intravenous, non-lyophilized (eg, liquid), 500 mg
96365
Intravenous infusion, for therapy and prophylaxis or diagnosis (specify substance or drug); initial, up to 1 hour
96366
Each additional hour (list separately in addition to code for primary procedure)

This resource provides information from a complex and evolving medical coding system. The treating physician is solely responsible for diagnosis coding and determination of the appropriate ICD-10-CM codes that describe the patient's condition and are supported by the medical record.

All codes listed in this guide are for informational purposes and are not an exhaustive list. The CPT®, HCPCS, and ICD-10-CM codes provided are based on AMA or CMS guidelines. The billing party is solely responsible for coding of services (eg, CPT coding). Because government and other third-party payer coding requirements change periodically, please verify current coding requirements directly with the payer being billed.

Medicare coverage and billing requirements are dependent in part on where the patient is treated. CPT=Current Procedural Terminology.

*Privigen is covered by Medicare Part B for treatment in the patient's home only for these diagnoses. Other diagnoses treated in the home may be covered by Medicare Part D.

S-codes are HCPCS codes used by some private health plans for billing and reimbursement. Medicaid plans may use S-codes as well, but Medicare does not use them.25

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