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ASCENIV® (immune globulin intravenous [human] – slra) is a 10% liquid intravenous immunoglobulin indicated for the treatment of primary humoral immunodeficiency (PI) in adults and adolescents aged 12 to 17 years. Accurate billing and coding are essential for appropriate reimbursement and compliance. Below is a guide to assist healthcare providers:

Product Information

• NDC Codes:

• 5 g/50 mL single-use vial: NDC 69911-0020-05

• 10 g/100 mL single-use vial: NDC 69911-0020-10

Coding Details:

• HCPCS Code:

• J1554 – Injection, immune globulin (ASCENIV), 500 mg

• Billing Units: Report the number of 500 mg increments administered. For example, for a 5 g (5000 mg) dose, enter 10 units.

• ICD-10-CM Diagnosis Codes:

o Select the appropriate code based on the patient's condition. Examples include:

§ D80.0 – Hereditary hypogammaglobulinemia

§ D83.9 – Common variable immunodeficiency, unspecified

· CPT Codes:

o 96365 – Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour

o 96366 – Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (list separately in addition to code for primary procedure)

Sample CMS-1500 Claim Form Entries:

· Locator 21: Enter the appropriate ICD-10-CM diagnosis code (e.g., D80.0).

· Locator 24A: Specify the date of service.

· Locator 24B: Enter the place of service code (e.g., 11 for office).

· Locator 24D: List HCPCS code J1554 and, on a separate line, the applicable CPT code (96365).

· Locator 24E: Reference the diagnosis code from Locator 21.

· Locator 24G: Indicate the number of units administered (e.g., 10 for a 5 g dose).

Additional Considerations:

· NDC Reporting: Include the National Drug Code (NDC) in the shaded area of Locator 24D, formatted appropriately.

· JW Modifier: Use the JW modifier to report any discarded drug amount, if applicable.

· Payer Policies: Verify specific coding, coverage, and payment policies with individual payers, as they may have unique requirements.

For comprehensive information and resources, refer to the ASCENIV Guide to Billing and Reimbursement provided by ADMA Biologics.

It's crucial to stay updated with payer-specific guidelines and any changes in coding standards to ensure accurate billing practices.