The Essential Guide to Medicare IVIG Coverage

Medicare provides coverage for IVIG and SCIG therapies in many instances, but navigating the details can sometimes be difficult. This guide will provide an overview of how IG therapies are covered under Medicare.

Medicare will provide coverage for IVIG based on:

• The diagnosis
• The location of therapy
• The route of administration 

Medicare coverage for IVIG or SCIG depends on the diagnosis, treatment setting, route of administration, and applicable benefit rules. Part B may cover qualifying home IVIG for primary immune deficiency and certain other medically necessary treatments. Part D may cover eligible outpatient immune globulin prescriptions when Part B does not apply, subject to plan rules.

Medicare IVIG Coverage Under Part B

IVIG is covered under Medicare Part B if the following criteria are met:

1. IVIG is administered at home.
2. IVIG is given intravenously; an infusion pump is not required solely to qualify for the home IVIG benefit.
3. The treating physician has determined that the administration of IVIG at home is medically appropriate.
4. The patient has a qualifying primary immune deficiency diagnosis and meets Medicare coverage requirements. The diagnosis codes below are examples; a code alone does not guarantee coverage.

Medicare-covered Diagnosis Codes for Part B:

For covered Part B IVIG, Original Medicare generally pays 80% of the Medicare-approved amount after any applicable deductible. The patient typically owes 20%, which supplemental insurance may cover. Medicare Part B also covers qualifying home IVIG administration services, including nursing and certain related items and supplies; coverage is not limited to the drug.

For CIDP, certain immune globulin products may qualify for Part B coverage under the durable medical equipment (DME) infusion-pump benefit when all pump, drug, and medical-necessity requirements are met. Coverage is not limited to subcutaneous IG solely because of the July 2021 policy. Benefit eligibility must be verified for each therapy.

Medicare IVIG Coverage Under Part D

When Part B does not cover the prescribed immune globulin, Part D may cover it if the drug is eligible under Part D and the plan approves the prescription. FDA labeling, medically accepted indications, formulary rules, prior authorization, and other coverage criteria may apply. Off-label use is not automatically covered. Coverage for Susac syndrome or other off-label conditions must be confirmed under the applicable plan or Medicare coverage policy.

Conditions for Which IVIG May Be Prescribed (Coverage Varies)

• Primary immunodeficiency
• Myasthenia gravis
• Chronic inflammatory demyelinating polyneuropathy (CIDP)
• Immune thrombocytopenic purpura (ITP)
• B-cell chronic lymphocytic leukemia (CLL)
• Stiff-person syndrome
• Bone marrow transplant/hematopoietic stem cell transplant
• Dermatomyositis
• Polymyositis
• Multifocal motor neuropathy
• HIV infection
• Guillain-Barre syndrome
• Lambert-Eaton myasthenic syndrome
• Parvovirus B19-induced pure red cell aplasia
• Kawasaki syndrome (pediatric)
• Fetal/neonatal alloimmune thrombocytopenia
• Isoimmune hemolytic disease of newborn
• Neonatal hemochromatosis
• Immune checkpoint inhibitor-related toxicity
• CAR-T therapy-related hypogammaglobulinemia
• Acquired red cell aplasia
• Acute disseminated encephalomyelitis
• Rasmussen encephalitis
• Enteroviral meningoencephalitis
• Autoimmune mucocutaneous blistering disease
• Autoimmune hemolytic anemia
• Autoimmune neutropenia
• Systemic lupus erythematosus
• Birdshot retinochoroidopathy
• BK virus-associated nephropathy
• Churg-Strauss syndrome
• Hematophagocytic lymphohistiocytosis (HLH)
• Macrophage Activation Syndrome (MAS)
• Hyperimmunoglobulinemia E syndrome
• Multiple myeloma
• Opsoclonus-myoclonus
• Post-transfusion purpura
• Solid organ transplantation
• Major surgery associated secondary immunosuppression
• Hematologic malignancy-associated secondary immunosuppression
• Major burns associated secondary immunosuppression
• Collagen-vascular disease-associated secondary immunosuppression
• Toxic epidermal necrolysis
• Stevens-Johnson syndrome
• Toxic shock syndrome
• Toxic necrotizing fasciitis

Standard Part D benefit and copay structures apply. 

For more information on out-of-pocket expenses for Part D, visit https://www.medicare.gov/health-drug-plans/part-d/basics/costs.

Nursing Costs for IVIG

Under Original Medicare, qualifying home IVIG administration services for primary immune deficiency may be covered by Part B, including nursing and related services. After any applicable deductible, patients generally owe 20% of the Medicare-approved amount. Other home infusion nursing services are covered only when the applicable Medicare benefit requirements are met.

Costs will vary under Medicare Advantage. A full benefits investigation is necessary to determine the exact cost. Speak to an AmeriPharma® billing specialist for more information.

Copay Assistance

AmeriPharma® offers assistance to help with any remaining copay you may have on IVIG after using Medicare. Using advanced software, AmeriPharma® will review all available funding sources and match you with a program that fits your needs. A copay specialist will help you with the application process.

For more information, speak to one of our specialists about how AmeriPharma® can help.

How to Enroll in Medicare

You may sign up for Medicare online, by phone, or in person at your local Social Security office.

Medicare enrollment is available during a 7-month enrollment period that starts 3 months before you turn 65. You must enroll in Medicare prior to turning 65 if you want your coverage to start on the month you turn 65. You may also enroll in Medicare up to 3 months after the month you turn 65, as outlined on the Medicare website. 

Individuals with specific disabilities may qualify for Medicare before they turn 65 years old.

The 2026 Medicare Open Enrollment period is from October 15 to December 7, 2026. Changes made during this time will go into effect on January 1, 2027.

During this time, Medicare enrollees are able to review and make changes to their current coverage, including cost, coverage, and provider and pharmacy networks.

Medicare’s Open Enrollment period is also known as the “annual enrollment period” or “AEP”. There may also be other times during the year when people can enroll in a plan, which are called “open enrollment” or “special enrollment” periods. 

For more information, visit medicare.gov.

The Inflation Reduction Act

The Inflation Reduction Act changed Medicare Part D prescription drug costs. In 2026, the annual out-of-pocket threshold for covered Part D drugs is $2,100 and the standard deductible is $615. For 2027, the out-of-pocket threshold will be $2,400 and the standard deductible will be $700. Individual plans may have lower deductibles.

Additionally, the Medicare Prescription Payment Plan (MPPP) lets Part D enrollees spread eligible out-of-pocket prescription costs into monthly payments. It does not reduce the total amount owed.

FAQs

Does Medicare cover IVIG for CIDP?

For CIDP, coverage depends on the prescribed product and how it is administered. Certain pump-administered immune globulin treatments may qualify under Part B DME rules; other eligible prescriptions may be covered under Part D. Under Original Medicare Part B, patients generally owe 20% of the approved amount after the applicable deductible.

Does Medicare cover IVIG for Guillain-Barre syndrome?

IVIG for Guillain-Barré syndrome is not automatically covered. Part D coverage may be available when the drug and indication meet plan and Medicare requirements; inpatient or provider-administered treatment may fall under different benefits.

Does Medicare cover IVIG for Myasthenia Gravis?

IVIG for myasthenia gravis is not automatically covered under Part D. Coverage depends on the drug, setting, medically accepted indication, and the plan’s requirements.

Is Privigen covered by Medicare?

Privigen may be covered under Medicare Part B when applicable medical-necessity and benefit requirements are met. HCPCS J1459 identifies injection, immune globulin (Privigen).

Is Gamunex covered by Medicare?

Gamunex-C may be covered under Medicare Part B when applicable requirements are met. HCPCS J1561 identifies injection, immune globulin (Gamunex-C/Gammaked), non-lyophilized.