Author: GDIT, (800) 688-6696
Effective with date of service Oct. 16, 2018, the NC Medicaid and Health Choice programs cover immune globulin intravenous, human - ifas (Panzyga®) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J1599 - Injection, Immune Globulin, Intravenous, Non-lyophilized (e.g. liquid), Not Otherwise Specified, 500 mg.
Panzyga solution contains 10% IgG (100 mg/mL) in 10 mL, 25 mL, 50 mL,100 mL, 200 mL, and 300 mL single-use bottles.
It is indicated for the treatment of:
- Primary Humoral Immunodeficiency (PI) in patients 2 years of age and older.
- Chronic Immune Thrombocytopenia (ITP) in adults.
Recommended Dose:
- Treatment of PI: 300 to 600 mg/kg administered every three to four weeks
- Treatment of ITP in Adults: 1 g/kg daily for two consecutive days
See full prescribing information for further detail.
For Medicaid and NCHC Billing
- The ICD-10-CM diagnosis code required for billing is/are: D69.3 - Immune thrombocytopenic purpura; D80.0 - Hereditary hypogammaglobulinemia; D80.1 - Nonfamilial hypogammaglobulinemia; 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; D81.3 - Adenosine deaminase [ADA] deficiency; D82.0- Wiskott-Aldrich syndrome; 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
- Providers must bill with HCPCS code: J1599 - Injection, Immune Globulin, Intravenous, Non-lyophilized (e.g. liquid), Not Otherwise Specified, 500 mg.
- One Medicaid and NC Health Choice unit of coverage is: 500 mg
- The maximum reimbursement rate per unit is: $89.64
- Providers must bill 11-digit National Drug Codes (NDCs) and appropriate NDC units. The NDCs are: 68982-0820-01, 68982-0820-02, 68982-0820-03, 68982-0820-04, 68982-0820-05, 68982-0820-06, 68982-0820-81, 68982-0820-82, 68982-0820-83, 68982-0820-84, 68982-0820-85, 68982-0820-86
- NDC units should be reported as "UN1".
- For additional information, refer to the January 2012, Special Bulletin, National Drug Code Implementation Update.
- For additional information regarding NDC claim requirements related to the PADP, refer to the PADP Clinical Coverage Policy No. 1B, Attachment A, H.7 on the NC Medicaid website.
- Providers shall bill their usual and customary charge for non-340B drugs.
- PADP reimburses for drugs billed for Medicaid and NC Health Choice beneficiaries by 340B participating providers who have registered with the Office of Pharmacy Affairs (OPA). Providers billing for 340B drugs shall bill the cost that is reflective of their acquisition cost. Providers shall indicate that a drug was purchased under a 340B purchasing agreement by appending the "UD" modifier on the drug detail.
- The fee schedule for the PADP is available on NC Medicaid's PADP web page.
*Information current as of Nov. 28, 2018 and is not a substitute for professional judgment. For full prescribing information, please refer to current package insert or other appropriate sources prior to making clinical judgments.