Hizentra Coding Information - Diagnosis and ICD-10-CM billing codes for 20% SCIg therapy

Sep 27, 2026

Uploaded by iuabcfuw

Coding information for chronic inflammatory demyelinating polyneuropathy (CIDP) covering diagnosis and billing code selection for 20% subcutaneous immunoglobulin (SCIg) therapy. The guide explains that treating physicians are responsible for diagnosis code determination based on the medical record, and that listed CPT, HCPCS, and ICD-10-CM codes follow AMA or CMS guidance. It details eligible Medicare Part B maintenance coverage, notes Part D denial, provides relevant ICD-10-CM diagnosis code examples, and includes HCPCS and CPT administration code references plus NDC and prior authorization instructions.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages18

Reading Time45 min

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ICD-10-CM Diagnosis Codes

Prior Authorization (PA)

Coding Information for Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) Diagnosis and ICD-10-CM billing codes for 20% subcutaneous Ig (SCIg) therapy Please see full Important Safety Information on back and enclosed full prescribing information for Hizentra, including boxed warning. 2 | Hizentra Coding Information
Diagnosis and billing codes for 20% SCIg therapy
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 codes1 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®,2-4 HCPCS,5,6 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. | Medicaid and most insurers cover Hizentra for the treatment of patients with chronic inflammatory demyelinating polyneuropathy (CIDP) as maintenance therapy to prevent relapse of neuromuscular disability and impairment. Medicare Part B coverage falls within the External Infusion Pump Local Coverage Determination (LCD) administered by the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) . Medicaid coverage policy varies by state. Coverage by other payers varies by payer and provider contract. | | --- | --- | | ICD-10-CM Diagnosis Codes1
The following ICD-10-CM codes1 may be used to identify patient medical conditions typically associated with Hizentra use.
G61 Chronic inflammatory demyelinating polyneuritis
G61 .81* Chronic inflammatory demyelinating polyneuritis
Chronic inflammatory demyelinating polyneuropathy
Chronic inflammatory demyelinating polyradiculoneuropathy
Polyneuropathy (multiple nerve disorder)
Polyneuropathy, chronic inflammatory demyelinating
Polyradiculoneuropathy, chronic inflammatory demyelinating
Polyradiculoneuropathy, inflammatory demyelinating
ICD=International Classification of Diseases
HCPCS=Healthcare Common Procedure Coding System
CPT=Current Procedural Terminology
Coverage for maintenance treatment of CIDP with subcutaneous immunoglobulin is only eligible for coverage under Medicare Part B.
Claims for Part D coverage will be denied.
*Medicare Part B–approved diagnosis codes for treatment with Hizentra in the home . All other diagnoses may qualify for coverage under Medicare Part D plans.

Call us now for reimbursement support

For assistance with Prior Authorization (PA), request a PA checklist or connect with a CSL Field Reimbursement Manager from Hizentra Connect.
1-877-355-4447
Monday–Friday, 8 AM to 8 PM ET |
Prior Authorization
When a payer requires prior authorization:
Request the approval and authorization reference code in writing
Insert the authorization reference code into Field 23 of the CMS-1500 claim form when billing for services. Enter the authorization reference code in the equivalent field on the electronic claim form (ASC 837P, Loop 2300, Segment REF02, with the Qualifier G1 entered to Segment REF01), unless otherwise directed by the payer
If required by the payer, attach a copy of the authorization approval letter to the paper claim
form; use the payer’s designated procedure
for submitting documentation with electronic claim forms
Please see full Important Safety Information on back and enclosed full prescribing information for Hizentra, including boxed warning.
| 3 | Billing Codes
The following HCPCS codes describe supplies (including drugs) rendered by the billing provider. CMS publishes and maintains the HCPCS code set. These codes are entered to paper claim form CMS-150

FAQs

Who is responsible for choosing the ICD-10-CM diagnosis codes for CIDP treatment?

The treating physician is solely responsible for diagnosis coding and for determining the appropriate ICD-10-CM codes supported by the medical record.

Which Medicare coverage applies to maintenance treatment of CIDP with subcutaneous immunoglobulin?

Maintenance treatment is only eligible for coverage under Medicare Part B, while claims for Part D coverage will be denied.

What steps are required when a payer requires prior authorization for Hizentra billing?

Request written approval and an authorization reference code, enter that code in Field 23 of CMS-1500 (or the equivalent electronic claim field with the specified qualifiers), and attach the approval letter to paper claims when required.

Sep 27, 2026

Uploaded by iuabcfuw