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To place an order for BIVIGAM [Immune Globulin Intravenous (Human), 10% Liquid] please see information below:
5800 Park of Commerce Blvd, NW
Boca Raton, FL 33487
Toll free: 800-458-4244, option 1
The information contained in this guide is provided for informational purposes only and is current as of April 2023. Providers are encouraged to contact their payers for specific information as coding rules and guidelines are subject to payer discretion and should be verified by the paying entity. It is the provider’s sole responsibility to determine and submit appropriate codes, charges, and modifiers for services rendered. The information provided in this guide is subject to change without notice.
Healthcare providers make the ultimate determination as to when to use a specific product based on clinical appropriateness for a patient. Third-party payment for medical products and services is affected by numerous factors, and ADMA Biologics cannot guarantee success in obtaining insurance payments.
|J1556||Injection, Immune Globulin (BIVIGAM) Intravenous, Non-Lyophilized (e.g., Liquid), 500 mg|
|S9338||Home infusion therapy, immunotherapy, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem|
|NDC Number to Use on All Claim Forms*||Size||Grams Protein||Outer Package NDC Number||Inner Package NDC Number|
|NDC Number to Use on All Claim Forms*
|Outer Package NDC Number||69800-6502-1|
|Inner Package NDC Number||69800-6502-2|
|Outer Package NDC Number||69800-6503-1|
|Inner Package NDC Number||69800-6503-2|
*For billing requiring an 11-digit NDC, add the preceding zero as shown above.
|96365||Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour|
|96366||Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (list separately in addition to code for primary procedure)|
For additional information please call 1-800-458-4244.
aCenters for Medicare and Medicaid Services (CMS). HCPCS file located at: https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS-Quarterly-Update;
bOptum® Current Procedural Coding Expert, publisher of CPT, a registered trademark of the AMA. Copyright 2022 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.
BIVIGAM is an Immune Globulin Intravenous (Human), 10% Liquid, indicated for the treatment of patients with primary humoral immunodeficiency (PI). This includes, but is not limited to, the humoral immune defect in common variable immunodeficiency (CVID), X linked agammaglobulinemia, congenital agammaglobulinemia, Wiskott-Aldrich syndrome, and severe combined immunodeficiencies (SCID).
WARNING: THROMBOSIS, RENAL DYSFUNCTION, AND ACUTE RENAL FAILURE