CurrentViva HealthPolicy IC-0071

Intravenous immune globulin (IVIG) coverage and medical necessity

Policy governs prior authorization, length of approval, dosing, medical necessity criteria, renewal criteria, maximum billable HCPCS units and product-specific HCPCS/NDC mappings for intravenous immunoglobulin (IVIG) products for multiple indications.

Policy Summary

PayerViva Health

PolicyIntravenous immune globulin (IVIG) coverage and medical necessity

Policy CodePolicy IC-0071

Change TypeNo material change

Effective Date

Next Review Date

Key ActionObtain baseline BUN and serum creatinine within 30 days of request; prior authorization will not be validated without these values.

POLICY UPDATE CHANGES

No material changes — brief indicates has_material_change = false

MultipleIndications listed

J-codesHCPCS mappings

NDCs listedNDC references

VariousMax HCPCS units

120+ICD-10 codes

Coverage Summary

Policy IC-0071 governs prior authorization and coverage for intravenous immune globulin (IVIG) products across FDA-approved and compendia-recommended indications. It addresses multiple IVIG products (for example: Asceniv, Alyglo, Bivigam, Gamunex-C, Gammagard Liquid/ERC/S/D, Gammaked, Gammaplex, Octagam, Privigen, Panzyga, Qivigy, Yimmugo and others) and provides product specifications, dosing and administration guidance, HCPCS to NDC crosswalks, and maximum billable HCPCS unit limits by indication. The policy requires providers to follow prior authorization and renewal governance (initial PA validity periods and renewal frequencies vary by indication) and to bill using product-specific HCPCS codes/units (where 1 billable unit = 500 mg for listed products) with corresponding NDC mapping as provided in the document.

Top-level thresholds & quick facts

Key IgG thresholdsIgG <200 mg/dL (PID and some secondary deficiency rules); IgG <400 mg/dL (IgG subclass deficiency, HIV-infected children, allogeneic BMT/HSCT, BCMA CAR T hypogammaglobulinemia); IgG <600 mg/dL (anti-CD19 CAR T hypogammaglobulinemia)

Anti-CD19 / BCMA CAR T thresholdsAnti-CD19: IgG <600 mg/dL for hypogammaglobulinemia-related coverage; BCMA-targeted: IgG <400 mg/dL

Platelet thresholds for ITP (acute)Manage acute bleeding if platelet count <30 x 10^9/L; increase platelets prior to invasive procedures if <100 x 10^9/L; severe thrombocytopenia defined as <20 x 10^9/L

Platelet threshold for chronic ITP (renewal response)Renewal response indicated by platelet count ≥30 x 10^9/L and at least doubling baseline

HCPCS unit definition1 billable unit = 500 mg for listed products (used for J-codes/unit billing)

Initial Approval / Medical Necessity Criteria

Initial Approval / Medical Necessity Criteria (general preconditions)

Prior authorization validity is provided when the general baseline and indication-specific criteria are met:

ALL of the following

Indication-specific criteria (see individual indication nodes)
- Primary Immunodeficiency (PID) criteria (see PID node): Refer to PID criteria node
- IgG Subclass Deficiency criteria: Refer to IgG Subclass Deficiency node
- Acute and Chronic ITP criteria: Refer to Acute ITP and Chronic ITP nodes
- CIDP criteria: Refer to CIDP node
- Guillain-Barré criteria: Refer to Guillain-Barré node
- Multifocal Motor Neuropathy criteria: Refer to Multifocal Motor Neuropathy node
- HIV Infected Children criteria: Refer to HIV Infected Children node
- Myasthenia Gravis criteria: Refer to Myasthenia Gravis node
- Dermatomyositis criteria: Refer to Dermatomyositis node
- Polymyositis criteria: Refer to Polymyositis node
- Complications of Transplanted Solid Organ and Bone Marrow Transplant criteria: Refer to Complications of Transplanted Solid Organ and Bone Marrow Transplant node
- Stiff-Person Syndrome criteria: Refer to Stiff-Person Syndrome node
- Allogeneic Bone Marrow or Stem Cell Transplant criteria: Refer to Allogeneic Bone Marrow or Stem Cell Transplant node
- Fetal Alloimmune Thrombocytopenia (FAIT) criteria: Refer to FAIT node
- Autoimmune Mucocutaneous Blistering Diseases criteria: Refer to Autoimmune Mucocutaneous Blistering Diseases node
- Acquired Immune Deficiency secondary to ALL/MM/CLL/SLL criteria: Refer to respective acquired immune deficiency nodes
- Management of Immune Checkpoint Inhibitor-Related Toxicities criteria: Refer to Management of Immune Checkpoint Inhibitor-Related Toxicities node
- Management of CAR T-Cell-Related Toxicities criteria: Refer to Management of CAR T-Cell-Related Toxicities node
- Supportive Care after Rethymic transplant criteria: Refer to Supportive Care after Rethymic transplant node
- Cancer-Associated Venous Thromboembolic Disease criteria: Refer to Cancer-Associated Venous Thromboembolic Disease node

Indication-specific criteria groups (by indication)

Indication-specific criteria. Each entry requires meeting the listed logical combination of criteria.

Primary Immunodeficiency (PID)

IgG threshold or infection plus vaccine response
- Infection history and antibody response: Patient has a history of multiple hard to treat infections (one or more listed) AND deficiency in producing antibodies to vaccination with titers drawn before challenge and between 4 and 8 weeks after vaccination
  Infection history examples: four or more ear infections in 1 year; two or more serious sinus infections in 1 year; two or more months antibiotics with little effect; two or more pneumonias in 1 year; recurrent deep skin/organ abscesses; persistent thrush/fungal infections; need for IV antibiotics; two or more deep-seated infections including septicemia; family history of PID

IgG Subclass Deficiency: Patient has an IgG level < 400 mg/dL AND history of recurrent infections AND is receiving prophylactic antibiotic therapyIgG < 400 mg/dL

Length of Authorization and Maximum Units

Length of Authorization

Prior authorization validity provided as follows unless otherwise specified:

Initial validity

Initial validity 1 month for: Acute ITP; Myasthenia Gravis; Kawasaki's Disease; Neonatal Alloimmune Thrombocytopenia (NAIT); Toxic Shock Syndrome; Management of Immune Checkpoint Inhibitor Related Toxicities; Cancer-Associated Venous Thromboembolic Disease1 month
List of indications provided in source
Initial validity 2 months for: Management of CAR T-Cell-Related Toxicities: AIDP-type; Guillain-Barré Syndrome (AIP)2 months
Initial validity 3 months for: CIDP; Multifocal Motor Neuropathy; Dermatomyositis; Polymyositis; Allogeneic Bone Marrow or Stem Cell Transplant3 months
Initial validity 6 months for: Other indications unless otherwise specified6 months
FAIT validity: Fetal Alloimmune Thrombocytopenia (FAIT): prior authorization validity provided through delivery date onlythrough delivery
Not renewable

Renewal frequency exceptions

Standard renew frequency: Standard: renew every 12 months12 months
Allogeneic BMT/Stem Cell Transplant renew: Allogeneic Bone Marrow or Stem Cell Transplant: renew every 3 months3 months
Dermatomyositis/Polymyositis renew: Dermatomyositis/Polymyositis: renew every 6 months6 months
Autoimmune Mucocutaneous Blistering Diseases renew: Autoimmune Mucocutaneous Blistering Diseases: renew every 6 months

Not renewable indications

Not renewable list: Acute ITP; Guillain-Barré Syndrome (AIP); Myasthenia Gravis; Kawasaki's Disease; FAIT; NAIT; Toxic Shock Syndrome; Management of Immune Checkpoint Inhibitor Related Toxicities; Cancer-Associated Venous Thromboembolic Disease; Management of CAR T-Cell-Related Toxicities: AIDP-typeNot renewable

Maximum Units (per dose and over time) / HCPCS Units

Maximum billable HCPCS units and per-# days by indication (1 billable unit = 500 mg):

Units per indication

PID and Supportive Care after Rethymic transplant: Billable Units = 180; Per # days = 21; alternate dosing: 200-800 mg/kg every 21-28 days (dose guidance elsewhere)180 units per 21 days
IgG Subclass Deficiency: Billable Units = 90; Per # days = 1490 units per 14 days
CIDP: Load: Billable Units = 460; Per # days (load) = 5; Maintenance: Billable Units = 230; Per # days (maintenance) = 21Load 460 (5 days); Maintenance 230 (21 days)

Coding (HCPCS, NDC, ICD-10)

HCPCS codes mapped to IVIG products (covered when medically necessary)HCPCSCovered

J1554	Asceniv, 500 mg
J1552	Alyglo, 500 mg
J1556	Bivigam, 500 mg
J1572	Multiple products listed (Gamunex-C, Gammagard Liquid, Gammagard ERC, Gammagard S/D, Gammaked, Gammaplex, Octagam, Privigen, Panzyga, Panzyga variants, etc.) mapped to J1572/J1561/J1569/J1599/J1566/J1568 as noted in source
J1557	Gammaplex mapping (per source)
J1459	Privigen mapping (per source)
J1576	Panzyga mapping (per source)

HCPCS — Immune globulin intravenous codes referencedHCPCS

J1572	Injection, immune globulin, intravenous, non- (multiple products mapped to this code in document)
J1459	Listed as equivalent mapping to J1572 in document
J1576	Mapped for Panzyga in document
J1599	Mapped for some products (Qivigy, Yimmugo, other entries) in document
90283	Immune globulin (IgIV), human, for intravenous use (listed with units 1-5)

HCPCS — Immune globulin administration / product mapping to NDCsmixed

90283 - unit mappings

90283 cited repeatedly as immune globulin (IgIV), human, for intravenous use with units 1-5

NDCs for products (reference list)NDC

69800-0250-XX	Asceniv
61476-0104-XX	Alyglo
69800-6502-XX	Bivigam (5 g)
69800-6503-XX	Bivigam (10 g)
61953-0005-XX	Gamunex-C (example NDC listed)
00944-2700-XX	Gammagard Liquid (example NDC listed)
00944-2705-XX	Gammagard ERC
00944-2656-XX	Gammagard S/D
76125-0900-XX	Gammaked
64208-8234-XX	Gammaplex 5%

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NDCs listed (product-specific, truncated with XX placeholders)NDC

61953-0005-XX	Listed for multiple products (Privigen, Panzyga, etc.)
61953-0004-XX	Listed for multiple products
44206-0437-XX	Mapped in document
44206-0438-XX	Mapped in document
44206-0439-XX	Mapped in document
00069-1011-XX	Panzyga NDC listed
00069-1109-XX	Panzyga NDC listed
00069-1224-XX	Panzyga NDC listed
00069-1312-XX	Panzyga NDC listed
00069-1415-XX	Panzyga NDC listed

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Covered ICD-10 Diagnosis Codes (neurologic / neuromuscular / optic neuritis / meningitis / encephalitis / myelitis / mononeuropathies)ICD-10Covered

G03.9	Meningitis, unspecified
G04.81	Other encephalitis and encephalomyelitis
G04.89	Other myelitis
G04.90	Encephalitis and encephalomyelitis, unspecified
G04.91	Myelitis, unspecified
G25.82	Stiff-man syndrome
G56.80	Other specified mononeuropathies of unspecified upper limb
G56.81	Other specified mononeuropathies of right upper limb
G56.82	Other specified mononeuropathies of left upper limb
G56.83	Other specified mononeuropathies of bilateral upper limbs

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Covered ICD-10 Diagnosis Codes (cardiac / pulmonary / dermatologic / rheumatologic / myositis / myalgia / obstetric / fetal conditions / transplant complications / transplant status)ICD-10Covered

I30.8	Other forms of acute pericarditis
I30.9	Acute pericarditis, unspecified
I40.8	Other acute myocarditis
I40.9	Acute myocarditis, unspecified
J70.2	Acute drug-induced interstitial lung disorders
J70.4	Drug-induced interstitial lung disorders, unspecified
L10.0	Pemphigus vulgaris
L10.2	Pemphigus foliaceous
L12.0	Bullous pemphigoid
L12.1	Cicatricial pemphigoid

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Provider Actions & Billing Rules

Prior Authorization

Prior authorization required with baseline renal labs

Obtain baseline BUN and serum creatinine within 30 days of the prior authorization request. Prior authorization will not be validated or processed without documented baseline BUN and serum creatinine values.

Affected requirement: baseline BUN and serum creatinine obtained within 30 days of request
Operational note: PA requests lacking these labs will be returned/denied until values provided

Documentation Required

Document indication-specific criteria

Providers must supply indication-specific objective evidence to support medical necessity. Include relevant laboratory results, imaging, electrophysiologic testing, pathology, and clinical history as applicable to the requested indication.

Primary immunodeficiency: quantitative IgG level and vaccine response/antibody titers (pre- and post-vaccination titers drawn 4–8 weeks after challenge)
Recurrent infection indications: infection history and prior antibiotic/prophylaxis documentation
Neuromuscular disorders (e.g., CIDP, GBS, multifocal motor neuropathy): electrodiagnostic testing reports and baseline strength/functional measures (e.g., INCAT, MRC, 6-MWT)
Dermatomyositis/polymyositis: muscle biopsy reports when available
GBS and other CNS/PNS disorders: cerebrospinal fluid (CSF) analysis when required
Antibody-mediated conditions: specific antibody titers and serologic testing results

Billing Rule

HCPCS unit billing, HCPCS→NDC mapping, and dose calculation guidance

Billing and coding rules for IVIG claims: HCPCS unit definition, unit-to-dose conversion, rounding guidance, and mapping of HCPCS product codes to NDCs. Follow unit calculation guidance (1 unit = 500 mg) and apply weight-based dosing rounding and adjusted body weight rules where applicable.

Affected HCPCS codes: J1554, J1552, J1556, J1572, J1557, J1459, J1576, J1599, 90283
Unit rule: 1 unit = 500 mg (0.5 g) of IVIG
Dose calculation guidance: calculate total grams required (dose mg/kg × patient weight kg ÷ 1000 = grams); convert to units by (grams ÷ 0.5 g per unit); round per payer-specified rounding/adjusted weight guidance
HCPCS to NDC mapping: submit NDC for the specific IVIG product administered per claim line where payer requires NDC linkage to HCPCS
Billing note: follow payer-specific instructions for reporting multiple NDCs and J-code modifiers when mixing products or using multiple vials

Documentation Required

Documentation and denial risks; CMS & coding references

Maintain and submit documentation that supports antibody response to vaccination when clinically required, monitor for laboratory toxicity, and be aware of renewal denial risks when required labs or toxicity monitoring are absent. Use listed ICD-10 diagnosis codes for medical necessity and reference applicable CMS national and local coverage determinations.

Vaccination titer documentation for antibody response: pre- and post-vaccination titers (post 4–8 weeks) must be available when used to demonstrate antibody production deficiency
Renewal denial risk: missing toxicity monitoring (e.g., absent periodic BUN/creatinine) or failure to provide required labs at renewal may result in denial
Use of listed ICD-10 codes in Appendix 1: claims must be coded with the diagnosis codes specified in Appendix 1 to support medical necessity
Refer to CMS NCD/LCD/LCA where applicable: multiple Medicare determinations are listed in this document and must be followed for Medicare members
Appendix A NQTL checklist considerations: ensure non-quantitative treatment limitations and utilization management processes are documented and applied consistently per Appendix A guidance

Background & Definitions

This policy addresses coverage and administration of multiple IVIG products (listed by brand) for FDA‑approved and compendia‑recommended indications; it includes product specifications (e.g., concentrations, IgA content, stabilizers), dosing and administration guidance (including weight adjustment and rounding rules), HCPCS to NDC crosswalks for each product (NDCs shown with 'XX' placeholders), and these product details are provided for reference to support billing and medical necessity determination.

The document includes and references Medicare determinations (NCD 250.3 and multiple jurisdictional LCDs/LCAs) and lists numerous local coverage articles; readers should consult the "Medicare Determinations" / Appendix 2 section below for the specific Medicare documents and jurisdictional mappings where present.

Definitions (brief)

BUNBlood urea nitrogen; required baseline within 30 days of request

IgGImmunoglobulin G serum level; specific numeric thresholds (e.g., <200 mg/dL, <400 mg/dL, <600 mg/dL) are used for coverage decisions

HCPCS unit definitionOne billable unit equivalent = 500 mg for listed IVIG products (per HCPCS/NDC mappings)

Medicare Determinations & References

Date (effective)	Name	Number	Type
2002-10-01	Intravenous Immune Globulin for the Treatment of Autoimmune Mucocutaneous Blistering Diseases	250.3	NCD
various	Multiple Local Coverage Articles referenced (see references)	A59105; A54641; A54643; A54660; A54662; A57187; A57194; A57554; A57160; A57778; A56786; A56718; A56779	LCD/LCA (jurisdiction-specific)
various	Multiple jurisdiction-specific NCD/LCA/LCD documents referenced	various (e.g., A57187, A54660, A54641, A54643, A57194, A54662, A56786, A56718, A57778, A57554, A59105, A56779, A57160, 250.3)	LCD/LCA/NCD (jurisdiction-specific)

Revision History

2025-11-04Last reviewLatest

Policy status: CURRENT; last review conducted on 2025-11-04 (Document IC-0071).

Policy Summary

PayerViva Health

PolicyIntravenous immune globulin (IVIG) coverage and medical necessity

Policy CodePolicy IC-0071

Change TypeNo material change

Effective Date

Next Review Date

Key ActionObtain baseline BUN and serum creatinine within 30 days of request; prior authorization will not be validated without these values.

On This Page

Acute ITP

Acute ITP - bleeding or pre-op or severe: Used to manage acute bleeding due to severe thrombocytopenia (platelet count < 30 x 10^9/L); OR used to increase platelet counts prior to invasive procedures (platelet count < 100 x 10^9/L); OR patient has severe thrombocytopenia (platelet count < 20 x 10^9/L)various platelet thresholds

Chronic ITP: Patient is at increased risk for bleeding (platelet count < 30 x 10^9/L) AND has failure/contraindication/intolerance to corticosteroids AND duration of illness > 6 monthsplatelet count < 30 x 10^9/L

CIDP

Core clinical features: Disease course progressive or relapsing/remitting > 2 months AND abnormal/absent deep tendon reflexes
Electrodiagnostic criteria: Electrodiagnostic testing indicating demyelination (one of several listed criteria such as partial motor conduction block in ≥2 motor nerves, distal CMAP duration increase plus other demyelination criterion, abnormal temporal dispersion in ≥2 motor nerves, reduced motor conduction velocity in ≥2 motor nerves, prolonged distal motor latency in ≥2 motor nerves, absent F wave in ≥2 motor nerves plus another criterion, or prolonged F wave latency in ≥2 motor nerves)
Treatment and baseline documentation: Patient is refractory or intolerant to corticosteroids given in therapeutic doses over at least three months AND baseline strength/weakness documented with objective tool (e.g., INCAT, MRC, 6-MWT, Rankin)

Guillain-Barré Syndrome (AIP): Patient has severe disease requiring assistance to ambulate AND onset < 1 month AND abnormal/absent deep tendon reflexes AND diagnosis confirmed by CSF analysis

Multifocal Motor Neuropathy: Progressive focal asymmetric limb weakness (>1 month) WITHOUT sensory symptoms AND complete or partial conduction block or abnormal temporal dispersion in ≥2 motor nerves AND normal sensory nerve conduction on all nerves tested AND baseline strength/weakness documented with objective tool

HIV Infected Children: Patient < 13 years of age AND patient has an IgG level < 400 mg/dLIgG < 400 mg/dL

Myasthenia Gravis (acute exacerbation): Positive anti-AchR antibodies AND acute exacerbation with impending myasthenic crisis (respiratory/bulbar compromise) AND failing conventional immunosuppressant therapy alone AND will be on combination therapy with corticosteroids or other immunosuppressant

Dermatomyositis: Severe active disease AND proximal weakness in all upper and/or lower limbs with either muscle biopsy proven dermatomyositis or classic skin manifestations OR clinically amyopathic dermatomyositis AND failed trial of corticosteroids AND failed trial of immunosuppressant AND will be on combination therapy AND documented baseline exam and muscular strength/function

Polymyositis: Severe active disease AND proximal weakness in all upper and/or lower limbs AND diagnosis confirmed by muscle biopsy AND failed corticosteroids AND failed immunosuppressant AND will be on combination therapy AND documented baseline exam and muscular strength/function

Complications of Transplanted Solid Organ and Bone Marrow Transplant: Used for one or more of: suppression of panel reactive anti-HLA antibodies prior to transplant; treatment of antibody-mediated rejection of solid organ transplant; prevention or treatment of viral infections (e.g., CMV, Parvo B-19, Polyoma BK)

Stiff-Person Syndrome: Patient has anti-GAD antibodies AND failed >2 of benzodiazepines/anti-spasticity agents/antiepileptics AND documented baseline physical exam

Allogeneic Bone Marrow or Stem Cell Transplant: Used for prevention of acute GVHD or infection AND transplant was allogeneic AND patient has an IgG level < 400 mg/dLIgG < 400 mg/dL

Fetal Alloimmune Thrombocytopenia (FAIT): Coverage when ANY of the following historic/screening items present: previous FAIT pregnancy; family history; screening reveals platelet alloantibodies

Prior authorization validity provided through delivery date only

Autoimmune Mucocutaneous Blistering Diseases: Diagnosis of pemphigus/pemphigoid spectrum disorders AND severe extensive debilitating disease AND diagnosis confirmed by biopsy AND progressive disease refractory to corticosteroids plus immunosuppressant AND documented baseline exam

Acquired Immune Deficiency secondary to ALL or MM: Patient has recurrent life-threatening infections OR used for prevention of infection AND patient has an IgG level < 400 mg/dL; note for myeloma subtract M spike from IgG to estimate normal IgG portionIgG < 400 mg/dL

Acquired Immune Deficiency secondary to CLL or SLL: Patient has IgG < 200 mg/dL OR IgG < 500 mg/dL plus recurrent sinopulmonary infections requiring IV antibiotics or hospitalization OR history of multiple hard to treat infections plus deficient vaccine response with titers drawn before and 4-8 weeks after vaccinationIgG < 200 mg/dL or IgG < 500 mg/dL with infections

Management of Immune Checkpoint Inhibitor-Related Toxicities: Patient receiving immune checkpoint inhibitor AND has one of listed severe/moderate toxicities (examples include severe bullous dermatitis adjunct to rituximab, SJS/TEN, severe myasthenia gravis, demyelinating disease, myocarditis not improved after 24-48h steroids, G2-4 pneumonitis with steroid failure timelines, encephalitis with high-dose methylprednisolone, steroid-refractory myositis, hemolytic anemia G3-4 refractory to steroids/rituximab, severe aplastic anemia refractory to steroids, thrombocytopenia with bleeding)

Examples listed in source

Management of CAR T-Cell-Related Toxicities: Patient has received CAR T-cell therapy (anti-CD19 or BCMA) AND meets one of the therapy-specific rules

Anti-CD19: G4 CRS refractory to high-dose steroids and anti-IL-6 OR hypogammaglobulinemia IgG <600 mg/dL with serious/recurrent infections OR AIDP-type; BCMA: G4 CRS refractory OR IgG <400 mg/dL OR AIDP-type; prophylactic prior to CAR-T if IgG ≤400 mg/dL with serious persistent/recurrent bacterial infections

Supportive Care after Rethymic transplant: Used as immunoglobulin replacement in pediatric congenital athymia after Rethymic implantation OR re-initiation 2 months after stopping if IgG trough lower than normal for age

Cancer-Associated Venous Thromboembolic Disease: Diagnosis of refractory HIT, autoimmune HIT, or high bleeding risk with HIT

Immune thrombocytopenia/ITP: Billable Units = 460; Per # days = 28460 units per 28 days

FAIT: Billable Units = 230; Per # days = 7230 units per 7 days

Kawasaki's Disease: Billable Units = 460; Per # days = 2 doses only460 units (up to 2 doses)

Multifocal Motor Neuropathy: Billable Units = 460; Per # days = 28; Dose up to 2 g/kg divided over 5 days in 28-day cycle (see dosing guidance)460 units per 28 days

ALL/MM: Billable Units = 90; Per # days = 2190 units per 21 days

CLL/SLL: Billable Units = 90; Per # days = 2190 units per 21 days

HIV (Pediatric Patients only): Billable Units = 46; Per # days = 1446 units per 14 days

Guillain-Barré: Billable Units = 460; Per # days = 5 (for two courses only)460 units per 5 days (repeat once within 6 weeks if needed)

Myasthenia Gravis: Billable Units = 460; Per # days = 28; dosing: 1-2 g/kg divided as specified in dosing guidance460 units per 28 days

Auto-immune blistering diseases: Billable Units = 460; Per # days = 28; dosing up to 2 g/kg divided over 5 days in a 28-day cycle460 units per 28 days

Allogeneic Bone Marrow or Stem Cell Transplant: Load: Billable Units = 120; Per # days (load) = 7 for 90 days; Maintenance: Billable Units = 120; Per # days (maintenance) = 21; dosing: 500 mg/kg once weekly x 90 days then every 3-4 weeks per dosing guidanceLoad 120 units (weekly x90 days); Maintenance 120 units per 21 days

Dermatomyositis: Billable Units = 460; Per # days = 28; dosing: 2 g/kg divided over 2-5 days in a 28-day cycle460 units per 28 days

Complications of transplanted solid organ or bone marrow transplant: Billable Units = 460; Per # days = 28; dosing varies by scenario (see source)460 units per 28 days (varies)

Cancer-Associated Venous Thromboembolic Disease: Billable Units = 230; Per # days = 2 doses only; dosing example: 1 g/kg daily x 2 days230 units (2 doses)

Management of Immune Checkpoint Inhibitor-Related Toxicities: Billable Units = 460; Per # days = 5 (for one cycle only); dosing: 2 g/kg divided over 5 days x1 course460 units per 5 days

Management of CAR T-Cell-Related Toxicities: AIDP-type: Billable Units = 460; Per # days = 5 (for two courses only). All other types: Billable Units = 120; Per # days = 28AIDP 460 units per 5 days (repeat once); Others 120 units per 28 days