WebCoverage will be provided for IVIG when it is determined to be medically necessary because the medical criteria and guidelines shown below are met. BENEFIT APPLICATION Please refer to the member’s individual Evidence of Coverage (E.O.C.) for benefit determination. Coverage will be approved according to the E.O.C. limitations if the WebThis policy addresses the coverage of immune globulin products FDA-approved for intravenous infusion (IVIg) when appropriate criteria are met with consideration for members. The intent of this coverage policy is to ensure appropriate selection of patients for therapy based on product labeling, clinical guidelines, and clinical studies.

Intravenous Immune Globulin (IVIg) - UHCprovider.com

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Optum - Official Site

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