CommercialPrior AuthHigh impact
Parenteral Immunoglobulins (CPB 0206, reviewed 2026-10-08)
Aetna·Allergy & Immunology, Neurology, Rheumatology +4 more·Medical Policy
We identified it
Oct 16, 2026
Summary
Aetna's Parenteral Immunoglobulins policy (CPB 0206) was reviewed on 2026-10-08 and establishes medical necessity criteria for intravenous immunoglobulins (IVIG) and subcutaneous immunoglobulins (SCIG) across multiple conditions. The policy requires precertification for all listed IVIG and SCIG products and applies a site-of-care utilization management overlay. Billing teams must ensure claims include proper diagnosis confirmation and meet specific clinical criteria before submission.
Action Required
Billing team must implement precertification requirements for all Aetna participating providers and members in applicable plan designs. Before submitting claims for IVIG (Alyglo, Asceniv, Bivigam, Flebogamma DIF, Gammagard Liquid, Gammagard Liquid ERC, Gammagard S/D, Gammaked, Gammaplex, Gamunex-C, Octagam, Panzyga, Privigen, Qivigy, Yimmugo) or SCIG (Cutaquig, Cuvitru, Hizentra, HyQvia, Xembify), call (866) 752-7021 or fax (888) 267-3277 for precertification. Obtain Statement of Medical Necessity (SMN) forms from Specialty Pharmacy Precertification. Ensure documentation verifies the member meets specific clinical criteria for the indicated condition (e.g., genetic testing confirmation, IgG levels, recurrent bacterial infection history, vaccine response testing). Review site-of-care utilization management requirements and confirm appropriate infusion setting. Update billing system workflows to flag these codes as requiring precertification before claim submission to avoid denials.