Parenteral Immunoglobulins — CPB 0206 | AETNA Coverage Update

TL;DR: Aetna, a CVS Health company, modified CPB 0206 governing parenteral immunoglobulin coverage, effective November 20, 2025. Billing teams managing IVIG and SCIG claims under CPT 90283 and 90284 need to confirm their prior authorization workflows and medical necessity documentation match the updated criteria before submitting claims.

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Quick-Reference Table

Field	Detail Copy
Payer	Aetna, a CVS Health company
Policy	Parenteral Immunoglobulins — CPB 0206
Policy Code	CPB 0206
Change Type	Modified
Effective Date	November 20, 2025
Impact Level	High
Specialties Affected	Immunology, neurology, hematology, oncology, rheumatology, transplant medicine, infusion therapy
Key Action	Audit your precertification workflows for CPT 90283 and 90284 before submitting any IVIG or SCIG claims under the updated policy

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Aetna Parenteral Immunoglobulin Coverage Criteria and Medical Necessity Requirements 2025

Aetna's immunoglobulin coverage policy under CPB 0206 Aetna system covers IVIG and SCIG therapy under CPT 90283 (immune globulin for intravenous use) and CPT 90284 (subcutaneous immune globulin, 100 mg per unit). Whether Aetna covers immunoglobulin therapy under this policy depends entirely on a patient meeting specific, layered medical necessity criteria tied to their diagnosis.

The policy groups covered indications by condition type. The criteria differ meaningfully across groups, so a blanket "immunodeficiency" diagnosis won't get you through prior authorization. Your clinical documentation needs to match the exact sub-criteria for each condition.

Primary Immunodeficiency

For severe combined immunodeficiency (SCID) or congenital agammaglobulinemia (including X-linked or autosomal recessive forms), Aetna requires at least one of: genetic or molecular testing confirming the diagnosis, a pretreatment IgG level under 200 mg/dL, or an absence or very low T-cell count (CD3 under 300/microliter) — or the presence of maternal T cells in the circulation for SCID.

For Wiskott-Aldrich syndrome, DiGeorge syndrome, ataxia-telangiectasia, or other non-SCID combined immunodeficiencies, Aetna requires all three of: confirmed diagnosis via genetic or molecular testing where applicable, a history of recurrent bacterial infections (pneumonia, otitis media, sinusitis, sepsis, or gastrointestinal infections), and impaired antibody response to pneumococcal polysaccharide vaccine.

Common variable immunodeficiency (CVID) carries its own checklist. The member must be at least two years old. Other causes of immune deficiency — drug-induced, genetic disorders, HIV, malignancy — must be excluded. Pretreatment IgG must be under 500 mg/dL or at least two standard deviations below the mean for age. A history of recurrent bacterial infections is required. And the member must show impaired antibody response to pneumococcal polysaccharide vaccine. All five criteria apply.

For hypogammaglobulinemia (unspecified), IgG subclass deficiency, selective IgA deficiency, selective IgM deficiency, or specific antibody deficiency, the policy requires a history of recurrent bacterial infections, impaired vaccine response, and at least one of a set of specific lab thresholds:

The real issue with this policy is the specificity of the lab thresholds. Submitting a claim with a pretreatment IgG of 510 mg/dL for CVID isn't a close call — it's a denial. Make sure your ordering physicians document these values explicitly in the medical record before the prior authorization request goes in.

Precertification Is Mandatory

Precertification of IVIG products — Alyglo, Asceniv, Bivigam, Flebogamma DIF, Gammagard Liquid, Gammagard Liquid ERC, Gammagard S/D, Gammaked, Gammaplex, Gamunex-C, Octagam, Panzyga, Privigen, Qivigy, and Yimmugo — is required for all Aetna participating providers and members in applicable plan designs. The same applies to SCIG products: Cutaquig, Cuvitru, Hizentra, HyQvia, and Xembify.

To precertify, call (866) 752-7021 or fax (888) 267-3277. Statement of Medical Necessity forms are available through Aetna's Specialty Pharmacy Precertification portal. A missing or mismatched prior authorization is the fastest path to a claim denial on these accounts.

Site of Care Policy Applies

Aetna's Site of Care Utilization Management Policy applies to every IVIG and SCIG product listed above. This means Aetna can direct members to lower-cost infusion settings. If your facility bills for infusions that could be done in an outpatient or home setting, expect scrutiny. Review Aetna's Site of Care for Specialty Drug Infusions policy before authorizing a site.

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Aetna Parenteral Immunoglobulin Exclusions and Non-Covered Indications

The policy is explicit that coverage under CPB 0206 applies to commercial medical plans only. Medicare criteria are handled separately through Aetna Medicare Part B criteria — don't apply this CPB to Medicare Advantage claims without verifying the applicable Medicare-side criteria first.

Conditions that don't meet the specific diagnostic thresholds listed above — regardless of how clinically appropriate the treating physician believes IVIG to be — will not meet Aetna's definition of medical necessity under this policy. A pretreatment IgG of 510 mg/dL for CVID, an unconfirmed diagnosis without genetic testing where required, or a lack of documented impaired vaccine response are each sufficient grounds for denial.

The policy also doesn't extend to every related indication automatically. The full policy covers a broad range of secondary and acquired immunodeficiencies, neurologic conditions, hematologic disorders, and transplant indications — but each carries its own sub-criteria. Don't assume that because IVIG is appropriate for one condition in a patient's record, it automatically clears criteria for a second.

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Coverage Indications at a Glance

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Aetna Immunoglobulin Billing Guidelines and Action Items 2025

This policy has teeth. The lab thresholds are specific, the product list is long, and precertification is non-negotiable. Here's what to do before November 20, 2025 — and after.

Copy Action Items

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CPT, HCPCS, and ICD-10 Codes for Parenteral Immunoglobulins Under CPB 0206

Covered CPT Codes (When Selection Criteria Are Met)

Code	Type	Description Copy
90283	CPT	Immune globulin (IgIV), human, for intravenous use
90284	CPT	Immune globulin (SCIg), human, for use in subcutaneous infusions, 100 mg, each

Other CPT Codes Related to CPB 0206

These codes appear in the policy's code list as related procedures. They are not automatically covered under the immunoglobulin criteria — they reflect the broader clinical context in which immunoglobulin therapy may be considered (transplant, bone marrow, CAR-T, muscle biopsy, transfusion).

Muscle Biopsy

Thoracic / Thymus Procedures

Code	Type	Description Copy
32673	CPT	Thoracoscopy, surgical; with resection of thymus, unilateral or bilateral

Heart/Lung or Heart Transplantation

Blood Transfusion

CAR-T Cell Therapy

Bone Marrow and Hematopoietic Progenitor Cell Transplantation

Renal Transplantation

The full policy lists 240 CPT codes and 1,179 ICD-10-CM codes. The complete code set reflects the breadth of conditions — transplant, hematologic, neurologic, rheumatologic — for which immunoglobulin therapy may be considered. For the full code list, review CPB 0206 directly at app.payerpolicy.org/p/aetna/0206.

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