Parenteral Immunoglobulins — CPB 0206 | AETNA Coverage Update

TL;DR: Aetna, a CVS Health company, modified CPB 0206 covering parenteral immunoglobulins—including IVIG and SCIG products billed under CPT 90283 and 90284—effective November 20, 2025. If your team bills immunoglobulin therapy for Aetna commercial members, your prior authorization process and medical necessity documentation need to be current before claims go out.

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Field	Detail
Payer	Aetna, a CVS Health company
Policy	Parenteral Immunoglobulins
Policy Code	CPB 0206
Change Type	Modified
Effective Date	November 20, 2025
Impact Level	High
Specialties Affected	Immunology, neurology, hematology, rheumatology, nephrology, infectious disease, transplant medicine, oncology
Key Action	Confirm prior authorization is in place for all IVIG and SCIG products before billing CPT 90283 or 90284 for Aetna commercial members

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Aetna Parenteral Immunoglobulin Coverage Policy and Medical Necessity Requirements 2025

The Aetna parenteral immunoglobulin coverage policy under CPB 0206 governs both intravenous immunoglobulins (IVIG) and subcutaneous immunoglobulins (SCIG) for Aetna commercial plan members. This is not a Medicare policy—for Medicare Part B criteria, Aetna directs you to their separate Medicare step-therapy page.

The core of the policy is a tiered medical necessity framework. Aetna breaks covered indications into primary immunodeficiency, secondary immunodeficiency, autoimmune and inflammatory conditions, and several other disease categories. Each category carries its own lab thresholds, clinical history requirements, and diagnostic confirmation standards.

Primary Immunodeficiency — The Most Specific Criteria

For severe combined immunodeficiency (SCID) or congenital agammaglobulinemia, Aetna requires one of: genetic or molecular testing confirming the diagnosis; a pretreatment IgG level below 200 mg/dL; or absence of T cells (CD3 T cells below 300 per microliter) or presence of maternal T cells in circulation (the maternal T-cell criterion applies to SCID only).

For Wiskott-Aldrich syndrome, DiGeorge syndrome, ataxia-telangiectasia, or other non-SCID combined immunodeficiency, the criteria are cumulative—you need all three: genetic or molecular confirmation where applicable, a documented history of recurrent bacterial infections, and an impaired antibody response to pneumococcal polysaccharide vaccine.

Common variable immunodeficiency (CVID) has five criteria, all required. The member must be age two or older. Other causes of immune deficiency—drug-induced, genetic disorders, HIV, malignancy—must be excluded. Pretreatment IgG must be below 500 mg/dL or at least two standard deviations below the mean for age. There must be a history of recurrent bacterial infections. And the member must show an impaired antibody response to pneumococcal polysaccharide vaccine.

For unspecified hypogammaglobulinemia, IgG subclass deficiency, selective IgA deficiency, selective IgM deficiency, or specific antibody deficiency, Aetna requires recurrent bacterial infections plus impaired vaccine response, plus at least one of several lab thresholds: IgG below 500 mg/dL or two-plus standard deviations below age mean; IgA below 7 mg/dL with normal IgG and IgM; IgM below 30 mg/dL with normal IgG and IgA; or IgG subclass deficiency confirmed on at least two separate occasions.

Why This Matters for Your Billing Team

The lab thresholds are specific, and Aetna will look for them. A claim for CPT 90283 or 90284 that lacks documented pretreatment IgG levels, vaccine response testing, or infection history is a claim denial waiting to happen. Make sure your clinical documentation matches the exact sub-criteria for the patient's diagnosis before you bill.

Prior authorization is mandatory for every IVIG and SCIG product on this policy. That list includes IVIG products: Alyglo, Asceniv, Bivigam, Flebogamma DIF, Gammagard Liquid, Gammagard Liquid ERC, Gammagard S/D, Gammaked, Gammaplex, Gamunex-C, Octagam, Panzyga, Privigen, and Yimmugo. SCIG products requiring prior auth: Cutaquig, Cuvitru, Hizentra, HyQvia, and Xembify. If you're billing any of these and don't have a prior authorization on file, stop before submitting.

To get prior authorization, call (866) 752-7021 or fax (888) 267-3277. Statement of Medical Necessity forms are available through Aetna's Specialty Pharmacy Precertification portal.

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Aetna IVIG and SCIG Exclusions and Non-Covered Indications

CPB 0206 is a long policy with dozens of covered indications, but it also carries a significant list of conditions where IVIG or SCIG is considered experimental, investigational, or simply not medically necessary under Aetna's criteria. The policy summary provided here was truncated, so the full exclusions list requires direct review of the source policy at the CPB 0206 link.

What the policy makes clear: not every autoimmune or inflammatory condition automatically qualifies. The Aetna IVIG coverage policy applies indication-specific criteria. A diagnosis alone is not enough. Billing for a condition that meets the ICD-10 code but doesn't satisfy the clinical criteria will result in a denial on medical necessity grounds—not a coding error, but a coverage determination.

Site of care is also a factor. Aetna's Site of Care Utilization Management Policy applies to all the IVIG and SCIG products listed above. If your patient is receiving infusions in a hospital outpatient setting but could be managed in a home or office-based setting, Aetna may push back on reimbursement. Review the Site of Care for Specialty Drug Infusions UM policy before billing for facility-based administration.

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Coverage Indications at a Glance

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Aetna Immunoglobulin Billing Guidelines and Action Items 2025

Immunoglobulin billing under this policy is high-dollar and high-scrutiny. These steps apply starting November 20, 2025.

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

These are the two primary billing codes for immunoglobulin therapy under CPB 0206. Both require prior authorization and documented medical necessity under the indication-specific criteria above.

Other CPT Codes Referenced in CPB 0206

These codes appear in the policy as contextually related procedures. They are not the primary immunoglobulin billing codes, but they indicate the breadth of clinical scenarios where immunoglobulin therapy may intersect with other covered services.

Key ICD-10-CM Diagnosis Codes

CPB 0206 references 1,157 ICD-10-CM codes. The policy data provided here does not include the full code list. Access the complete ICD-10 mapping directly at the CPB 0206 source policy. Your billing team should cross-reference every claim's primary diagnosis against the approved indication list before submission. A diagnosis code that falls outside the covered list—even for a patient who is clinically appropriate—will generate a claim denial under this coverage policy.

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