Sponsors (4)
The bill expands and clarifies Medicare coverage for IVIG for primary immunodeficiency—improving patient access and reducing provider billing uncertainty—while increasing Medicare spending risk and creating administrative implementation burdens.
Medicare beneficiaries with primary immunodeficiency will have IVIG treatments and related services covered under the specified payment rule starting Oct 1, 2026, improving access to necessary care.
Hospitals and outpatient providers will have clearer payment coverage for specified IVIG HCPCS codes, reducing billing uncertainty and likely simplifying claims processing.
The HHS Secretary can update the HCPCS list after Jan 1, 2026, allowing timely adjustments as new IVIG products emerge and helping maintain relevant coverage.
Taxpayers and the Medicare program may face increased spending to cover IVIG and related services beginning Oct 1, 2026, raising program costs.
If future HCPCS list updates broaden coverage to higher-cost IVIG formulations, beneficiaries or Medicare could incur substantially higher program costs absent explicit cost-control measures.
CMS and other administrators will face implementation and administrative burdens to update coding and payment systems before the Oct 1, 2026 effective date.
Based on analysis of 2 sections of legislative text.
Adds IVIG for primary immunodeficiency (specified by HCPCS codes) and related items/services into a Medicare payment rule; Secretary may update codes.
Official title: To amend title XVIII of the Social Security Act to improve access to skilled nursing facilities for primary immunodeficiency patients.
Introduced April 27, 2026 by Adrian Smith · Last progress April 27, 2026
Adds specific intravenous immune globulin (IVIG) products used to treat primary immunodeficiency disease to the Medicare payment rule at 42 U.S.C. § 1395yy(e)(2)(A)(iii), and makes related items and services explicitly covered under that payment rule. The list references specific HCPCS codes as of January 1, 2026 and allows the Secretary to update the list; the change applies to items and services furnished on or after October 1, 2026.