Intravenous Immune Globulin (IVIG) (J1566, J1599) Specific brand names: Flebogamma® (J1572), Gammagard® liquid (J1569), Gammaked® (J1569), Gammaplex® (J1557), Gammunex® (J1561), Gammaplex (J1557), ......Cytogam® (J0850), Bivigam® (J1556) MD DETERMINATION FORM Patient Name...Intravenous immune globulin_IVIG_MD Determination Form 06.18.15.doc...