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Federal Employee Plan® and RhoGam

Provider Administrative Policy

Policy Date
December 2006
Revised/July 2012
Provider Type(s)


Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.


Federal Employee Plan® and RhoGam

The following Rho(D) immune globulin (human) drugs/pharmaceuticals are medically necessary when administered to Rh-negative mothers antepartum and postpartum:

  • RhoGam
  • Gamulin Rh
  • HypoRho-D

Allowances for RhoGam may be paid in addition to the maternity benefit. Allowances will be paid under the maternity level and not the medical benefit level.

Policy History

Date Action Reason
July 2012 Revised Added registration mark

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