Policy Application
All claims submitted for this policy will be processed according to the policy effective date and associated revision effective dates in effect on the date of service.
Policy
Home infusion therapy services include the provision of nutrients, antibiotics, and other drugs and fluids administered intravenously, including all medically appropriate and necessary supplies. A home infusion therapy provider provides these services to members or their families who have been trained in the administration of these services.
Home infusion therapy providers must have a separately signed participation agreement and a separate National Provider Identifier (NPI). A home infusion provider is not the same as a home health agency.
The Healthcare Common Procedure Coding System (HCPCS) “S” codes identified for home infusion therapy (HIT) services are based on a “per diem” reimbursement methodology. The per diem includes all supplies, care coordination and professional pharmacy services. The per diem code is billed for each day that a patient receives an infusion and one day equals 24 hours.
Note: Nursing services and drug products are reimbursed separately from the HIT code per diem.
Billing Guidelines
- Submit claims on CMS-1500 claim electronic 837P format using CPT and/or HCPCS codes for service provided.
- Include one calendar month per line.
- Use Place of Service code(s)
- 12 (Home) for services provided in the patient’s home
- 11 (office) services provided in provider’s office
- 49 (independent clinic) for home infusion suite
- When a home infusion cassette is changed in a clinic setting, only the provider who refills the pump should bill for the service. The physician’s office and the home infusion provider should not both bill for the infusion service as that is a duplication of services.
Drugs
Drug products that are separately reimbursed pricing is based on the Injectables-Other Pharmacy fee schedule. This fee schedule is available on the Online Fee Schedule Portal and is updated in February, May, August, and November to reflect quarterly changes.
Submit all drugs with specific HCPCS code and units as defined by the code description. For drugs without a specific HCPCS code, use J3490, J3590, J7799 or J9999. Provide the narrative, NDC number, dosage and units supplied.
Multiple Therapies
For patients receiving multiple drugs, submit the most frequently administered drug therapy as the primary therapy. For patients receiving continuous infusions, submit the therapy as once every 24 hours.
When multiple therapies in the same category are done on the same date of service as primary
therapy, append the following modifiers to the “S” code:
- SH identifies the second concurrently administered infusion therapy.
- SJ identifies the third or more concurrently administered infusion therapy.
Nursing Services
Nursing services include evaluation and assessment, education, and training for the patient or caregiver, inspection and consultation of aseptic home environment, catheter insertion, and patient assessment.
Home Infusion Therapy Codes
The following codes are included below for informational purposes only and are subject to change without notice. Inclusion or exclusion of a code does not constitute or imply subscriber coverage or provider reimbursement.
HIT CPT/HCPCS
S0155
|
S5497
|
S5502
|
S9326
|
S9327
|
S9328
|
S9330
|
S9331
|
S9336
|
S9338
|
S9345
|
S9346
|
S9347
|
S9348
|
S9349
|
S9351
|
S9357
|
S9359
|
S9361
|
S9363
|
S9373
|
S9374
|
S9375
|
S9376
|
S9377
|
S9379
|
S9490
|
S9497
|
S9500
|
S9501
|
S9502
|
S9503
|
S9504
|
