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The purpose of this coding policy is to provide reporting guidelines for Infusion Therapy services rendered in the home or in an Ambulatory Infusion Suite by Blue Cross & Blue Shield of Mississippi (BCBSMS) and Advanced Health System, Inc. (AHS) State Network Providers. Home Infusion Providers must ensure that Infusion Therapy services are reported accurately using national coding guidelines, including but not limited to CPT/HCPCS procedure codes, ICD-10 diagnosis codes, modifiers, and valid place of service codes.
Compliance with this policy does not guarantee reimbursement. Reimbursement is determined by other factors, including but not limited to Members’ contract benefits, Medical Policy, and medical necessity criteria. All Infusion Therapy services are subject to prior authorization.
Coverage and medical necessity criteria for reimbursement of parenteral and enteral infusion therapy in the home and the usage of an implantable pump are defined in the following Medical Policies which can be found at www.bcbsms.com and/or www.MyAccessBlue.com:
Parenteral (PEN) and Enteral (EN) Nutrition Support in the Home
Implantable Infusion Pump
Infusion Therapy Defined
Infusion Therapy means services and supplies required for the administration of an Infusion Therapy regimen either in a Member’s home or an Ambulatory Infusion Suite (AIS) of a Home Infusion Therapy (HIT) Provider. These services and supplies must be:
Medically Necessary for the treatment of the disease;
Ordered by a physician;
Can be, as determined by BCBSMS, safely administered in the home or AIS;
Provided by a Network Infusion Therapy Provider approved by BCBSMS, when prior authorization
has been obtained from BCBSMS;
Ordinarily in lieu of inpatient therapy; and
More cost effective than inpatient therapy.
The following scenarios are not considered HIT and may not be reported as such on the claim:
Therapeutic agents instilled into an implanted or ambulatory pump in the practitioner’s
office or a hospital setting
Medications delivered to the practitioner’s office for infusion/instillation in the office or
hospital settings
Infusion therapy provided in a location other than a patient’s home
Infusion therapy solely provided in an AIS
Per Diem Definition and Billing Guidelines
A per diem is a payment for each day maintenance is performed or a therapeutic agent is actually infused into the body by the Infusion Therapy Provider. One day equals 24 hours. Documentation should include the start date/time of the drug infusion and the end date/time of the infusion. The per diem and drugs may only be billed with spanned dates if a drug is being administered on each date within the spanned date range. The number of units of the per diem should equal the number of 24-hour periods that the drug was administered as one day equals 24 hours.
Each per diem code includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment. Nursing services and drug products should be billed separately from the per diem HCPCS “S” codes. The per diem “S” code descriptions encompass most of the services performed to manage home patient care, including the pharmacists’ clinical patient care services, care coordination, and a wide range of operational and administrative services. Accordingly, these codes include professional pharmacy services.
The per diem include all necessary supplies and equipment, including but not limited to the following – IV start kits and sterile site dressings, IV fluids utilized as vehicles for administering other therapeutic agents, sterile saline/water utilized as diluent for therapeutic agents, flush solutions, tubing, filters, needles, syringes, disposable drug delivery systems, daily rental of ambulatory infusion pumps, and anaphylactic agents. The IV pole and fluids for infusion medications are considered as supplies and are included in the per diem. DME and supplies should not be billed separately.
A per diem should be billed (1) on the day a drug(s) is infused into the patient by the Infusion Therapy Provider and (2) on any day administrative services are rendered by the Infusion Therapy Provider related to the infusion, such as medical supervision, professional pharmacy services, nursing, patient or caregiver training, patient support and/or care coordination. A per diem can only be billed by the Infusion Therapy Provider that performed the infusion. It is not appropriate to bill a per diem for a day when no service is provided to the patient. The patient’s receipt of a drug via infusion does not in and of itself justify billing a per diem; the Infusion Provider must provide some service for each day a per diem is billed. It is not appropriate to bill a per diem when medication is received via an implanted device (e.g., an implanted pump) and no other service is provided on that day.
Separate Billing Guidelines
All services, including drugs, the per diem, and nursing must be billed on one claim. A per diem without a drug is not reimbursable. Nursing billed without a drug on date of service is only reimbursable when performing a line dressing change or drawing medication related labs. These services should be billed with S9529 and are limited to one unit. S9529 should not be billed with a spanned date.
Nursing time billed should represent the amount of time in the home with the patient; pre-home preparation, travel time, post-visit reporting, and follow-up activities are not billable. Maintenance (care of single or multiple lumen infusion catheters or implanted access devices) is only separately billable when the maintenance service is the only service provided on the date of service and catheter care is actually administered. Flushes for catheter maintenance are not considered adjunctive therapies and are not separately billable or reimbursable as these supplies are included in the per diem. Similarly, diluents or vehicles for administration of other therapeutic agents are not separately billable or reimbursable and are included in the per diem. Therapeutic agents billed without an associated per diem are considered a pharmacy benefit and not reimbursable when billed by a Infusion Therapy Provider.
Intravenous Push (IVP) medications and intramuscular (IM) injections dispensed as adjunctive therapy to Infusion Therapy may be billed with the appropriate HCPCS code, but a separate per diem is not billable. IVP and IM as a sole agent is not reimbursable. Self-administered medications are defined as drugs the Member takes by mouth or otherwise administers to themselves, such as oral medications, topical medications, inhalation, or self-administered injectables, are not billable or reimbursable.
The Provider may only bill for the quantity of the drug actually administered, not unused mixed, compounded, opened quantities, or waste. Single dose vials are an exception.
Coding and Billing Guidelines
Infusion Therapy Providers must utilize the most current coding and billing guidelines regarding the reporting of CPT/HCPCS procedure codes, ICD-10 diagnosis codes, modifiers, and place of service codes. The Infusion Therapy Provider must report the per diem “S” HCPCS code on the CMS-1500 claim form. The drug administered on the same date of service and the nursing visit provided concurrently with the Infusion Therapy services must also be reported on the same claim.
HIT and AIS claims must be submitted to the Blue Cross/Blue Shield Plan in whose service area the patient’s home, or equivalent setting, is located as this is where services were rendered. Claims for services rendered to Members who reside and/or receive services out of state should not be submitted to BCBSMS.
Place of Service (POS)
For reporting services to BCBSMS, home infusion Providers should report place of service code ‘12’ for all home infusion services performed in the patient’s private residence (home).
POS Code | Place of Service Name | Place of Service Description |
12 | Home | The location, other than a hospital or other facility, where the patient receives care in a private residence |
For reporting services to BCBSMS that took place in an Ambulatory Infusion Suite use place of service code 49 – Independent Clinic.
POS Code | Place of Service Name | Place of Service Description |
49 | Independent Clinic | The location, not part of a hospital and not described by any other Place of Service Code, that is organized and operated to provide preventive, diagnostic, therapeutic, rehabilitative, or palliative services to outpatients, only. |
Modifiers
For services requiring highly technical nursing services, the Provider should append modifier “SD” to the applicable CPT/HCPCS code.
Modifier | Description |
SD | Services provided by registered nurse with specialized, highly technical home infusion training |
For services provided in the Ambulatory Infusion Suite, append modifier “SS” to the appropriate CPT/HCPCS code.
The ‘SS’ modifier should not be appended to the codes when services are rendered in the home.
Sometimes for a therapy that is administered in the home, a particular nursing encounter is provided in the AIS. While an occasional nursing encounter occurs in the AIS for purposes of clinical monitoring or access to care, this is an extension of the continuity of care for a home patient. Stating again, on these occasions the service performed in the AIS is a continuation of the service provided to the home infusion therapy patient.
For the drugs associated with the ongoing provision of the therapy, the –SS modifier isn’t used for coding of the drugs. However, the –SS modifier is used for coding of specific nursing encounters performed within the Advanced Infusion Suite, such as with 99601-SS (infusion/specialty drug administration).
Modifier | Description |
SS | Home infusion services provided in the infusion suite of the iv therapy Provider |
Either modifier “SH” or “SJ” should be appended to indicate that two or more therapies were provided on the same date of service.
Modifier | Description |
SH | Second concurrently administered infusion therapy |
SJ | Third or more concurrently administered infusion therapy |
To identify the route of administration of a drug that is not specified in the HCPCS code description, modifiers “JA” and “JB” may be appended to the HCPCS code. These modifiers are only reported with drugs administered.
Modifier | Description |
JA | Administered intravenously |
JB | Administered subcutaneously |
To identify a more/complex high level of care provided, modifier “TG” should be appended to the applicable HCPCS per diem code.
Modifier | Description |
TG | Complex/high tech level of care |
The following services are not included in the per diem and should be reported separately.
Drugs
Lipids, specialty amino acid formulas, and CPT/HCPCS codes for drugs other than those included in a standard total parenteral nutrition formula.
Nursing Services
In the Home
99601 (Home infusion/specialty drug administration, per visit (up to 2 hours)
99602 (Home infusion/specialty drug administration, per visit (up to 2 hours); each additional hour (List separately in addition to code for primary procedure))
In the Ambulatory Infusion Suite
99601-SS (Home infusion/specialty drug administration, per visit (up to 2 hours)
99602-SS (Home infusion/specialty drug administration, per visit (up to 2 hours); each additional hour (List separately in addition to code for primary procedure))
Non-Routine Catheter Procedures
S5517 (Home infusion therapy, all supplies necessary for restoration of catheter patency or declotting)
S5518 (Home infusion therapy, all supplies necessary for catheter repair)
S5520 (Home infusion therapy, all supplies (including catheter) necessary for a peripherally inserted central venous catheter (PICC) line insertion)
S5521 (Home infusion therapy, all supplies (including catheter) necessary for a midline catheter insertion)
S5522 (Home infusion therapy, insertion of peripherally inserted central venous catheter (PICC), nursing services only (no supplies or catheter included))
S5523 (Home infusion therapy, insertion of midline venous catheter, nursing services only (no supplies or catheter included))
This policy is applicable to all lines of business.
The coding guidelines outlined in Coding Policy should not be used in lieu of the Member's specific benefits plan language.
5/16/2022: New Policy Added
2021 CPT Manual, Professional Edition
2021 HCPCS Level II Professional Manual
National Home Infusion Association’s (NHIA) National Coding Standard for Home Infusion Claims under HIPAA version 1.11.01h Effective January 1, 2020
National Home Infusion Association’s (NHIA) 2013 NHIA Quick Coding Reference forHome Infusion Therapy
The following codes are reported for per diem home infusion therapy services.
Anti-Infective Therapies (antibiotics/ antifungals/ antivirals) | |
Code | Description |
S9494 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code with home infusion codes for hourly dosing schedules S9497-S9504) |
S9497 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 3 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9500 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 24 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9501 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 12 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9502 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 8 hours, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9503 | Home infusion therapy, antibiotic, antiviral, or antifungal; once every 6 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9504 | Home infusion therapy, antibiotic, antiviral, or antifungal; once every 4 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
Chemotherapy | |
Code | Description |
S9329 | Home infusion therapy, chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code with S9330 or S9331) |
S9330 | Home infusion therapy, continuous (twenty-four hours or more) chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9331 | Home infusion therapy, intermittent (less than twenty-four hours) chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
Anti-Infective Therapies (antibiotics/ antifungals/ antivirals) | |
Code | Description |
S9494 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code with home infusion codes for hourly dosing schedules S9497-S9504) |
S9497 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 3 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9500 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 24 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9501 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 12 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9502 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 8 hours, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9503 | Home infusion therapy, antibiotic, antiviral, or antifungal; once every 6 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9504 | Home infusion therapy, antibiotic, antiviral, or antifungal; once every 4 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
Chemotherapy | |
Code | Description |
S9329 | Home infusion therapy, chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code with S9330 or S9331) |
S9330 | Home infusion therapy, continuous (twenty-four hours or more) chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9331 | Home infusion therapy, intermittent (less than twenty-four hours) chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
Enteral Therapy | |
Code | Description |
S9340 | Home therapy; enteral nutrition; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem |
S9341 | Home therapy; enteral nutrition via gravity; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem |
S9342 | Home therapy; enteral nutrition via pump; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem |
S9343 | Home therapy; enteral nutrition via bolus; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem |
Hydration Therapy | |
Code | Description |
S9373 | Home infusion therapy, hydration therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use with hydration therapy codes S9374-S9377 using daily volume scales) |
S9374 | Home infusion therapy, hydration therapy; one liter per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9375 | Home infusion therapy, hydration therapy; more than one liter but no more than two liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9376 | Home infusion therapy, hydration therapy; more than two liters but no more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9377 | Home infusion therapy, hydration therapy; more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies (drugs and nursing visits coded separately), per diem |
Pain Management Therapy | |
Code | Description |
S9325 | Home infusion therapy, pain management infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment, (drugs and nursing visits coded separately), per diem (do not use this code with S9326, S9327 or S9328) |
S9326 | Home infusion therapy, continuous (twenty-four hours or more) pain management infusion; administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9327 | Home infusion therapy, intermittent (less than twenty-four hours) pain management infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9328 | Home infusion therapy, implanted pump pain management infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
Total Parenteral Nutrition (TPN) Therapy | |
Code | Description |
S9364 | Home infusion therapy, total parenteral nutrition (TPN); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula (lipids, specialty amino acid formulas, drugs other than in standard formula and nursing visits coded separately), per diem (do not use with home infusion codes S9365-S9368 using daily volume scales) |
S9365 | Home infusion therapy, total parenteral nutrition (TPN); one liter per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula (lipids, specialty amino acid formulas, drugs other than in standard formula and nursing visits coded separately), per diem |
S9366 | Home infusion therapy, total parenteral nutrition (TPN); more than one liter but no more than two liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula (lipids, specialty amino acid formulas, drugs other than in standard formula and nursing visits coded separately), per diem |
S9367 | Home infusion therapy, total parenteral nutrition (TPN); more than two liters but no more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula (lipids, specialty amino acid formulas, drugs other than in standard formula and nursing visits coded separately), per diem |
S9368 | Home infusion therapy, total parenteral nutrition (TPN); more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula (lipids, specialty amino acid formulas, drugs other than in standard formula and nursing visits coded separately), per diem |
Specialty Therapies | |
Code | Description |
S9336 | Home infusion therapy, continuous anticoagulant infusion therapy (e.g., heparin), administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9338 | Home infusion therapy, immunotherapy, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9339 | Home therapy; peritoneal dialysis, administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9345 | Home infusion therapy, anti-hemophilic agent infusion therapy (e.g., factor viii); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9346 | Home infusion therapy, alpha-1-proteinase inhibitor (e.g., prolastin); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9347 | Home infusion therapy, uninterrupted, long-term, controlled rate intravenous or subcutaneous infusion therapy (e.g., epoprostenol); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9348 | Home infusion therapy, sympathomimetic/inotropic agent infusion therapy (e.g., dobutamine); administrative services, professional pharmacy services, care coordination, all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9349 | Home infusion therapy, tocolytic infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9351 | Home infusion therapy, continuous or intermittent anti-emetic infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and visits coded separately), per diem |
S9353 | Home infusion therapy, continuous insulin infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9355 | Home infusion therapy, chelation therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9357 | Home infusion therapy, enzyme replacement intravenous therapy; (e.g., imiglucerase); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9359 | Home infusion therapy, anti-tumor necrosis factor intravenous therapy; (e.g., infliximab); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9361 | Home infusion therapy, diuretic intravenous therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9363 | Home infusion therapy, anti-spasmotic therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9370 | Home therapy, intermittent anti-emetic injection therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9372 | Home therapy; intermittent anticoagulant injection therapy (e.g., heparin); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code for flushing of infusion devices with heparin to maintain patency) |
S9490 | Home infusion therapy, corticosteroid infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9537 | Home therapy; hematopoietic hormone injection therapy (e.g., erythropoietin, g-csf, gm-csf); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9538 | Home transfusion of blood product(s); administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (blood products, drugs, and nursing visits coded separately), per diem |
S9558 | Home injectable therapy; growth hormone, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9559 | Home injectable therapy, interferon, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9560 | Home injectable therapy; hormonal therapy (e.g.; leuprolide, goserelin), including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9562 | Home injectable therapy, palivizumab, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9590 | Home therapy, irrigation therapy (e.g., sterile irrigation of an organ or anatomical cavity); including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9061 | Home administration of aerosolized drug therapy (e.g., pentamidine); administrative services, professional pharmacy services, care coordination, all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
Not Otherwise Classified (NOC) Therapy | |
Code | Description |
S9379 | Home infusion therapy, infusion therapy, not otherwise classified; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9542 | Home injectable therapy, not otherwise classified, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
Catheter Care Note: These codes are to be used as a standalone therapy, or during days not covered under per diem by another therapy. | |
Code | Description |
S5497 | Home infusion therapy, catheter care / maintenance, not otherwise classified; includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S5498 | Home infusion therapy, catheter care / maintenance, simple (single lumen), includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment, (drugs and nursing visits coded separately), per diem |
S5501 | Home infusion therapy, catheter care / maintenance, complex (more than one lumen), includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S5502 | Home infusion therapy, catheter care / maintenance, implanted access device, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment, (drugs and nursing visits coded separately), per diem (use this code for interim maintenance of vascular access not currently in use) |
Nursing and Professional Services | |
Code | Description |
99601 | Home infusion/specialty drug administration, nursing services; per visit (up to 2 hours) |
99602 | Each additional hour (list separately in addition to code 99601) |
The per diem “S” codes are used to code the services associated with the provision of catheter care only when provided as a standalone therapy, or during days not covered under per diem by another therapy. The codes can be used to specify the maintenance for single or multiple lumens in the catheter, as well as for an implanted access device (i.e., implanted port). Excluded from any per diem “S” code are supplies required for non-routine catheter procedures.
Code | Description |
S5517 | Home infusion therapy, all supplies necessary for restoration of catheter patency or declotting |
S5518 | Home infusion therapy, all supplies necessary for catheter repair |
S5520 | Home infusion therapy, all supplies (including catheter) necessary for a peripherally inserted central venous catheter (PICC) line insertion |
S5521 | Home infusion therapy, all supplies (including catheter) necessary for a midline catheter insertion |
S5522 | Home infusion therapy, insertion of peripherally inserted central venous catheter (PICC), nursing services only (no supplies or catheter included) |
S5523 | Home infusion therapy, insertion of midline venous catheter, nursing services only (no supplies or catheter included) |
Nursing billed without a drug on date of service is only reimbursable when performing a line dressing change or drawing medication related labs. These services should be billed with S9529 and are limited to one unit. S9529 should not be billed with a spanned date.
Code | Description |
S9529 | Routine venipuncture for collection of specimen(s), single home bound, nursing home, or skilled nursing facility patient |
Standard Additives - The TPN "S" codes (S9364 - S9368) include some drugs and other products in the per diem. Specifically, products used in a standard TPN formula and included in the per diem are listed below.
Non-specialty amino acids (e.g., Aminosyn, FreAmine, Travasol)
Concentrated dextrose (e.g., D10, D20, D40, D50, D60, D70)
Sterile water
Electrolytes (e.g., CaC12, KCL, CPO4, MgSo4, NaAc, NaCl, NaPO4)
Standard multi-trace element solutions (e.g., MTE4, MTE5, MTE7)
Standard multivitamin solutions (e.g., MVI-13)
Special Additives or Proteins - Not included in the TPN per diem are the following items to be coded separately:
Specialty amino acids for renal failure (e.g., Aminess, Aminosyn-RF, NephrAmine, RenAmin)
Specialty amino acids for hepatic failure (e.g., HepatAmine)
Specialty amino acids for high stress conditions (e.g. Aminosyn-HBC, BranchAmin, FreAmine HBC, Trophamine)
Specialty amino acids with concentrations of 15% and above when medically necessary for fluid restricted patients (e.g., Aminosyn 15%, Novamine 15%, Clinisol 15%)
Lipids (e.g., Intralipid, Liposyn)
Added trace elements not from a standard multi-trace element solution (e.g., chromium, copper, iodine, manganese, selenium, zinc)
Added vitamins not from a standard multivitamin solution (e.g., folic acid, vitamin C, vitamin K)
Products serving non-nutritional purposes (e.g., heparin, insulin, iron dextran, Pepcid, Sandostatin, Zofran)
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