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  • Home Infusion Therapy: Frequently Asked Questions 

    1. What services are typically included under home infusion therapy?

    Home infusion therapy involves the administration of drugs and biologicals in a patient’s home, either by the patient, friends/family, or trained nursing staff. Home infusion therapy is always initiated by a prescription from a qualified physician who is overseeing a patient’s care. Physicians who provide home infusion therapy services typically get the necessary medications from one of three sources: 1) an in-house pharmacy owned by the practice; 2) an outside pharmacy that is contracted to provide drugs to the practice 3) pre-packaged/pre-mixed drugs from a variety of sources.

    Home infusion services typically also include administrative services, patient education/training services, pharmacy services, care coordination, and supplies and equipment. The physician’s nursing or pharmacy staff typically provides these services and supplies when the patient initially picks up the medications from the prescribing physician’s office. Home nursing services are occasionally provided through a home health agency to assist and monitor the patient in the home.

    2. Do payers cover home infusion therapy services?

    Coverage of home infusion therapy services varies by payer. While many private payers cover home infusion therapy services as long as certain conditions are met, Medicare coverage of these services is very limited in nature. IDSA continues to lobby Medicare and Congress to cover home infusion therapy services as a less expensive and more efficient means of administering life-saving infusion medications to Medicare beneficiaries. Privately insured patients should contact their insurance carriers to determine if home infusion therapy services are covered by their plan.

    Note: Medicare beneficaries often have access to home infusion therapy services if they are fully covered by secondary payers. However, typically providers must first submit a claim to Medicare for a denial before coverage from a seconary payers will kick-in. Use CPT codes 99601 (home infusion/visit, 2 hours) and 99602 (home infusion, each additional hour) for the Medicare denial.

    3. Do you have to be an accredited infusion center to provide home infusion therapy services?

    Many insurance carriers require home infusion therapy providers to go through an accreditation process in order to verify that the provider is complying with state and federal regulations and professional standards of practice, and is providing clinical and supportive services in a manner designed to ensure patient safety and quality of care. If you are considering providing home infusion therapy services through your practice, you may want to contact individual insurance carriers for their home infusion therapy accreditation requirements. 

    4. What are the recognized accreditation organizations for home infusion therapy providers?

    Three organizations (see below) accredit home infusion therapy providers. Please click on the organizations to learn about their specific requirements:

    Accreditation Commission for Health Care 

    Community Health Accreditation Program 

    Joint Commission for Accreditation of Healthcare Organizations 

    5. How do you code and bill for home infusion therapy services?

    Home infusion therapy services are typically billed using a “per diem” or bundled coding structure. Home infusion services that are bundled together in a per diem payment include professional pharmacy services, patient monitoring, education and counseling activities, all necessary supplies and equipment, and administrative and other support services. Drug products and nursing visits are coded separately from the per diem.

    The following per diem coding structure is commonly accepted by private payers: 

     

    Home Infusions 

    Description 

    HCPCS Code 

    Medicare Will not pay 

     

     

     

     

    IV Antiobiotic

    Every 3 hours

    S9497

    X

    IV Antiobiotic

    Every 24 hours

    S9500

    X

    IV Antiobiotic

    Every 12 hours

    S9501

    X

    IV Antiobiotic

    Every 8 hours

    S9502

    X

    IV Antiobiotic

    Every 6 hours

    S9503

    X

    IV Antiobiotic

    Every 4 hours

    S9504

    X

     

     

     

     

    ** 

     

     

     

    Modifers to be added for 2nd

    SH

    2nd antibiotic

    X

    & 3rd drug

    SJ

    3rd antibiotic

    X

     

     

    ** Modifiers added to indicate the second and third drugs, if indicated. Often, the second drug is billed out at half the standard per diem charge and the third is billed out at one-fourth of the standard per diem charge. The drug/nurse visit charges/reimbursement is not affected by the per diems. Always bill the more frequent per diem first as the reimbursement will be higher for this code. As an example, meropenem 1gm every 8 hours & vancomycin 1gm every 12 hours would be billed like this for one day:

     

    S9502 X 1 (day)

     

    J2185 X 30 (units) = 3 doses

     

    S9501-SH X 1 (day) {half per diem}

     

    J3370 X 4 (units) = 2 doses

    6. Where can I find additional home infusion therapy information?

    You can find additional home infusion therapy resources on IDSA’s Practice Management Forms and Documents webpage.



     

 

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