Home infusion therapy services involve administering medications, nutrients, or other solutions intravenously, subcutaneously, or through other non-oral routes in a patient’s home. Home infusion allows patients with chronic conditions like cancer, gastrointestinal diseases, and immune deficiencies to receive treatment while avoiding lengthy hospital stays.
The home infusion industry has grown rapidly in recent years, prompted by a shift toward outpatient and home-based care. Home infusion provides a more convenient and comfortable environment for patients compared to receiving infusions in hospitals, clinics or physicians’ offices. It also helps lower healthcare costs by reducing facility fees and shortening inpatient stays.
However, home infusion therapy involves complex billing and reimbursement protocols that must accurately capture the services, supplies, medications and nursing care involved. Proper billing is essential for home infusion providers to receive appropriate payment for their services from public and private payers.
This article provides an overview of common home infusion billing practices, codes and guidelines.
Services and Supplies Included in Home Infusion Billing
Home infusion billing encompasses a range of professional services, disposable medical supplies, implanted durable medical equipment, and prescription medications provided in the home setting.
Professional Services
This includes skilled nursing services to administer infusions, provide patient education, and monitor the patient. It also covers care coordination by the home infusion pharmacy, clinical monitoring, and medication management and evaluation by pharmacists.
Codes used to bill home infusion nursing and clinical services include:
- CPT codes for intravenous infusion therapy, injections, and chemotherapy administration
- HCPCS codes G031, G032, G034 and G035 for registered nurse services
- HCPCS codes G043 and G044 for clinical assessment and monitoring by a pharmacist
Disposable Medical Supplies
These include IV tubing, catheters, dressings, needles, syringes, saline, heparin, and other supplies used during infusion therapy.
Billing codes include:
- HCPCS codes for venous access catheters, infusion pumps, and IV therapy supplies
- Revenue codes indicating home IV therapy under 0274, 0275, 0279
- NDCs for saline, heparin, and ancillary IV supplies
Durable Medical Equipment
These are items like ambulatory infusion pumps, stationary pumps, and pole mounts installed in the patient’s home for long-term use.
- HCPCS codes E0779, E0780, E0781 for ambulatory infusion pumps
- HCPCS K0462 for intravenous pole used for gravity-fed infusions
Prescription Medications
Injectable drugs, antibiotics, pain medications, chemotherapy, and other drugs administered through infusion or injection are a major component of home infusion therapy.
- National Drug Codes (NDCs) identify the specific medication and dosage
- HCPCS codes JXXXX for certain intravenous drugs like chemotherapy
- Revenue code 0636 indicates drugs requiring specific identification
HCPCS vs. CPT Codes in Home Infusion Billing
Home infusion billing utilizes both the Level II HCPCS (Healthcare Common Procedure Coding System) code set and the Level I CPT (Current Procedural Terminology) code set maintained by the American Medical Association.
In general, CPT codes are used for medical services like nursing, drug administration, and evaluations by clinical staff. HCPCS codes are used for supplies, equipment, and certain medications.
Key CPT codes for home infusion include:
- 96360-96365 for intravenous infusion
- 96400-96450 for chemotherapy administration
- 96372 for subcutaneous/intramuscular injections
- 99601 for nursing care during infusion
Common HCPCS codes are:
- G031, G032, G034, G035 for nursing services
- E0779, E0780, E0781 for ambulatory infusion pumps
- QXXXX for injectable drugs
Both CPT and HCPCS codes are required to fully document the range of products and services provided during home infusion care.
Billing for Implanted Vascular Access Devices
Many home infusion patients have a central venous catheter, portacath, Peripherally Inserted Central Catheter (PICC) or other vascular access device surgically implanted to allow frequent infusions.
The initial surgical implantation of these devices is billed using CPT codes such as:
- 36568, 36569 for implantation of tunneled central catheter
- 36580, 36581 for implantation of implanted port
- 36584, 36585 for PICC line placement
Ongoing maintenance of vascular access devices for home infusion is billed monthly using HCPCS codes such as:
- G0257 for port maintenance
- G0268 for PICC maintenance
These monthly codes cover flushing, dressing changes, and monitoring during home infusion therapy.
Diagnosis Coding
Accurate ICD-10 diagnosis coding is crucial for home infusion billing and reimbursement. Diagnosis codes must document the underlying condition requiring chronic infusion therapy.
Common home infusion diagnoses include:
- C00-C96 codes for cancer conditions like leukemia requiring chemotherapy
- K50, K51 for Crohn’s disease and complications
- E83.01 for chronic iron deficiency anemia
- Z94.1 for kidney transplant status requiring immune suppression drugs
- J15.8 for severe pneumonia requiring IV antibiotics
Documenting the appropriate diagnosis codes on claims substantiates why home infusion is reasonable and necessary for the patient.
Billing Medicare for Home Infusion Therapy
Medicare covers home infusion therapy for chronically ill patients requiring certain IV medications or frequent injections. Services must be provided by a Medicare-enrolled home infusion therapy supplier.
Medicare Part B covers the professional services, supplies, and medications. Part A may provide additional coverage if the patient qualifies for home health services.
Effective January 1, 2021, Medicare implemented new permanent home infusion therapy benefits as mandated by the 21st Century Cures Act.
Key aspects include:
- New home infusion therapy payment categories replace the daily drug codes
- Professional services billed for each infusion drug administration calendar day
- Supplies are billed separately per diem rather than bundled with the drug
- Certain home infusion drugs now covered, including inotropic and antibiotic therapies
Under this structure, home infusion providers bill for:
- Professional services using CPT infusion codes on CMS-1500
- Supplies using HCPCS codes on UB-04 with revenue code 0278
- Drugs using NDCs on UB-04 with revenue code 0636
Documentation should make clear that services qualify for the home infusion benefit and aren’t duplicative with home health care.
Many Medicare Advantage plans also cover home infusion. Providers must follow the plans’ billing and authorization protocols.
Billing Private Insurance for Home Infusion
Private insurers have varying benefits, reimbursement policies, and procedures for home infusion. However, billing generally follows a similar structure to Medicare.
Key steps include:
- Verify patient’s home infusion coverage and preauthorization requirements
- Obtain prior authorization if required by the payer
- Bill professional services using CPT codes
- Bill supplies and equipment using HCPCS codes
- List NDCs for prescription medications on claims
- Use standard UB-04 form for institutional billing
- Provide clinical documentation if requested by the payer
Some plans require designated home infusion network providers. Others only cover certain infusion medications. Careful verification of benefits can help avoid claims denials.
Summary
Home infusion therapy allows patients to safely receive complex treatments at home. However, home infusion also involves multifaceted billing requirements. By accurately capturing all professional services, supplies, equipment, drugs and diagnoses, home infusion providers can successfully bill public and private payers and receive appropriate reimbursement for providing compassionate home-based care.
