Billing Guidelines for Medicare Home Infusion Therapy (HIT)

Billing Guidelines for Medicare Home Infusion Therapy (HIT)

Basics of Home Infusion Therapy (HIT)

Under Fee-for-service (FFS) Medicare, home infusion therapy (HIT) involves the intravenous or subcutaneous administration of drugs or biologicals to an individual at home. The components needed to perform home infusion include the drug (for example, antivirals, immune globulin), equipment (for example, a pump), and supplies (for example, tubing and catheters). Likewise, nursing services are necessary to train and educate the patient and caregivers on the safe administration of infusion drugs in the home.

Medicare Coverage

The Medicare home infusion therapy services benefit covers the professional services, including nursing services, furnished in accordance with the plan of care, patient training and education (not otherwise covered under the durable medical equipment (DME) benefit), remote monitoring, and monitoring services for the provision of home infusion drugs, furnished by a qualified home infusion therapy supplier in the individual’s home. The home infusion therapy services are covered for the safe and effective administration of certain drugs and biologicals administered intravenously, or subcutaneously for an administration period of 15 minutes or more, in the home of an individual, through a pump that is an item of DME. The infusion pump and supplies (including home infusion drugs) will continue to be covered under the DME benefit.

Defining Qualified Home Infusion Therapy Supplier

Only a qualified home infusion therapy supplier can bill for services under the new home infusion therapy services benefit. A qualified home infusion therapy supplier must be accredited by a Medicare approved Accreditation Organization (AO) and is required to enroll in Medicare as a Part B supplier (new specialty D6). A home infusion therapy supplier is not required to enroll as a DME supplier, but a DME supplier or Home Health Agency should consider enrolling as a home infusion therapy supplier if they intend to provide home infusion therapy services beyond what is covered under the DME benefit or Home Health benefit, respectively. Section 1861(iii)(3)(D)(i) of the Social Security Act defines a qualified home infusion therapy supplier as a pharmacy, physician, or other provider of services or supplier licensed by the State in which the pharmacy, physician, or provider of services or supplier furnishes items or services.

Billing Codes for Home Infusion Therapy

The HCPCS codes G0088, G0089, and G0090 signify an initial HIT service visit only and were created as part of the implementation of the permanent HIT benefit. These codes were not in use during the Temporary Transitional Payment (TTP) period.

G0068

Professional services for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each infusion drug administration calendar day in the individual’s home, each 15 minutes.

G0069

Professional services for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual’s home, each 15 minutes.

G0070

Professional services for the administration of intravenous chemotherapy or other intravenous highly complex drug or biological infusion for each infusion drug administration calendar day in the individual’s home, each 15 minutes.

G0088

Professional services, initial visit, for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each infusion drug administration calendar day in the individual’s home, each 15 minutes.

G0089

Professional services, initial visit, for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual’s home, each 15 minutes.

G0090

Professional services, initial visit, for the administration of intravenous chemotherapy or other highly complex infusion drug or biological for each infusion drug administration calendar day in the individual’s home, each 15 minutes.

Billing Scenario

If a patient receiving home infusion therapy is also under a home health plan of care and receives a visit that is unrelated to the administration of the home infusion drug, then payment for the home health visit would be covered under the Home Health Prospective Payment System (HH PPS) and billed on the home health claim. Additionally, if a patient is receiving an infusion drug that is not identified as a “home infusion drug”, then the professional services for the administration of the drug would remain covered under the HH PPS if the patient is eligible for home health services.

If the home visit includes the provision of home health services in addition to, and separate from, home infusion therapy services, the home health agency (also enrolled as a qualified home infusion therapy supplier) would submit both a home health claim under the HH PPS and a home infusion therapy services claim under the home infusion therapy services benefit. However, the agency must separate the time spent furnishing services covered under the HH PPS from the time spent furnishing services covered under the home infusion therapy services benefit.

When the home health agency (HHA) furnishing home health services is also enrolled as a qualified home infusion therapy supplier, and a home visit is exclusively for the purpose of the administration of the home infusion drug, the home health agency would only submit a home infusion therapy services claim under the home infusion therapy services benefit.

CPT codes, descriptions and other data only are copyright 2022. American Medical Association. All Rights Reserved.

Medisys Data Solutions is a leading medical billing company providing complete assistance in medical billing and coding functions for Medicare, Medicaid, government and private payers. We shared billing guidelines for Medicare Home Infusion Therapy (HIT) for reference, you can refer CMS webpage on “Home Infusion Therapy Services” for detailed understanding. In case any assistance needed for Medicare medical billing services, contact us at info@medisysdata.com/ 302-261-9187

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