UHIN Home Health Standard is compatible with all ASC X12N HIPAA recommendations.
Purpose: The purpose of this Standard is to provide a uniform standard of billing for Home Health Care claims/encounters.
Applicability: Applies to three types of Home Health Services:
- Home Health Care Nursing Visits/IV Home Infusion
- IV Home Infusion Services/Supplies
- Home Health Drugs billed with IV Home Infusion Services/Supplies [Some payers accept billing for drugs through their Retail Pharmacy benefit. This section does not apply to Retail Drug Pharmacy billing.]
Details:
The three types of Home Health Services that are standardized for billings include:
- Home Health Care Nursing Visits/IV Home Infusion
All home health care nursing visits (Table I) are billed using the ASC X12 005010X223A2 837 Institutional Claims Encounter Implementation Guide for electronic claims and the UB04 form and/or the CMS 1500 form for paper claims/encounters. Revenue codes and all applicable Health Care Procedure Code System (HCPCS) codes will be used to identify the home health care nursing visit/supplies (see Tables I and II). General revenue codes (e.g. 420, 440, 550 etc.) are not accepted for billing.
Home Health Care Nursing Visit/Supplies Codes - Table I
- IV Home Infusion Services/Supplies
IV home infusion services/supplies (Table II and Table III) are billed using the ASC X12 005010X222A1 837 Professional Claim Encounter Implementation Guide for electronic claims/encounters and CMS 1500 form for paper claims/encounters. The HCPCS codes are used.
IV Home Infusion Line Item Code List – Table II
Per Diem Code List – Table III[1]
- Home Health Drugs billed with IV Home Infusion Services/Supplies
Home health drugs billed with IV home infusion services/supplies use the ASC X12 005010X222A1 837 Professional Claim Encounter Implementation Guide for electronic claims/encounters and the CMS 1500 form for paper claims/encounters. The HCPCS and the National Drug Code (NDC) are required for drugs billed. The NDC code must be placed in the shaded portion of the line in Box 24 D-H of the paper form. [This section does not apply to Retail Pharmacy].
- Implementation: HIPAA Implementation schedule of the ASC X12 5010 837 Professional and Institutional Technical Report Type 3 (TR3).
|
Original |
A* 1 |
A* 2 |
V3 |
A* 1 |
A* 2 |
ORIGINATION DATE |
06/26/99 |
09/06/00 |
05/16/03 |
10/5/2010 |
|
|
APPROVAL DATE |
11/23/99 |
09/09/02 |
5/12/04 |
02/02/2011 |
|
|
EFFECTIVE DATE |
12/23/99 |
10/09/02 |
6/12/04 |
03/02/2011 |
|
|
Table I
Revenue Codes
Home Health Revenue Codes ** ** Does not include IV, PO, HME/DME
CODE |
DESCRIPTION |
UNITS |
Comments |
270 |
Supplies |
Each |
|
|
|
|
|
410 |
Respiratory Therapy |
Visit |
|
419 |
Respiratory Therapy |
Hour |
|
|
|
|
|
421 |
Physical Therapy |
Visit |
|
422 |
Physical Therapy |
Hour |
|
424 |
Physical Therapy Evaluation/Revaluation |
Visit |
|
|
|
|
|
431 |
Occupational Therapy |
Visit |
|
432 |
Occupational Therapy |
Hour |
|
434 |
Occupational Therapy Evaluation/Revaluation |
Visit |
|
|
|
|
|
441 |
Speech Pathology |
Visit |
|
442 |
Speech Pathology |
Hour |
|
444 |
Speech Pathology Evaluation/Revaluation |
Visit |
|
|
|
|
|
551 |
Skilled RN Nursing |
Visit |
|
552 |
Skilled RN Nursing |
Hour |
|
|
|
|
|
561 |
Medical Social Services |
Visit |
|
562 |
Medical Social Services |
Hour |
|
|
|
|
|
571 |
Home Health Aide |
Visit |
|
572 |
Home Health Aide |
Hour |
|
579 |
Personal Care Aide |
Hour |
Often used in County. AAA contracts or private pay arrangements |
|
|
|
|
581 |
Private Duty LPN |
Visit |
|
582 |
Private Duty LPN |
Hour |
|
|
|
|
|
651 |
Hospice Routine |
Per Diem |
|
652 |
Hospice Continuous |
Per Diem |
|
655 |
Hospice Service |
Per Diem |
Inpatient Respite (to replace rev code 653) |
656 |
Hospice Service |
Per Diem |
Hospice Inpatient (to replace rev code 654) |
657 |
Hospice Physician |
Visit |
|
659 |
Hospice Continuous |
Hour |
|
ENTERAL, PARENTERAL NUTRITIONENTERAL, PARENTAL NUTRITION
CODE |
DESCRIPTION |
B4034 |
Enteral feeding supply kit; syringe, per day |
B4035 |
Enteral feeding supply kit; pump fed, per day |
B4036 |
Enteral feeding supply kit; gravity fed, per day |
B4081 |
Nasogastric tubing with stylet |
B4082 |
Nasogastric tubing without stylet |
B4083 |
Stomach tube – Levine type |
B4087 |
Gastrostomy/Jejunostomy tubing |
B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
B4100 |
Food thickener, administered orally, per oz |
B4102 |
Enteral formula, for adults, used to replace fluids and electrolytes (e.g. clear liquids, 500 ml = 1 unit |
B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g. clear liquids) 500 ml = 1 unit |
B4104 |
Additive for enteral formula (e.g. fiber) |
B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain) includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories =1 unit |
B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates, (e.g. glucose polymers), proteins/amino acids (e.g. glutamine, arginine), fat (e.g. medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
B4157 |
Enteral formula, nutritionally complete, for special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
B4159 |
Enteral formula, for pediatrics, nutritionally complete soy based with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
B4162 |
Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
B4220 |
Parenteral nutrition supply kit, premix, per day |
B4222 |
Parenteral nutrition supply kit, home mix, per day |
B4224 |
Parenteral nutrition administration kit, per day |
B9002 |
Enteral nutrition infusion pump-with alarm |
B9006 |
Parenteral nutrition pump, stationary |
E0776 |
I.V. pole |
B4086 |
Gastronomy/jejunostomy tube any material, any type (Standard or low profile) each |
B4034 |
Enteral feeding supply kit; syringe, per day |
B4035 |
Pump fed, per day |
A9900 |
Backpack, enteralite – Misc Supplies Please indicate definition or description |
B4086 |
Gastrostomy, 18fr mic-key |
B9999 |
Noc for parenteral supplies |
NUTRIENTS
B4164 |
Parenteral nutrition solution: carbohydrates (dextrose) 50% or less (500 ML = 1 unit) homemix |
B4168 |
Parenteral nutrition solution: Amino Acid, 3.5% (500 ML = 1 unit) homemix |
B4172 |
Parenteral nutrition solution : amino acid, 5.5% through 7% (500 ML = 1 unit) homemix |
B4176 |
Parenteral nutrition solution: amino acid, 7% through 8.5%, (500 ML = 1 unit) homemix |
B4178 |
Parenteral nutrition solution: amino acid, greater that 8.5% (500 ML = 1 unit) homemix |
B4180 |
Parenteral nutrition solution: carbohydrates (dextrose), greater than 50% (500 ML = 1 unit) homemix |
B4185 |
Parenteral nutrition solutions: lipids, 10% with administration set (500 ML = 1 unit) |
B4186 |
Parenteral nutrition solution, lipids, 20% with administration set (500 ML = 1 unit) |
B4189 |
Parenteral nutrition solution; compound amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 10 to 51 grams of protein. Premix |
B4193 |
Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 52 to 73 grams of protein. Premix |
B4197 |
Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength 74 to 100 grams of protein. Premix |
B4199 |
Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, over 100 grams of protein. Premix |
B4216 |
Parenteral nutrition additives (vitamins, trace elements, heparin, electrolytes) homemix per day. (each day = 1 unit) |
B5000 |
Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, Renal - Aminosyn RF, Nephramine, Renamine. premix (each day = 1 unit) |
B5100 |
Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, Hepatic - Freamine HBC, Hepatamine. premix. (each day = 1 unit) |
B5200 |
Parenteral nutrition solution: compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, stress-branch chain amino acids. premix |
Table II
I.V. SUPPLIES
CODE |
DESCRIPTION |
S5520 |
Home infusion therapy, all supplies (including catheter) necessary for a peripherally inserted central venous catheter (PICC) line insertion |
S5522
|
Home infusion therapy insertion of peripherally inserted central venous catheter (PICC) nursing services only (no supplies or catheter included) |
S5521
|
Home infusion therapy, all supplies (including catheter) necessary for a midline catheter insertion. |
S5523 |
Home infusion therapy insertion of midline central venous catheter nursing services only (no supplies or catheter included) |
S5521 |
Home infusion therapy, all supplies (including catheter) necessary for a peripherally inserted central venous catheter (PICC) line insertion. |
S1015 |
IV tubing extension set |
S1015 |
IV tubing extension set |
A6257 |
Transparent film, 16 sq. in., or less, each dressing |
E0791 |
Parenteral infusion pump, stationary, single or multi-channel. |
K0552 |
Supplies for external infusion pump, syringe type cartridge, sterile, each |
E0779 |
Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater |
E0780 |
Ambulatory infusion pump, mechanical, reusable, for infusion less than 8 hours. |
E0781 |
Ambulatory Infusion pump single or multiple channels with administrative equipment, worn by patient |
A9901 |
Dispensing fee |
S1015 |
Extension Sets |
A4927 |
Gloves(per 100) |
A4930 |
Gloves(per pair) sterile |
A4621 |
Mask |
A4455 |
Wipes, adhesive remover |
A4245 |
Wipes, skin preps |
A4223 |
Infusion supplies not used with external infusion pump per cassette or bag |
Nutrition Assessment
CODE |
DESCRIPTION |
S9470 |
Nutritional counseling, dietician visit |
97802 |
Medical nutritional therapy, initial assessment ( 15 min increments up to 4 units or one hour) |
97803 |
Medical nutritional therapy, reassessment ( 15 min increments up to 4 units or one hour) |
PUMPS
CODE |
DESCRIPTION |
Category 1: Totally disposable units – nonelectronic |
|
A4305 |
Disposable drug delivery system flow rate of 50 mil or greater |
Category 2: Insulin pump - insulin specific pump, nonimplanted |
|
E0784 |
External ambulatory infusion pump, insulin |
A4230 |
Infusion set external insulin pump, non needle cannula |
A4231 |
Infusion set for external insulin pump, needle type |
A4232 |
Syringe with needle for external insulin pump, sterile, 3cc |
Category 3: Stationary pump for patients who are (partially) bed bound |
|
B9002 |
Enteral nutrition infusion pump-with alarm |
B4035 |
Enteral feeding supply kit; pump fed, per day move to nutrients table?? |
B4034 |
Enteral feeding supply kit; syringe fed, per day |
B4035 |
Enteral feeding supply kit; pump fed, per day |
B9006 |
Parenteral nutrition infusion pump, stationary |
E0791 |
I.V. infusion pump (pancreatic for regulated or controlled dose) or similar Parentral infusion pump, Stationary, single or multi-channel |
E0781 |
Ambulatory infusion pump. Single or multiple channels, electric or battery operated, with administrative equipment, worn by patient |
A4222 |
Supplies for external drug infusion pump, per cassette or bag |
Category 4: Semi-stationary or ambulatory pump for specific product infusion |
|
Group A. 50 to 100 ml delivery, electronic, for home use only |
|
E0780 |
Ambulatory Infusion pump. Mechanical reusable for infusion less than 8 hours |
E0779 |
Ambulatory Infusion pump. Mechanical reusable for infusion less than 8 hours or grater |
K0552 |
Syringe replacements for the I.V. flow control device Supplies for external infusion pump, syringe type cartridge, sterile, each |
E0781 |
Pump with cartridge (pancreatic like) TPN and I.V. Ambulatory infusion pump. Single or multiple channels, electric or battery operated, with administrative equipment, worn by patient |
A4222 |
Supplies for external drug infusion pump, per cassette or bag (list drugs separately) ???? |
E0781 |
Ambulatory infusion pump. Single or multiple channels, electric or battery operated, with administrative equipment, worn by patient |
Group B. 250 to 400 ml delivery, electronic, for home use only |
|
E0781 |
Ambulatory infusion pump (such as Maxx or microject), single or multiple channels, with administrative equipment worn by patient |
A4222 |
Supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
A4221 |
Supplies for maintenance for drug infusion catheter, per week |
Group C. 50 to 100 ml delivery, mechanical |
|
A4305 |
Disposable drug delivery system flow rate of 50 mil or greater |
A4306 |
Disposable drug delivery system flow rate of 50 mil or less |
A4209 |
Syringe with needle, sterile 5cc or greater |
K0455 |
Infusion pump used for uninterrupted parenteral administration of medication, epoprostinol or treprostinol |
Group D. Miscellaneous |
|
A9900 |
Disposable or accessory |
A9900 |
Disposable or accessory |
K0601 |
Replacement battery for external infusion pump owned by patient silver oxide 1.5v each |
K0602 |
Replacement battery for external infusion pump owned by patient silver oxide 3v each |
K0603 |
Replacement battery for external infusion pump owned by patient alkline 1.5v each |
K0604 |
Replacement battery for external infusion pump owned by patient lithium 3.6v each |
K0605 |
Replacement battery for external infusion pump owned by patient lithium 4.5v each |
K0620 |
Tubular elastic dressing, any width, per linear yard |
A9900 |
Disposable or accessory |
Table III
PER DIEM CODES
Codes |
Summary Description |
Code Description |
Chemotherapy |
||
S9330 |
Continuous* |
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 |
|
* Code Use Procedure: |
Continuous defined as 24 hours or more |
S9331 |
Intermittent* |
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 |
|
* Code Use Procedure: |
Intermittent defined as less than 24 hours |
S9329* |
Not Otherwise Classified |
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). A descriptor should be included in when used. |
|
* Code Use Limited: |
Used only if more specific "S" code is unavailable or if the not otherwise classified (NOC) code is required for use under provider-payer agreement |
Codes |
Summary Description |
Code Description |
Anti-Infective Therapies (antibiotics/ antifungals/ antivirals) |
||
S9497 |
Q3 hours |
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 |
S9504 |
Q4 hours |
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 |
S9503 |
Q6 hours |
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 |
S9502 |
Q8 hours |
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 |
S9501 |
Q12 hours |
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 |
S9500 |
Q24 hours |
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 |
S9494* |
Not Otherwise Classified |
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 with home infusion codes for hourly dosing schedules S9497-S9504) – If time descriptor is required and other codes do not apply then it should be included in description |
|
* Code Use Limited: |
Used only if more specific "S" code is unavailable or if the not otherwise classified (NOC) code is required for use under provider-payer agreement |
Codes |
Summary Description |
Code Description |
|
Enteral Nutrition |
|
S9343 |
Bolus therapy administration |
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 |
S9341 |
Gravity therapy administration |
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 |
Therapy administration via pump |
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 |
S9340* |
Not Otherwise Classified |
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. A descriptor should be included in when used. |
|
* Code Use Limited: |
Used only if more specific "S" code is unavailable or if the not otherwise classified (NOC) code is required for use under provider-payer agreement |
Codes |
Summary Description |
Code Description |
|
Hydration Therapy |
|
S9374 |
1.0 liter |
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 |
>1.0 to 2.0 liters |
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 |
>2.0 to 3.0 liters |
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 |
>3.0 liters |
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 |
S9373* |
Not Otherwise Classified |
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). A descriptor should be included in when used. |
|
* Code Use Limited: |
Used only if more specific "S" code is unavailable or if the not otherwise classified (NOC) code is required for use under provider-payer agreement |
Codes |
Summary Description |
Code Description |
|
Pain Management |
|
S9326 |
Continuous* |
Home infusion therapy, continuous (twenty-four hours or more) pain management infusion; administrative services, professional pharmacy services, care coordination all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
|
* Code Use Procedure: |
Continuous defined as 24 hours or more |
S9327 |
Intermittent* |
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 |
|
* Code Use Procedure: |
Intermittent defined as less than 24 hours |
S9328 |
Implanted pump |
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 |
S9325* |
Not Otherwise Classified |
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) – A descriptor should be included in when used. |
|
* Code Use Limited: |
Used only if more specific "S" code is unavailable or if the not otherwise classified (NOC) code is required for use under provider-payer agreement |
Codes |
Summary Description |
Code Description |
|
Total Parenteral Nutrition* |
|
|
*Procedures for TPN Coding: |
1. Standard TPN formula includes the following components: non-specialty amino acids, concentrated dextrose, sterile water, electrolytes, standard multi-trace element solutions and standard multivitamin solutions. |
|
|
2. Components not included in standard TPN formula are specialty amino acids, lipids, trace elements not from a standard multi-trace element solution, vitamins not from a standard multivitamin solution, and products serving non-nutritional purposes. Such components are billed on claims with NDC number addition to the TPN per diem "S" code. |
S9365 |
1.0 liter |
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 |
>1.0 - 2.0 liter |
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 |
>2.0 -3.0 liter |
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 acids, drugs other than in standard formula and nursing visits coded separately), per diem |
S9368 |
> 3.0 liter |
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 |
S9364* |
Not Otherwise Classified |
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 S9365-9368 using daily volume scales). A descriptor should be included in when used. |
|
* Code Use Limited: |
Used only if more specific "S" code is unavailable or if the not otherwise classified (NOC) code is required for use under provider-payer agreement |
Codes |
Summary Description |
Code Description |
|
Miscellaneous Infusion Therapy Per Diems |
|
S9336 |
Continuous anti-coagulants |
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 |
S9538 |
Transfusional blood products |
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 |
S9345 |
Anti-hemophilic factors |
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 |
S9355 |
Chelation |
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 |
Codes |
Summary Description |
Code Description |
|
Miscellaneous Infusion Therapy Per Diems |
(Continued) |
S9338 |
Immunomodulating agents |
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 |
S9348 |
Inotropic |
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 |
S9346 |
Alpha-1 proteinase inhibitor (e.g. Prolastin) |
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 |
S9359 |
Anti-tumor necrosis factor-alpha |
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 |
S9357 |
Imiglucerase |
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 |
S9347 |
Epoprostenol therapy |
Home infusion therapy, uninterrupted, long-term, controlled rate intravenous or subcutaneous infusion therapy (e.g. epoprostenol); administrative services, professional pharmacy services, care coordination, all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9351 |
Continuous anti-emetic therapy |
Home infusion therapy, continuous anti-emetic infusion therapy; administrative services, professional pharmacy services, care coordination, all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
Codes |
Summary Description |
Code Description |
|
Miscellaneous Infusion Therapy Per Diems |
(Continued) |
S9363 |
Anti-spasmotic agents |
Home infusion therapy, anti-spasmodic intravenous therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9361 |
Diuretics |
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 |
S9353 |
Continuous insulin therapy |
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 |
S9349 |
Tocolytic therapy |
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 |
S9490 |
Corticosteroid |
Home infusion therapy, corticosteroid infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9379* |
Miscellaneous Infusion Therapy Per Diems |
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. A descriptor should be included in when used. |
|
* Code Use Limited: |
Used only for miscellaneous infusion therapies not otherwise described by more specific per diem "S" codes. |
Codes |
Summary Description |
Code Description |
|
Miscellaneous Non-Infusion Therapy Per Diems |
(Continued) |
S9061 |
Aerosolized medications |
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 |
S9370 |
Intermittent anti-emetic |
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 |
Intermittent anti-coagulant |
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) |
S9537 |
Blood component stimulating factors |
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 |
S9558 |
Growth hormone |
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 |
Interferon |
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 |
Hormonal therapy (Leuprolide, goserelin) |
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 |
Codes |
Summary Description |
Code Description |
|
Miscellaneous Non-Infusion Therapy Per Diems |
(Continued) |
S9339 |
Home Therapy, peritoneal dialysis |
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 |
S9562 |
Palivizumab |
Home injectable therapy, palivizumab, including administrative services, professional pharmacy services, coordination of care, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9590 |
Irrigation |
Home injectable therapy, irrigation therapy (e.g. sterile irrigation of an organ or anatomical cavity); including administrative services, professional pharmacy services, coordination of care, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
S9542* |
Miscellaneous Non-Infusion Therapy Per Diems |
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. A descriptor should be included in when used. |
|
* Code Use Limited: |
Used only for miscellaneous non-infusion therapies not otherwise described by more specific per diem "S" codes. |
Codes |
Summary Description |
Code Description |
|
Catheter Care |
|
S5498* |
Catheter care maintenance - single lumen |
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 |
|
* Code Use Procedure: |
Used when catheter care provided as a standalone therapy, or during days not covered under per diem by another therapy |
S5501* |
Catheter care maintenance - more than 1 lumen |
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 |
|
* Code Use Procedure: |
Used when catheter care provided as a standalone therapy, or during days not covered under per diem by another therapy |
S5502* |
Catheter care maintenance-interim (implanted access device) |
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) |
|
* Code Use Procedure: |
Used when catheter care provided as a standalone therapy, or during days not covered under per diem by another therapy |
S5517* |
Catheter declotting supply kit |
Home infusion therapy, all supplies necessary for restoration of catheter patency or declotting |
|
* Code Use Procedure: |
Supplies required for non-routine catheter procedures are coded separately from other per diem "S" codes. |
S5518* |
Catheter repair supply kit |
Home infusion therapy, all supplies necessary for catheter repair |
|
* Code Use Procedure: |
Supplies required for non-routine catheter procedures are coded separately from other per diem "S" codes. |
S5520* |
PICC line catheter kit |
Home infusion therapy, all supplies (including catheter) necessary for a peripherally inserted central venous catheter (PICC) line insertion |
|
* Code Use Procedure: |
Supplies required for non-routine catheter procedures are coded separately from other per diem "S" codes. |
|
Midline catheter kit |
Home infusion therapy, all supplies (including catheter) necessary for midline catheter insertion |
|
* Code Use Procedure: |
Supplies required for non-routine catheter procedures are coded separately from other per diem "S" codes. |
S5497* |
Not Otherwise Classified |
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. A descriptor should be included in when used. |
|
* Code Use Limited: |
Used only if required for use under provider-payer agreement; otherwise, codes S5498, S5501 and S5502 are used. |
Codes |
Summary Description |
Code Description |
|
Nursing |
Provision of home infusion, specialty drug administration and/or associated nursing services and procedures by high tech or specialized high tech registered nurse. |
99600
|
Unlisted |
Unlisted Home Visit Service or Procedure. A descriptor should be included in when used. |
99601
|
High-tech R.N. services per visit up to 2 hours |
Home infusion/specialty drug administration, nursing services; per visit (up to 2 hours)
|
99601 |
Specialized high-tech R.N. services per visit up to 2 hours |
Home infusion/specialty drug administration, nursing services; per visit (up to 2 hours) |
|
* Code Use Procedure: |
Used if required under provider-payer agreement, or to distinguish the provider’s fees for specialized high-tech home infusion nursing. |
99602
|
High-tech R.N. services each additional hour |
Each additional hour (list separately in addition to code S9802) |
99602 |
Specialized high-tech R.N. services each additional hour |
Each additional hour (list separately in addition to code S9802) |
|
* Code Use Procedure: |
Used if required under provider-payer agreement, or to distinguish the provider’s fees for specialized high-tech home infusion nursing. |
S5522* |
PICC line insertion w/o supplies |
Home infusion therapy, insertion of peripherally inserted central venous catheter (PICC), nursing services only (no supplies or catheter included) |
|
* Code Use Procedure: |
Coded separately from S9802 and S9803, as well as separately from any other per diem "S" code. |
Codes |
Summary Description |
Code Description |
|
Nursing |
Provision of home infusion, specialty drug administration and/or associated nursing services and procedures by high tech or specialized high tech registered nurse. (continued) |
S5523* |
Midline insertion w/o supplies |
Home infusion therapy, insertion of midline central venous catheter, nursing services only (no supplies or catheter included) |
|
* Code Use Procedure: |
Coded separately from S9802 and S9803, as well as separately from any other per diem "S" code. |
-TU* |
Overtime |
Special payment rate, overtime |
-TV* |
Holidays/Weekends |
Special payment rate, holidays/weekends |
|
* Code Use Procedure: |
Used only if distinction of after hours service is needed per provider-payer agreement or to distinguish provider's usual and customary fees. No more than one of these modifiers shall be used to qualify a nursing code. |
Codes |
Summary Description |
Code Description |
|
Other Specialized Home Services |
|
S9214 |
Gestational diabetes management |
Home management of gestational diabetes, includes 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 any home infusion per diem code) |
S9211 |
Gestational hypertension management |
Home management of gestational hypertension, includes 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 any home infusion per diem code) |
S9213 |
Preeclampsia management |
Home management of preeclampsia, includes 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 any home infusion per diem code) |
S9212 |
Postpartum hypertension management |
Home management of postpartum hypertension, includes 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 any home infusion per diem code) |
S9208 |
Preterm labor management |
Home management of preterm labor, including administrative services, professional pharmacy services, care coordination, and all necessary supplies or equipment (drugs and nursing visits coded separately), per diem (do not use this code with any home infusion per diem code) |
Codes |
Summary Description |
Code Description |
|
Other Specialized Home Services |
(continued) |
S9209 |
Preterm premature rupture of membranes (PPROM) management |
Home management of preterm premature rupture of membranes (PPROM), including administrative services, professional pharmacy services, care coordination, and all necessary supplies or equipment (drugs and nursing visits coded separately), per diem (do not use this code with any home infusion per diem code) |
99500 |
R.N. services per visit (not to be used for home infusion therapy) |
Home visit for prenatal monitoring and assessment to include fetal heart rate, non-stress test, uterine monitoring, and gestational diabetes monitoring |
S9123 |
R.N. services per hour (not to be used for home infusion therapy) |
Nursing care, in the home; by registered nurse, per hour (use for general nursing care only, not to be used when CPT codes 99500-99600 or S codes S9802-S9803 can be used.) |
-TU* |
Overtime |
Special payment rate, overtime |
-TV* |
Holidays/Weekends |
Special payment rate, holidays/weekends |
|
* Code Use Procedure: |
Used only if distinction of after hours service is needed per provider-payer agreement or to distinguish provider's usual and customary fees. No more than one of these modifiers shall be used to qualify a nursing code. |
Codes |
Summary Description |
Code Description |
|
Extra Services |
|
S9381* |
High Risk/Escort |
Delivery or service to high risk areas requiring escort or extra protection, per visit |
|
* Code Use Procedure: |
May be coded separately from other per diem "S" codes. |
S5035* |
Infusion device routine service |
Home infusion therapy, routine service of infusion device (e.g. pump maintenance) |
|
* Code Use Procedure: |
May be coded separately from other per diem "S" codes. |
S5036* |
Infusion device repair |
Home infusion therapy, repair of infusion device (e.g. pump repair) |
|
* Code Use Procedure: |
May be coded separately from other per diem "S" codes. |
|
Not Otherwise Specified |
|
S9379* |
Miscellaneous Infusion Therapy Per Diems |
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. A descriptor should be included in when used. |
|
* Code Use Limited: |
Used only for miscellaneous infusion therapies not otherwise described by more specific per diem "S" codes. |
Codes |
Summary Description |
Code Description |
|
Not Otherwise Specified |
(Continued) |
S9542* |
Miscellaneous Non-Infusion Therapy Per Diems |
Home injectable therapy; not otherwise classified, including administrative services, professional pharmacy services, coordination of care, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem. A descriptor should be included in when used. |
|
* Code Use Limited: |
Used only for miscellaneous non-infusion therapies not otherwise described by more specific per diem "S" codes. |
S9810* |
Pharmacy service, not otherwise specified, per hour |
Home therapy; professional pharmacy services for provision of infusion, specialty drug administration, and/or disease state management, not otherwise classified, per hour (do not use this code with any per diem code) |
|
* Code Use Procedure: |
Do not use if a diem "S" code is also used that includes professional pharmacy services. |
-TU* |
Overtime |
Special payment rate, overtime |
-TV* |
Holidays/Weekends |
Special payment rate, holidays/weekends |
|
* Code Use Procedure: |
Used with S9810 only if distinction of after hours service is needed per provider-payer agreement or to distinguish provider's usual and customary fees. No more than one of these modifiers shall be used to qualify the code. |
Codes |
Summary Description |
Code Description |
|
Modifiers |
|
-SD* |
"Specialized" high-tech nursing |
Services provided by registered nurse with specialized, highly technical home infusion training |
-TU* |
Overtime |
Special payment rate, overtime |
-TV* |
Holidays/Weekends |
Special payment rate, holidays/weekends |
-SH* |
2nd Therapy |
Second concurrently administered infusion therapy |
-SJ* |
3rd Therapy |
Third or more concurrently administered infusion therapy |
|
* Code Use Limited: |
Used only if distinction is needed per provider-payer agreement or to distinguish provider's usual and customary fees. Modifiers –TU and –TV may not be used together to qualify a code. |
[1] "This list in part was obtained from the NHIA National Home Infusion Association, COPYRIGHT 2003 NHIA - ALL RIGHTS RESERVED and included with permission from the National Home Infusion Association"
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