Home Health Standard v3

Sara Vandermolen

February 05, 2020 21:55

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 (list drug separately)
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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Table I

Table II

Table III

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