Home Health Standard v3

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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:

  1. 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

  1. 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]

  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]. 

  1. 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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