Outpatient and Home Infusion Therapy: List of Codes
[Pages:1]Outpatient and Home Infusion Therapy: List of Codes
Outpatient Infusions
Description
Code
Medicare Will not pay
Antibiotics
Office Visit -25
E/M
Infusion Supplies
A4222
X
1st hr inf
90765
Addl hr(s) inf
90766
Infusion Sequential
90767
Infusion, Concurrent Drug(s) list separately
90768 HCPCS Code(s)
Chemo Drugs
Office Visit -25
E/M
Monoclonal antibody agents Infusion supplies
A4222
X
This includes:
Hydration Inf
90760
Remicade
Addl hr(s) hydration
90761
Tysabri
Infusion, sequential
90767
Infusion, concurrent
90768
1st hr chemo inf
96413
Addl hrs(s) chemo inf
96415
1st IV push
90774
Addl IV push(s) Drug(s) list separately
90775 HCPCS Code(s)
IVIG
Office Visit -25
E/M
Infusion Supplies
A4222
X
Add on code 1st hour inf
G0332 90765
Addl hr(s) inf
90766
IV Push (usually not done) Drug(s) list separately
90775 HCPCS Code(s)
MISC
Prolonged services-up to 1hr
99358
With some insurance carriers, you will need to add modifier -59 to the pushes and/or infusion supplies code.
Home Infusions
*
IV Antiobiotic IV Antiobiotic IV Antiobiotic IV Antiobiotic IV Antiobiotic IV Antiobiotic
Description
Every 3 hours Every 24 hours Every 12 hours Every 8 hours Every 6 hours Every 4 hours
HCPCS Code Medicare Will not pay
S9497
X
S9500
X
S9501
X
S9502
X
S9503
X
S9504
X
**
Modifers to be added for 2nd SH
& 3rd drug
SJ
2nd antibiotic
X
3rd antibiotic
X
* 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.
** Modifiers added to indicate the second and third drugs, if indicated. Typically the second drug is billed out at half the standard per diem charge and the third is billed out at one-fourth of the standard per diem charge. The drug/nurse visit charges/reimbursement is not affected by the per diems. Always bill the more frequent per diem first as the reimbursement will be higher for this code. For example: Merrem 1gm every 8 hours & Vancomycin 1gm every 12 hours would be billed like this for one day: S9502 X 1 (day) J2185 X 30 (units) = 3 doses S9501-SH X 1 (day) {half per diem} J3370 X 4 (units) = 2 doses
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