Outpatient and Home Infusion Therapy: List of Codes - IDSA

Outpatient and Home Infusion Therapy: List of Codes

Outpatient Infusions

Antibiotics

Chemo Drugs

Monoclonal antibody agents

This includes:

Remicade

Tysabri

IVIG

MISC

Description

Code

Office Visit -25

E/M

Infusion Supplies

A4222

1st hr inf

90765

Addl hr(s) inf

90766

Infusion Sequential

90767

Infusion, Concurrent

90768

Drug(s) list separately

HCPCS Code(s)

Office Visit -25

E/M

Infusion supplies

A4222

Hydration Inf

90760

Addl hr(s) hydration

90761

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)

90775

Drug(s) list separately

HCPCS Code(s)

Office Visit -25

E/M

Infusion Supplies

A4222

Add on code

G0332

1st hour inf

90765

Addl hr(s) inf

90766

IV Push (usually not done)

90775

Drug(s) list separately

HCPCS Code(s)

Prolonged services-up to 1hr

99358

Medicare Will not pay

X

X

X

With some insurance carriers, you will need to add modifier -59 to the pushes and/or infusion supplies code.

Home Infusions

Description

HCPCS Code

Medicare Will not pay

*

IV Antiobiotic

IV Antiobiotic

IV Antiobiotic

IV Antiobiotic

IV Antiobiotic

IV Antiobiotic

Every 3 hours

Every 24 hours

Every 12 hours

Every 8 hours

Every 6 hours

Every 4 hours

S9497

S9500

S9501

S9502

S9503

S9504

X

X

X

X

X

2nd antibiotic

3rd antibiotic

X

X

X

**

Modifers to be added for 2nd SH

& 3rd drug

SJ

* 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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