Home Infusion Therapy (HIT)

Overview

  • Effective January 2021, Social Security Act (SSA) (1861)(s) amended to establish new benefit by qualified specially enrolled HIT supplier who meets medical necessity conditions
    • Under plan of care (POC) established and care coordination under physician (MD/DO)
      1. Other providers may support POC
      2. Provides professional and visiting nursing services with plan of care (periodic review)
    • Coordinates among multiple entities; patients, physicians, hospital discharge planners, health plans, home infusion pharmacies, etc.
    • Monitoring and remote monitoring (bundled weekly into above)
    • Patient training and education not covered under Durable Medical Equipment (DME) benefit
    • Infusion pump systems and supplies continue coverage under DME benefit
    • Infusion drugs assigned to three payment categories (billed DME), by certain HCPCS J-codes
      1. Includes certain intravenous antifungals and antivirals, uninterrupted long-term infusions, pain management, inotropic, chelation drugs (J0133-J3285)
      2. Subcutaneous immunotherapy (J1551, J1555, J1558, J1559, J1561, J1562, J1569, J1575, with JB modifier)
      3. Certain chemotherapy drugs (J9000, J9039, J9040, J9065, J9100, J9190, J9360, J9370)
  • Eligible beneficiaries through Part B in their homes
    • With acute or chronic conditions
    • Administration of home infusion parenteral drug or biological administered IV or SubQ; 15 mins. or more, through home DME pump
  • Safe and effective provision and administration of home infusion therapy
    • Seven-day-a-week, 24-hours-a-day basis; complex, skilled services provided
    • Safely performed by, or under supervision of, professional or technical personnel (usually nurse)
    • Skilled services provided must be so complex; only performed by, or under supervision of professional or technical personnel

Enrollment

  • HIT must be accredited by CMS-approved organization prior to enrolling
  • CMS Accreditation accreditation@cms.hhs.gov
  • After accredited, enroll with Noridian Part B through PECOS (specialty D6)
    • Page 10, Section 2B, type of supplier, Other - “Home Infusion Therapy”
  • May subcontract with pharmacy, physician, or other qualified supplier (provider) of services
    • Home health agency may become accredited and enrolled as HIT supplier
  • May use same NPI number, with new Part B Medicare supplier number
  • CMS Home Infusion Therapy Provider List

Billing and Coding

  • Report highest visit Part B infusion G codes from DME applicable drugs
    • Initial home visit G0088 - G0090
    • Subsequent G0068 - G0070
  • For example:
    • G0090 (initial visit; administration of intravenous chemotherapy or other highly complex infusion drug(s), per calendar day, in beneficiary’s home; each 15 mins.) 104 minutes = seven units of service
  • Multiple visits same date = only one visit billed
  • Continue billing DME contractor for drugs, external pump, and supplies

Documentation

  • Medical review looks at beneficiary eligibility, plan of care requirements and medical necessity determinations

Payment

  • Special Medicare HIT fees under Fee Schedules (left side) - NOT under Medicare Physician Fee-for-Service (MPFS)
  • Payment for “infusion drug administration calendar day” only made when beneficiary furnished certain covered HCPCS J code (drug and biological) administered through covered DME pump
  • Payable only to HIT-enrolled supplier
  • Single payment when nurse in patient’s home while drug infused (equal five hours of infusion therapy)
  • Questions about HIT payment policy, email HomeInfusionPolicy@cms.hhs.gov

Resources

 

Last Updated Nov 02 , 2022