Home infusion therapy services includes the intravenous or subcutaneous organization of drugs or biologicals to a person at home. The components needed to perform home infusion incorporates the drug (for instance, antivirals, Immune globulin), equipment (for instance, a pump), and supplies (for instance, tubing and catheters). In like manner, nursing services are important to prepare and instruct the patient and caregivers on the safe administration of infusion drugs in the home. The Home Infusion Therapy (HIT) Benefit execute January 1, 2021. HIT administrations are eliminated from inclusion under the Medicare Home Health Benefit. If an agency has a home infusion pharmacy that is an accredited home infusion therapy supplier as well, they can now bill this service portion through the Part B benefit. The home health agency and the HIT supplier can be the same organization. Agencies that do not get accredited as a Part B HIT supplier may lose referrals, as they could not serve those Medicare IV patients under the home health benefit. Agencies that meet the qualifications, including accreditation and an accepted 855 application with Part B, can offer these services and market them as a specialty. There is the potential for those agencies to offer a new service line to patients who are not homebound and do not have another skilled need as these criteria are not required under the HIT benefit.
Coverage Under HIT Benefit
This separate Medicare Part B benefit category covers the service component of safe and effective administration of certain drugs and biologicals. The drugs must be either IV or subcutaneous and have an administration period of 15 minutes or more and less than five hours. The patient must be receiving these drugs at home and through an external infusion pump. The infusion pump and supplies are covered under the Part B DME benefit, and the DME supplier is responsible for the delivery and setup of the equipment and training and education on the operation of the infusion pump. The DME benefit also covers pharmacy services (i.e., drug preparation and dispensing). The DME MAC local coverage determination (LCD) self-administered drug exclusion list includes the drugs that are excluded. For the services to be covered, the patient should be under the care of an applicable provider including a physician, physician’s assistant, or nurse practitioner, and receiving the IV therapy in the patient’s home. The patient must be under a physician-established plan of care that prescribes the type, amount, and duration of infusion therapy services that are to be furnished and must be periodically reviewed by a physician. The skilled services provided must be so complex that they can only be safely and effectively performed by, or under the supervision of, professional or technical personnel. Services include patient evaluation and assessment, training and education of patients and their caretakers, assessment of vascular access sites and obtaining any necessary bloodwork, and evaluation of medication administration.
The HIT benefit has a single bundled payment made to a qualified HIT supplier for professional services. This is drafted in Change Request 11880. Qualified HIT suppliers can only bill and are paid for the HIT services furnished on the day of professional actual presence in the patient’s home and an infusion drug is administered on that calendar day. Hence, any care coordination or calls made for venipuncture, provided by the qualified home infusion therapy supplier that occurs outside of an infusion drug administration calendar day, would not be included in the payment for the visit. In the event that multiple drugs, which are not all assigned to the same payment category, are administered on the same infusion drug administration calendar day, a single payment would be made that is equal to the highest payment category. The G-codes that are billable under this benefit are:
|Table 2: Payment Categories for Home Infusion Therapy Professional Services (G-Codes)
|Intravenous anti-infective, pain management, chelation, pulmonary hypertension, inotropic, and other certain intravenous infusion drugs
|Subcutaneous immunotherapy and other certain Subcutaneous infusion drugs
|Chemotherapy and other certain highly complex intravenous drugs
How to become a qualified supplier?
Qualified suppliers must be certified, and CMS has designated approved HIT accreditation programs to have regulatory authority for oversight for the HIT suppliers. Qualified HIT suppliers may include
- A pharmacy
- Physician or other providers of services
- Supplier licensed by the state in which the pharmacy, physician, provider of services or supplier furnishes items or services.
- The supplier may subcontract with a pharmacy, physician, other qualified supplier or provider of medical services to meet these requirements.
Key Take-Away for Home Health
The home health agency, that is certified as an HIT supplier, may admit these patients when needing this service alone or may admit patients under the Medicare home health benefit that have additional skilled service needs covered under the home health benefit. Agencies need to ensure that visit note documentation for HIT services is separate from services billed under the home health benefit and that the only visit time that is reported on the home health claim is specific to that benefit while billing the HIT benefit covered visit time to Part B. If the home health agency is NOT accredited as a HIT supplier, the agency would NOT be able to admit patients requiring the HIT services unless there is an accredited supplier willing to provide the service or the home health agency is subcontracted to provide the service. ZEE Medical Billing is committed to providing Home Health and Hospice industries with the education and resources required to keep you performing at the highest level of success. Become a member of the HPS Alliance to get continuous access to exclusive industry resources, ongoing education, and consulting support from our team of seasoned industry professionals. For more assistance in any way, please don’t hesitate to contact us.