Home Infusion Therapy Billing Services
Home infusion billing pulls several services into one patient episode. A single course of therapy may include the drug, a compounding pharmacy, nursing visits, a pump, and daily supplies. Different payers pay for each piece in different ways, and the pieces do not always travel on the same claim.
Medicare pays for the drug, the equipment, and in-home professional services under separate rules. Many commercial payers use per diem rates instead. A home infusion billing process has to keep these pathways straight, track referrals and authorizations, and tie each billed day to documented care. Westmont connects providers with vetted billing experts who work in this space.
Who this is for
- Home infusion pharmacies
- Infusion nursing agencies and visiting nurse programs
- Specialty pharmacies with a home infusion line
- Health-system and hospital-owned home infusion programs
- Providers of IV antibiotics, hydration, nutrition, pain, and immune therapy at home
- Suppliers that bill pumps and infusion supplies
What gets billed
- Home IV antibiotic, antiviral, and antifungal therapy
- Subcutaneous immune globulin and other subcutaneous infusions
- Pain management infusions
- Hydration therapy
- Parenteral nutrition
- Chemotherapy and other complex infusions in the home
- Inotropic and pulmonary hypertension therapies
- Infusion pumps and related equipment
- Cassettes, tubing, and other infusion supplies
- Nursing visits for initial teaching and ongoing therapy
- Drug and compounding charges, where billed separately
Commonly billed codes
| Code | Type | What it covers |
|---|---|---|
| G0068 | HCPCS Level II | Medicare home infusion professional services for IV drugs such as anti-infectives, pain, and inotropes, per 15 minutes |
| G0069 | HCPCS Level II | Medicare home infusion professional services for subcutaneous infusions, per 15 minutes |
| G0070 | HCPCS Level II | Medicare home infusion professional services for IV chemotherapy and other highly complex infusions, per 15 minutes |
| G0088 | HCPCS Level II | Initial-visit version of the IV non-chemotherapy home infusion service |
| S9500 | HCPCS Level II | Per diem for home antibiotic, antiviral, or antifungal infusion given every 24 hours; commercial payers |
| S9501 | HCPCS Level II | Per diem for the same therapy given every 12 hours; commercial payers |
| S9494 | HCPCS Level II | Per diem for antibiotic, antiviral, or antifungal infusion that bundles administrative and pharmacy services; not used with the hourly-dosing S-codes; commercial payers |
| E0781 | HCPCS Level II | External ambulatory infusion pump worn by the patient |
| A4222 | HCPCS Level II | Infusion supplies used with an external pump, per cassette or bag |
| Z45.2 | ICD-10-CM | Encounter for adjustment and management of a vascular access device |
| Z79.2 | ICD-10-CM | Long-term use of antibiotics |
| M86.9 | ICD-10-CM | Osteomyelitis, unspecified |
Note
Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.
Billing challenges in home infusion
Separate payment for drug, equipment, and services. Medicare treats drugs, pumps, and professional services under different rules. Billers know which pieces go to which claim type and keep them linked to the same patient episode.
Per diem versus visit-based billing. Commercial per diem codes and Medicare visit-based codes work differently. Billers confirm the payer's method up front and avoid mixing code types that cannot be billed together.
Eligible drug and pump requirements. Medicare home infusion services depend on the drug and how it is given. Billers check current coverage lists and pump rules before starting therapy.
Prior authorization and referral tracking. Home infusion often starts quickly after a hospital discharge. Billers work with intake staff to secure authorizations and confirm benefits before the first dose.
Documentation of each billed day. Payers want records that connect each billed day or visit to a physician order and care delivered. Billers audit nursing notes and delivery records against what is billed.
Compounding and drug pricing. Drug costs and pricing methods vary by payer and contract. Billers compare payments to expected amounts and challenge underpayments.
Supply and pump rental tracking. Equipment may be rented or capped, and replacement supplies have set limits. Billers monitor rental periods and supply quantities to avoid denials.
Transitions from hospital or infusion center. Patients often move between sites of care. Billers confirm coverage and avoid overlap when a patient receives therapy in more than one setting.
How Westmont can help
- Matches your home infusion business with vetted billing experts experienced in per diem, Medicare, and drug billing
- Connects you with end-to-end revenue cycle support, from referral and benefit checks to payment posting
- Supports denial management and appeals tied to authorization and documentation issues
- Helps you find experts who assist with payer contracting and credentialing
- Gives you a way to compare billing options as your therapy mix grows
Frequently asked questions
What is home infusion billing?
Home infusion billing is the process of getting paid for drugs, nursing, pumps, and supplies used to give infusion therapy at home. It covers authorization, coding, claim submission, and follow-up. Because each payer may pay for these parts differently, careful setup and tracking are central to home infusion billing.
How does Medicare pay for home infusion therapy?
Medicare has a home infusion therapy services benefit for professional services tied to certain drugs given through a pump in the home. The drug and equipment are generally covered under separate rules. Eligibility and payment details change, so check current CMS guidance and your Medicare contractor.
What is a per diem in home infusion?
A per diem is a daily payment that covers a bundle of services or supplies for each day of therapy. Many commercial payers use per diem codes, such as the S-codes, but Medicare does not accept them. Always confirm in your contract what the daily rate includes and excludes.
Why do home infusion claims get denied?
Frequent causes include missing authorization, a drug or diagnosis that does not meet payer criteria, billing code types that cannot be combined, and weak documentation of nursing visits or deliveries. Many denials can be prevented by checking benefits and records before therapy begins.
Can one billing partner handle pharmacy and nursing claims?
Often yes, but it depends on how your business is set up. Pharmacy, nursing, and equipment claims can run through different systems and payer pathways. Ask any potential billing partner how they manage each piece, and look for experience with your payer mix and therapy types.
Related billing services
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