Page 292 - Medicare Benefit Policy Manual

suppliers. These provisions serve as the basis for determining the scope of the home
infusion drugs eligible for coverage of home infusion therapy services; outline
beneficiary qualifications and plan of care requirements; and establish who can bill for
payment under the benefit.

The Medicare home infusion therapy services benefit covers the professional services,
including nursing services, furnished in accordance with the plan of care, patient training
and education (not otherwise covered under the durable medical equipment (DME)
benefit), remote monitoring, and monitoring services for the provision of home infusion
drugs, furnished by a qualified home infusion therapy supplier in the individual’s home.
The home infusion therapy services are covered for the safe and effective administration
of certain drugs and biologicals administered intravenously, or subcutaneously for an
administration period of 15 minutes or more, in the home of an individual, through a
pump that is an item of DME. The infusion pump and supplies (including home infusion
drugs) will continue to be covered under the DME benefit.

320.1 - General Requirements for Payment of Home Infusion Therapy

Services
(Rev. 10547, Issued: 12-31-20, Effective: 01-01-21, Implementation: 01-04-21)

The home infusion therapy services must be furnished to an eligible beneficiary by, or
under arrangement with, a qualified home infusion therapy supplier that meets the health
and safety standards for qualified home infusion therapy suppliers at 42 CFR 486 Subpart
I, and all requirements set forth in 42 CFR 414 Subpart P.

As a condition for payment, qualified home infusion therapy suppliers must ensure that a
beneficiary meets certain eligibility criteria for coverage of services, as well as ensure
that certain plan of care requirements are met.

320.2 - Home Infusion Therapy Services Benefit is Separate from DME
Benefit
(Rev. 10547, Issued: 12-31-20, Effective: 01-01-21, Implementation: 01-04-21)

In order to avoid making duplicative payment, the training and education furnished under
the DME benefit is explicitly excluded from the home infusion therapy services payment.
The home infusion therapy services benefit provides a separate payment in addition to the
existing payment made under the DME benefit, thus explicitly and separately paying for
the home infusion therapy services. Therefore, the professional services covered under
the DME benefit are not covered under the home infusion therapy services benefit. While
the two benefits exist in tandem, the services are unique to each benefit and billed and
paid for under separate payment systems.

For DME infusion pumps, the DME benefit covers the infusion drugs and other supplies
and services necessary for the effective use of the pump, but does not explicitly require or