Page 295 - Medicare Benefit Policy Manual

To be eligible to receive home infusion therapy services under the home infusion therapy
benefit, a beneficiary must have Medicare Part B and meet each of the following
requirements:
A. The beneficiary must be under the care of an applicable provider, as defined in
section 1861(iii)(3)(A) of the Act as a physician, nurse practitioner, or physician
assistant.

B. The beneficiary must be under a physician-established plan of care that meets the
requirements specified in 42 CFR 414.1515 and 42 CFR 486.520, as described in
section 320.5 of this chapter.

Home infusion services must be furnished in the patient’s home, which means the place
of residence as defined for purposes of section 1861(n) of the Act used as the home of an
individual, including an institution that is used as a home (excluding hospitals, critical
access hospitals, and skilled nursing facilities as defined in section 1819(a)(1) of the Act).

320.4.1 - Home Infusion Therapy Services for Homebound Patients
(Rev. 10547, Issued: 12-31-20, Effective: 01-01-21, Implementation: 01-04-21)

A beneficiary is not required to be homebound in order to receive home infusion therapy
services. However, there may be instances where a beneficiary under a home health plan
of care also requires home infusion therapy services.

If a patient receiving home infusion therapy is also under a home health plan of care, and
receives a visit that is unrelated to home infusion therapy, then payment for the home
health visit would be covered under the Home Health Prospective Payment System (HH
PPS) and billed on the home health claim.

When the home health agency furnishing home health services is also enrolled as the
qualified home infusion therapy supplier furnishing home infusion therapy services, and a
home visit is exclusively for the purpose of furnishing items and services related to the
administration of the home infusion drug, the home health agency would submit a home
infusion therapy services claim under the home infusion therapy services benefit.

If the home visit includes the provision of other home health services in addition to, and
separate from, home infusion therapy services, the home health agency would submit
both a home health claim under the HH PPS and a home infusion therapy services claim
under the home infusion therapy services benefit. However, the agency must separate the
time spent furnishing services covered under the HH PPS from the time spent furnishing
services covered under the home infusion therapy services benefit.

If the qualified home infusion therapy supplier is not the same entity as the home health
agency furnishing the home health services, the home health agency would continue to
bill under the HH PPS on the home health claim, and the qualified home infusion therapy
supplier would bill for the services related to the administration of the home infusion
drugs on the home infusion therapy services claim.