Page 304 - Medicare Benefit Policy Manual

A unit of single payment is made for items and services furnished by a qualified home
infusion therapy supplier per payment category for each infusion drug administration
calendar day.

The J-codes for eligible home infusion drugs, the G-codes for the home infusion therapy
services, and billing instructions for home infusion therapy payments are found in the
Medicare Claims Processing Manual Chapter 32, Section 411.

320.8.2 - Infusion Drug Administration Calendar Day and Unit of Single
Payment
(Rev. 10547, Issued: 12-31-20, Effective: 01-01-21, Implementation: 01-04-21)

Section 1834(u)(7)(E)(i) of the Act states that payment to a qualified home infusion
therapy supplier for an “infusion drug administration calendar day” in the individual’s
home refers to payment only for the date on which professional services, as described in
section 1861(iii)(2)(A) of the Act, were furnished to administer such drugs to such
individual. This means the day on which home infusion therapy services are furnished by
a skilled professional in the individual's home on the day of infusion drug administration.
This includes all such drugs administered to such individual on such day.

A “single payment amount” for an infusion drug administration calendar day means that
all home infusion therapy services, which include professional services, including
nursing; training and education; remote monitoring; and monitoring, are built into the day
on which the services are furnished in the home and the drug is being administered. There
may be professional services furnished in the patient’s home that do not occur on a day
the drug is being administered, however, the home infusion therapy services payment is a
unit of single payment. In other words, payment for an infusion drug administration
calendar day is a bundled payment amount per visit in the patient’s home furnishing
services specifically related to the physical process by which the drug enters the patient’s
body. The home infusion therapy payment rates reflect the increased complexity of the
skilled professional services provided per payment category. The skilled services
provided on such day must be so inherently complex that they can only be safely and
effectively performed by, or under the supervision of, professional or technical personnel.
A unit of single payment is made for items and services furnished by a qualified home
infusion therapy supplier per payment category for each infusion drug administration
calendar day. Although the single payment covers both professional services under
section 1861(iii)(2)(A) and training and education, remote monitoring, and other
monitoring services under section 1861(iii)(2)(B), payment is only issued on days on
which professional services are provided in the patient’s home, by the qualified home
infusion therapy supplier.

The qualified home infusion therapy supplier must submit, in line-item detail on the
claim, an appropriate G-code for each infusion drug administration calendar day. The
claim should include the length of time, in 15-minute increments, for which professional
services were furnished. Billing instructions for home infusion therapy services are
found in the Medicare Claims Processing Manual Chapter 32 Section 411.