Page 305 - Medicare Benefit Policy Manual

320.8.3 - Initial Visits and Subsequent Visits for Home Infusion Therapy
Services
(Rev. 10547, Issued: 12-31-20, Effective: 01-01-21, Implementation: 01-04-21)

The first visit furnished by a qualified home infusion therapy supplier to furnish services
in the patient’s home may be longer or more resource intensive than subsequent visits.
For each of the three payment categories listed in 320.8.1 of this chapter, the payment
amounts are set higher for the first visit by the qualified home infusion therapy supplier
to initiate the furnishing of home infusion therapy services in the patient's home and
lower for subsequent visits in the patient's home.

If a patient receiving home infusion therapy services is discharged from such services, in
order to bill a first visit again, the patient’s history must show a gap of more than 60 days
between home infusion therapy service visits. This means that upon re-admission, there
cannot be a G-code billed for this patient within the past 60 days, and the last G-code
billed for this patient must show that the patient had been discharged. A qualified home
infusion therapy supplier could bill the first visit payment amount on day 61 for a patient
who had previously been discharged from service.

The G-codes for the initial and subsequent home infusion therapy service visits, and
instructions for billing for home infusion therapy services payments are found in the
Medicare Claims Processing Manual Chapter 32 Section 411.

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

All payments under this benefit may be subject to a medical review adjustment reflecting
the following:
1. Beneficiary eligibility.
2. Plan of care requirements.
3. Medical necessity determinations.