CMS Pub. 100-02, ch. 15, § 320.8.1

Payment for home infusion therapy services is contingent upon a corresponding home

infusion drug being covered and paid for under the DME benefit. Therefore, home

infusion therapy suppliers must ensure that the appropriate drug is billed by the DME

supplier no more than 30 days prior to the home infusion therapy service visit.

Home infusion drugs are assigned to three payment categories, as determined by the

HCPCS J-code:

- Payment category 1 includes certain intravenous infusion drugs for therapy,

prophylaxis, or diagnosis, such as antifungals and antivirals, inotropic and

pulmonary hypertension drugs, pain management drugs, chelation drugs; but

excludes chemotherapy and other highly complex drugs or biologicals.

- Payment category 2 includes subcutaneous infusions for therapy or prophylaxis,

such as certain subcutaneous immunotherapy infusions.

- Payment category 3 includes intravenous chemotherapy infusions, including

certain chemotherapy drugs, and other highly complex drugs and biologicals.

Specific billing codes are associated with each of the three payment categories in order

for qualified home infusion therapy suppliers to bill Medicare for home infusion therapy

services on an infusion drug administration calendar day.

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.