CMS Pub. 100-02, ch. 15, § 320.8.2

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.