CMS Pub. 100-04, ch. 20, § 180

Effective January 1, 2019 and until the implementation of the full home infusion therapy

benefit, Medicare makes separate temporary transitional payments for Home Infusion

Therapy (HIT) services to eligible home infusion suppliers (i.e., a licensed pharmacy that

provides external infusion pumps and external infusion pump supplies). This payment

amount covers the cost of professional services, including nursing services, training and

education (not otherwise paid for as durable medical equipment), remote monitoring, and

monitoring services for the provision of home infusion therapy furnished by a qualified

home infusion with administration of certain transitional home infusion drugs

administered through an item of DME.

Temporary transitional payments are made for HIT services based on the home infusion

drug provided. Home infusion drugs are assigned to three payment categories,

determined by the Healthcare Common Procedure Coding System (HCPCS) J-code.

Each DME MAC maintains a list of drugs that are administered through an item of DME

and HIT payment is made for days on which home infusion therapy services are

furnished by skilled professionals in the individual’s home on the day of infusion drug

administration.

Temporary Transitional Payment Categories for Home Infusion Therapy Services,

by Infusion Drug (J-Code)

Category 1

J-Code Description

J0133 Injection, acyclovir, 5 mg

J0285 Injection, amphotericin b, 50 mg

J0287 Injection, amphotericin b lipid complex, 10 mg

J0288 Injection, amphotericin b cholesteryl sulfate complex, 10 mg

J0289 Injection, amphotericin b liposome, 10 mg

J0895 Injection, deferoxamine mesylate, 500 mg

J1170 Injection, hydromorphone, up to 4 mg

J1250 Injection, dobutamine hydrochloride, per 250 mg

J1265 Injection, dopamine hcl, 40 mg

J1325 Injection, epoprostenol, 0.5 mg

J1455 Injection, foscarnet sodium, per 1000 mg

J1457 Injection, gallium nitrate, 1 mg

J1570 Injection, ganciclovir sodium, 500 mg

J2175 Injection, meperidine hydrochloride, per 100 mg

J2260 Injection, milrinone lactate, 5 mg

J2270 Injection, morphine sulfate, up to 10 mg

J2274 Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg

J2278 Injection, ziconotide, 1 microgram

J3010 Injection, fentanyl citrate, 0.1 mg

J3285 Injection, treprostinil, 1 mg

Category 2

J-Code Description

J1555 JB Injection, immune globulin (cuvitru), 100 mg

J1559 JB Injection, immune globulin (hizentra), 100 mg

J1561 JB Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid),

500 mg

J1562 JB Injection, immune globulin (vivaglobin), 100 mg

J1569 JB Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500

mg

J1575 JB Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immune globulin

Category 3

J-Code Description

J9000 Injection, doxorubicin hydrochloride, 10 mg

J9039 Injection, blinatumomab, 1 microgram

J9040 Injection, bleomycin sulfate, 15 units

J9065 Injection, cladribine, per 1 mg

J9100 Injection, cytarabine, 100 mg

J9190 Injection, fluorouracil, 500 mg

J9200 Injection, floxuridine, 500 mg

J9360 Injection, vinblastine sulfate, 1 mg

J9370 Injection, vincristine sulfate, 1 mg

The payment category for subsequent transitional home infusion drug additions to the

Local Coverage Determinations (LCDs) and compounded infusion drugs not otherwise

classified, as identified by HCPCS codes J7799 and J7999, will be determined by the

DME MAC.

A single unit of payment will be made for HIT services provided in the individual’s home

during an infusion drug administration calendar day.

Suppliers will report the following HCPCS G-codes associated with the payment

categories for the professional services furnished in the individual’s home and on an

infusion drug administration calendar day:

1. G0068: Professional services for the administration of anti-infective, pain

management, chelation, pulmonary hypertension, and/or inotropic infusion

drug(s) for each infusion drug administration calendar day in the individual’s

home, each 15 minutes.

Short Descriptor: Adm of infusion drug in home

2. G0069: Professional services for the administration of subcutaneous

immunotherapy for each infusion drug administration calendar day in the

individual's home, each 15 minutes.

Short Descriptor: Adm of immune drug in home

3. G0070: Professional services for the administration of chemotherapy for each

infusion drug administration calendar day in the individual's home, each 15

minutes.

Short Descriptor: Adm of chemo drug in home

In the event that multiple drugs, which are not all assigned to the same payment category,

are administered on the same infusion drug administration calendar day, a single payment

would be made that is equal to the highest payment category.

Providers should report visit length in 15-minute increments (15 minutes=1 unit). See

the table below for the rounding of units.

Rounding of Time Units

Unit Time

1 <23 minutes

2 = 23 minutes to <38 minutes

3 = 38 minutes to <53 minutes

4 = 53 minutes to <68 minutes

5 = 68 minutes to <83 minutes

6 = 83 minutes to <98 minutes

7 = 98 minutes to <113 minutes

8 = 113 minutes to <128 minutes

9 = 128 minutes to <143 minutes

10 = 143 minutes to <158 minutes

Claims that include G-codes for HIT services are not required to, but may also include

the HCPCS J-code for the infusion drug, the E-code for the external infusion pump, and

A-codes for supplies other than the drug.

A submitted claim for HIT services is subject to a Common Working File (CWF) edit in

the event that a transitional drug J-code is not found on the same claim as the billed

professional HIT services, or in claims history in the previous 30 days. If a J-code is not

found on the same claim as the billed professional services, the claims processing system

will recycle the G-code claim for the professional services associated with the

administration of the home infusion drug, until a claim containing the J-code for the

infusion drug is received in the CWF. The professional visit claim will recycle three

times (with a 30-day look back period) for a total of 15 business days. After 15 business

days, if no J-code claim is found in claims history, the G-code claim will be denied.

Suppliers must ensure that the appropriate drug associated with the visit is billed with the

visit or no more than 30 days prior to the visit. Visits are denied if the appropriate drug

for the visit is not billed. In the event that multiple visits occur on the same date of

service, suppliers must only bill for one visit and should report the highest paying visit

with the applicable drug. Claims reporting multiple visits on the same line item date of

service will be returned as unprocessable.