CMS Pub. 100-04, ch. 32, § 411.3

Codes

(Rev. 11430; Issued: 05-24-22; Effective: 07-01-22; Implementation: 07-05-22)

The home infusion therapy services payment is intended to cover the professional services needed for

the administration of certain home infusion drugs covered as supplies necessary for the effective use

of external infusion pumps. This payment separately and explicitly pays for the services related to the

administration of the drugs identified on the DME LCD for External Infusion Pumps, when such

services are furnished in the individual’s home. Section 1861(iii)(3)(C) of the Act defines “home

infusion drug” as a parenteral drug or biological administered intravenously, or subcutaneously for an

administration period of 15 minutes or more, in the home of an individual through a pump that is an

item of durable medical equipment (as defined in section 1861(n) of the Act). Such term does not

include insulin pump systems or self-administered drugs or biologicals on a self-administered drug

exclusion list.

Home infusion drugs are assigned to three payment categories, as determined by the HCPCS J-code.

Payment category 1 includes certain intravenous antifungals and antivirals, uninterrupted long-term

infusions, pain management, inotropic, chelation drugs. Payment category 2 includes subcutaneous

immunotherapy and other certain subcutaneous infusion drugs. Payment category 3 includes certain

chemotherapy drugs. CMS will continue to use the G-codes, established for the temporary

transitional payments in CYs 2019 and 2020, for the professional services furnished on an infusion

drug administration calendar day for each payment category. CMS has established a single payment

amount for each of the three categories for professional services furnished for each infusion drug

administration calendar day. Each payment category will be paid at amounts in accordance with

infusion codes and units for such codes under the physician fee schedule for each infusion drug

administration calendar day in the individual’s home for drugs assigned to such category. The

payment amounts are equal to 5 hours of infusion therapy in a physician’s office. Further policy

information can be found in Publication 100-02, Chapter 15, Section 320.

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

J3010 Injection, fentanyl citrate, 0.1 mg

J3285 Injection, treprostinil, 1 mg

Category 2

J-Code Description

J1551 JB Injection, immune globulin (cutaquig), 100mg

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

J1558 JB Injection, immune globulin (xembify), 100mg

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

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

J7799 JB This NOC code may be used to identify the subcutaneous immune globulin (cutaquig)

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

J9360 Injection, vinblastine sulfate, 1 mg

J9370 Injection, vincristine sulfate, 1 mg

It is important to note that this list is not static. The payment category may be determined by the

contractor for any new home infusion drug additions to the Local Coverage Determination (LCD) for

External Infusion Pumps as identified by the following not-otherwise-classified (NOC) codes:

- J7799 - Not otherwise classified drugs, other than inhalation drugs, administered through

DME

- J7999 - Compounded drug, not otherwise classified.

Attachment A: Billing for Home Infusion Therapy Services on or After January 1, 2021

Table 1 shows the time increments providers should report visit length in 15-minute increments (15 minutes

= 1 unit). See the table below for the rounding of units:

Table 1: Time Increments

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

Table 2 shows the use of the three G-codes established for the home infusion therapy benefit, and

reflects the therapy type and complexity of the drug administration.

Table 2: Payment Categories for Home Infusion Therapy Professional Services (G-Codes)

Category 1 Category 2 Category 3

Description

G-Code

Intravenous anti-infective,

pain management, chelation,

pulmonary hypertension,

inotropic, and other certain

intravenous infusion drugs

Subcutaneous

immunotherapy and

other certain

Subcutaneous infusion

drugs

Chemotherapy

and other certain

highly complex

intravenous drugs

Initial Visit G0088 G0089 G0090

Subsequent Visit G0068 G0069 G0070

Table 3 provides a list of J-codes associated with the home infusion drugs that fall within each category.

Table 3: Payment Categories for Home Infusion Drugs (J-Codes)

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

J3010 Injection, fentanyl citrate, 0.1 mg

J3285 Injection, treprostinil, 1 mg

Category 2

J-Code Description

J1551 JB Injection, immune globulin (cutaquig), 100mg

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

J1558 JB Injection, immune globulin (xembify), 100mg

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

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

J7799 JB This NOC code may be used to identify the subcutaneous immune globulin (cutaquig)

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

J9360 Injection, vinblastine sulfate, 1 mg

J9370 Injection, vincristine sulfate, 1 mg

The payment category may be determined by the contractor for any new home infusion

drug additions to the Local Coverage Determination (LCD) for External Infusion Pumps

as identified by the following not- otherwise-classified (NOC) codes:

- J7799 - Not otherwise classified drugs, other than inhalation drugs, administered through DME

- J7999 - Compounded drug, not otherwise classified