CMS Pub. 100-04, ch. 32, § 411.4

Contractors shall accept and pay for home infusion therapy services to eligible home infusion therapy suppliers

(new specialty D6) effective for claim lines with dates of service on or after January 1, 2021 using the one of

the following ‘G’ codes and applicable ‘J’ codes listed in section 411.3 of this chapter. Claims for the home

infusion therapy service G-codes are billed to the A/B MACs and are payable to home infusion therapy

suppliers; this service is no longer payable to DME suppliers. The applicable ‘J’ codes are billed to the

DME MACs by the DME supplier.

Contractors shall use Type of Service (TOS) Code 1 for all six G-codes. Contractors shall pay only one of

the G-codes per line item date of service when one of the drugs from the applicable category is billed with

the same line item date of service or a date of service within 30 days prior to the G-code visit.

NOTE:

• The fees associated with the G-codes on the MPFSD fee file will be “a per day rate;” therefore, the

units on the line should not be multiplied by the rate.

The drug remains separately payable from the G-code line item

Home infusion therapy 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.

Because the home infusion therapy services are contingent upon a home infusion drug J-code, home

infusion therapy suppliers must ensure that the appropriate drug associated with the visit is billed no more

than 30 days prior to the visit. In the event that multiple visits occur on the same date of service, or 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.

Suppliers must only bill for one visit and should report the highest paying visit with the applicable drug.

To differentiate the first visit from all subsequent visits, home infusion therapy suppliers may only bill one

of the “initial visit” G-codes to indicate an visit for a new patient who had previously received their last

home infusion therapy service visit more than 60 days prior to the new initial home infusion therapy service

visit.

Home infusion therapy suppliers should report visit length in 15-minute increments (15 minutes=1 unit). See the

Table 1 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 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

• G0068: Professional services for the administration of anti-infective, pain management, chelation,

pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding

chemotherapy or other highly complex drug or biological) for each infusion drug administration

calendar day in the individual’s home, each 15 minutes

Short Descriptor: Adm IV infusion drug in home

• G0069: Professional services for the administration of subcutaneous immunotherapy or other

subcutaneous infusion drug or biological for each infusion drug administration calendar day in the

individual's home, each 15 minutes

Short Descriptor: Adm SQ infusion drug in home

• G0070: Professional services for the administration of intravenous chemotherapy or other

intravenous highly complex drug or biological infusion for each infusion drug administration

calendar day in the individual's home, each 15 minutes.

Short Descriptor: Adm of IV chemo drug in home

• G0088: Professional services, initial visit, for the administration of anti-infective, pain management,

chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological

(excluding chemotherapy or other highly complex drug or biological) for each infusion drug

administration calendar day in the individual’s home, each 15 minutes.

Short Descriptor: Adm IV drug 1st home visit

• G0089: Professional services, initial visit, for the administration of subcutaneous immunotherapy or

other subcutaneous infusion drug or biological for each infusion drug administration calendar day in

the individual's home, each 15 minutes.

Short Descriptor: Adm SubQ drug 1st home visit

• G0090: Professional services, initial visit, for the administration of intravenous chemotherapy or

other highly complex infusion drug or biological for each infusion drug administration calendar day

in the individual's home, each 15 minutes.

Short Descriptor: Adm IV chemo 1st home visit