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Intravenous Therapy - General and Billing Information

 

The information contained herein pertains to intravenous therapy services (except chemotherapy, which has separate instructions) performed at a hospital or other healthcare facility on an outpatient basis. This information does not apply to intravenous therapies administered in the emergency room.

 

Using the correct combination of codes is the key to minimizing delays in claims processing. Please ensure that revenue codes and procedure codes reflect the diagnoses and services rendered. Third-digit subcategories for the revenue code are included in the Official UB-04 Data Specifications Manual.

 

Commonly billed services

The matrix below depicts commonly billed services and acceptable code ranges that correspond to HMSA's claims processing requirements for intravenous therapy other than chemotherapy. The matrix represents a range of possible combinations and should not be viewed as comprehensive.

 

Administration

Revenue Code Description Level of Code Code Description
260 Intravenous therapy: general classification HCPCS Q0081-22 Infusion therapy using other than chemotherapeutic drugs, per visit
76x Treatment/observation room     Although recommended by Medicare's ambulatory payment classification (APC), these codes are part of HMSA's all-inclusive rate and are not paid separately.

 

Notes: HMSA payments for IV therapy vary, depending upon the type of therapy provided. To ensure that claims are processed without delay and that payment is correct, please include a narrative description in the remarks section (Form Locator 80) that describes the therapy being provided.

 

IV therapy should be billed using revenue code 260 and HCPCS code Q0081 with modifier code 22. Therapies may include, but are not limited to, the following:

More than one therapy may be given to a patient on a specific date of service. In such a case, each therapy should be billed on a separate line. To indicate a second or subsequent therapy, use modifier SH or SJ as appropriate.

 

For example, when more than two therapies are rendered on a single day, the codes used would be as follows:

Incidental drugs and supplies

Incidental drugs and supplies are used to deliver the service. These items are included in the administration fee and are not paid separately.

 

Revenue Code Description Level of Code Code Description
25x Pharmacy HCPCS   Use HCPCS codes that describe the services rendered.
27x Medical/surgical supplies and devices HCPCS   Use HCPCS codes that describe the services rendered.
290, 291 Durable medical equipment (other than renal) HCPCS   Use of durable medical equipment while in the facility is part of the administration fee.

 

Drugs requiring specific identification

Drugs requiring specific identification must be billed separately.

 

Revenue Code Description Level of Code Code Description
636 Drugs requiring detailed coding HCPCS J1626 Injection, granisetron hydrochloride, 100 mcg
      J2430 Injection, pamidronate disodium, per 30 mg
      J3490 Unclassified drugs. When unlisted/NOC (not otherwise classified) J codes are used, enter the corresponding National Drug Code (NDC) information in form locator 43 of the UB-04

 

Refer to Intravenous Therapy UB-04 Highlights for more information.

 

First Published:08/22/2007
Latest Revision:04/16/2008
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