Miscellaneous Home Intravenous Administration

Miscellaneous home intravenous administration includes all other intravenously administered, FDA-approved prescription drugs that are not covered by an HMSA policy.

Drug Selection

The drug(s) selected for home infusion must meet the following criteria:

• The drug must be FDA-approved for indication dosage, frequency and duration.
• For off-label use, the indication must be listed in one of the following references:
  • USP DI – United States Pharmacopeial Drug Information.
  • AHFS – American Hospital Formulary Service Drug Information.

If the off-label use is not listed in one of the references above, consult HMSA’s policy on Off-Label Drug Use for criteria and other requirements.

Standard Duration of Treatment

The standard duration of treatment for IV administration of miscellaneous drugs varies, depending on the drug used. Please follow FDA guidelines for duration of treatment. The standard duration for off-label indications should be determined according to the literature supporting the use of the drug. Precertification is not required to begin therapy if the drug is being used for an FDA-approved indication or for an off-label indication listed in the above references and there is no HMSA policy covering the drug or service that requires precertification.

Precertification of Therapy Extension

If treatment exceeds the specified duration of therapy (according to FDA guidelines or off-label references), an extension request must be filed with HMSA at least five working days prior to the standard end date for the therapy. To precertify, please complete HMSA’s Precertification Request [PDF] and mail or fax the form and pertinent documentation as indicated.

Claims Filing Information

Please use the codes listed below when submitting claims. Billing should be done in seven-day intervals.

Miscellaneous Intravenous Administration

Nursing services (CPT codes 99601 and 99602) are covered and do not require precertification. Nursing services may be billed separately and are not included in the per diem for IV therapy.

Billing for Multiple Drugs within a Single Therapy

When a second or subsequent drug is added to the patient’s previously established treatment regimen, these items should be billed accordingly on separate service lines.

For example, if the patient has been taking a drug for 10 days, the administration of a second drug on day 11 would be billed on a separate service line using the appropriate per diem code and HCPCS modifier SH. Bill each drug separately, being sure to note the correct NDC number for each drug.

Example

The patient is experiencing an acute exacerbation of multiple sclerosis. The attending physician has prescribed 500 mg Solu-Medrol a day for five days.

Since only five days of therapy is needed to stop the patient’s current exacerbation, the provider bills the per diem charge for miscellaneous therapy on the first service line.

S9379 x 5 units

The drug is billed on the second service line using HCPCS code and the NDC number for the drug. This type of drug is packaged (vial for reconstitution) to be billed as a single unit, so it is not necessary to calculate units.

J3490 NDC: 00009-0758-01 x 5 units

Documentation

The following documentation should appear in the patient’s case file. In addition, this information should be included with precertification requests:

• Physician’s orders/prescriptions, including drug regimen, name of drug, dosage, frequency, route of administration and duration (include start and end dates)
• ICD-9-CM/ICD-10-CM diagnosis code(s)
• Clinical information regarding the patient’s diagnosis
• Clinical information regarding the patient’s progress and response to therapy
• Patient or caregiver’s informed consent for home IV therapy

Revision History