Healthcare Provider Solutions

This blog was co-authored by: Sharon Litwin, RN, MHA, HCS-D and Stacy Depp, RN, HCS-D, COS-C

 

The Home Infusion Therapy (HIT) benefit went into effect January 1, 2021.  HIT services are excluded from coverage under the Medicare Home Health Benefit.  If an agency has a home infusion pharmacy that is an accredited home infusion therapy supplier as well, they can now bill this service portion through the Part B benefit.  The home health agency and the HIT supplier can be the same organization.  Agencies that do not get accredited as a Part B HIT supplier may lose referrals, as they could not serve those Medicare IV patients under the home health benefit.

 

Agencies that meet the qualifications, including accreditation and an accepted 855 application with Part B, can offer these services and market them as a specialty. There is the potential for those agencies to offer a new service line to patients who are not homebound and do not have another skilled need as these criteria are not required under the HIT benefit.

 

Coverage Under HIT Benefit

 

This separate Medicare Part B benefit category covers the service component of safe and effective administration of certain drugs and biologicals. The drugs must be either IV or subcutaneous and have an administration period of 15 minutes or more and less than five hours. The patient must be receiving these drugs at home and through an external infusion pump.  The infusion pump and supplies are covered under the Part B DME benefit, and the DME supplier is responsible for delivery and setup of the equipment and training and education on operation of the infusion pump.

 

The DME benefit also covers pharmacy services (i.e., drug preparation and dispensing).  The DME MAC local coverage determination (LCD) self-administered drug exclusion list includes the drugs that are excluded.  For the services to be covered, the patient must be under the care of an applicable provider including a physician, nurse practitioner or physician’s assistant and receiving the IV therapy in the patient’s home.

 

The patient must be under a physician-established plan of care that prescribes the type, amount and duration of infusion therapy services that are to be furnished and must be periodically reviewed by a physician.  The skilled services provided must be so complex that they can only be safely and effectively performed by, or under the supervision of, professional or technical personnel.  Services include patient evaluation and assessment, training and education of patients and their caretakers, assessment of vascular access sites and obtaining any necessary bloodwork and evaluation of medication administration.

 

Bundled Payments

 

The HIT benefit has a single bundled payment made to a qualified HIT supplier for professional services.  This is outlined in Change Request 11880. Qualified HIT suppliers can only bill and be paid for the HIT services furnished on the day on which a professional is physically present in the patient’s home and an infusion drug is administered on that calendar day.  Therefore, any care coordination or visits made for venipuncture, provided by the qualified home infusion therapy supplier that occur outside of an infusion drug administration calendar day, would not be included in the payment for the visit.  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.

 

The G-codes that are billable under this benefit are:

 

Table 2: Payment Categories for Home Infusion Therapy Professional Services (G-Codes)
Description Category 1 Category 2 Category 3
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

 

 

How to become a qualified supplier?

 

Qualified suppliers must be accredited, and CMS has designated approved HIT accreditation programs to have regulatory authority for oversight for the HIT suppliers.  Qualified HIT suppliers may include: A pharmacy; physician or other provider of services; or supplier licensed by the state in which the pharmacy, physician, provider of services or supplier furnishes items or services.  The supplier may subcontract with a pharmacy, physician, other qualified supplier or provider of medical services to meet these requirements.

 

Key Take Away for Home Health

 

The home health agency, that is accredited as an HIT supplier, may admit these patients when needing this service alone or may admit patients under the Medicare home health benefit that have additional skilled service needs covered under the home health benefit.  Agencies will need to ensure that visit note documentation for HIT services is separate from services billed under the home health benefit and that the only visit time that is reported on the home health claim is specific to that benefit, while billing the HIT benefit covered visit time to Part B. If the home health agency is NOT accredited as an HIT supplier, the agency would NOT be able to admit patients requiring the HIT services unless there is an accredited supplier willing to provide the service or the home health agency is subcontracted to provide the service.

 

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