Wednesday, August 3, 2016

- CPT CODE 99601, 99602 -What is Ambulatory Infusion


Ambulatory infusion services include the administration of drug therapy by infusion or inhalation and related services, under the supervision of a licensed health care professional to ambulatory patients in the a room or office at an organization’s site, which has been designated as an ambulatory infusion suite. All ambulatory infusion service providers submit claims utilizing a CMS-1500 form.
Specific billing requirements by place service are:

Ambulatory Infusion Suite

o Place of service 11 for services rendered in an Ambulatory Infusion Suite AIS

o SS modifier to be billed with nursing service (99601 and/or 99602)

o Appropriate home infusion per diem HCPCS

o Appropriate HCPCS for medication administered/infused

Note: Self-administered medication; medications covered by a member’s pharmacy benefit; durable medical equipment, medical supplies and/or disposable supplies are not separately reimbursable.

INTRAVENOUS INFUSIONS

If the beneficiary is in need of intravenous infusion and an Infusion Clinic or ancillary Medicaid provider (who has no nurse) does not cover the service, or a family member/caregiver will not accept this task, the HHA may perform this service and bill accordingly.Other nontreatment-related interruptions would follow the same principle. If the beneficiary is late
returning home from a doctor’s appointment, the waiting time of the home health agency personnel cannot be counted as treatment time.

However, if the professional spends time with family or other caretakers in the home teaching them to care for the beneficiary, this activity is counted as treatment time. Calls to the physician by the nurse while in the beneficiary’s home to report on the beneficiary’s condition can also be counted as treatment time.


If the beneficiary is in need of intravenous infusion and an Infusion Clinic or ancillary Medicaid provider (who has no nurse) does not cover the service, or a family member/caregiver will not accept this task, the HHA may perform this service and bill accordingly.


These services must be billed as an Infusion Nurse Visit:

* Use Revenue Codes 0550, 0551, or 0552

* Use Procedure Codes:


* 99601 (per visit - up to two hours). Must be billed on the first claim line.

* 99602 (each additional hour). Must be billed on each additional claim line for each additional hour.

9.5 HOME HEALTH PROCEDURE CODES

When billing on the NUBC claim form, home health agencies must use the HCPCS codes located in the Healthcare Common Procedure Coding System manual and the revenue codes in the UB-04 Manual.

Refer to the Additional Code/Coverage Resource Materials subsection of the General Information for Providers Chapter for additional information regarding coverage parameters.


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