S9098 Home Phototherapy (HCPCS) Reimbursement | OpenPayer

Summary & Overview

HCPCS S9098: Home Visit Phototherapy Services, Per Diem

HCPCS Level II code S9098 denotes per diem home visit phototherapy services, encompassing equipment rental (for example, bili-lite units), nursing care, blood draws, supplies, and other ancillary services required to deliver phototherapy at home. This code supports care for patients who require phototherapy outside traditional outpatient or inpatient settings, reducing the need for clinic visits and enabling treatment in the patient’s residence. Nationally, home-based phototherapy is relevant for neonatal jaundice management and select dermatologic or metabolic conditions where treatment access or mobility is limited.

Key payers included in the coverage landscape are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what S9098 represents, typical sites of service, and the clinical context for use. The publication provides benchmarks on utilization and reimbursement where available, summarizes relevant policy considerations affecting home-based phototherapy billing, and outlines operational components captured by the code (equipment, nursing, supplies, and per diem structure).

Data not provided in the input, such as specific payer reimbursement rates, associated taxonomies, and ICD-10 diagnoses, are identified as unavailable and are not inferred. The material is intended for national audiences seeking authoritative guidance on code definition, service configuration, and payer inclusion for home-based phototherapy.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareS9098HCPCS Level IIhome phototherapyhome health servicesequipment rentalper diem billingnursing servicesphototherapy

Billing Code Overview

HCPCS Level II code S9098 represents home visit, phototherapy services (e.g., bili-lite) billed on a per diem basis. The code includes equipment rental, nursing services, blood draw, supplies, and other services needed to deliver phototherapy in the home setting.

Service Type: Home-based phototherapy services

Typical Site of Service: Patient's residence (home)

Clinical & Coding Specifications

Clinical Context

A term newborn with clinically significant neonatal jaundice is discharged home but requires daily phototherapy in the home environment due to elevated bilirubin levels and risk factors (e.g., prematurity, significant weight loss, ABO incompatibility). A home health nurse delivers and sets up a phototherapy device (e.g., bili-lite), provides routine nursing assessment, draws bilirubin levels by capillary or venous blood draw, supplies necessary consumables, educates caregivers on device safety and feeding, and documents daily bilirubin trends and infant status. Services are billed on a per diem basis under S9098 to cover equipment rental, nursing visit, blood draw, supplies, and associated nursing care.

Typical workflow:

Hospital or pediatric outpatient team orders home phototherapy and arranges home health referral.
Home health schedules daily visits; nurse delivers and configures the phototherapy unit in the infant's home.
Nurse performs baseline assessment, initiates phototherapy, obtains bilirubin level per protocol, and provides caregiver instruction.
Daily nursing visit includes monitoring, device maintenance, feeding support, documentation, and repeat bilirubin testing as indicated until bilirubin thresholds are met for discontinuation.
Home health documents services and submits per diem claim under S9098, attaching any applicable modifier(s) and the relevant ICD-10 diagnosis code(s).

Coding Specifications

HCPCS S0090: Sildenafil Citrate, 25 mg

HCPCS-S9208-HOME-MANAGEMENT-PRETERM-LABOR-PER-DIEM

HCPCS S9208: Home Management of Preterm Labor, Per Diem

HCPCS-S9055-GROWTH-FACTOR-WOUND-HEALING-PREPARATION

HCPCS S9055: Growth Factor Wound Healing Preparation

HCPCS-S5111-HOME-CARE-TRAINING-FAMILY-PER-SESSION

HCPCS S5111: Home Care Training, Family; Per Session

HCPCS-S0518-SUNGLASSES-FRAMES

HCPCS S0518: Sunglasses Frames

HCPCS-S0030-METRONIDAZOLE-INJECTION-500MG

HCPCS Level II S0030: Injection, Metronidazole 500 mg

HCPCS-S0270-PHYSICIAN-HOME-CARE-MONTHLY-MANAGEMENT

HCPCS S0270: Physician Management of Home Care, Monthly Case Rate

HCPCS-S8121-OXYGEN-CONTENTS-LIQUID-1-POUND

HCPCS S8121: Oxygen Contents, Liquid, 1 lb

HCPCS-S9989-SERVICES-OUTSIDE-UNITED-STATES

HCPCS S9989: Services Provided Outside the United States

HCPCS-S9432-MEDICAL-FOODS-NON-INBORN-ERRORS-OF-METABOLISM

HCPCS Level II S9432: Medical Foods for Non-Inborn Errors of Metabolism

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Modifier	Description	When to Use
`22`	Increased procedural services	Use when the home phototherapy visit requires substantially greater physician-ordered services or complexity beyond the typical per diem scope (rare; document rationale).
`23`	Unusual anesthesia	Not typically applicable to phototherapy; include only if unusual anesthesia services are provided during the visit.
`26`	Professional component	Use when billing separates professional interpretation or supervision from the technical component of a service related to the visit.
`51`	Multiple procedures	Use if multiple distinct billable procedures are provided the same day in addition to the phototherapy per diem and payer requires this modifier.
`52`	Reduced services	Use when services provided are partially reduced or discontinued and the per diem should reflect reduced scope.
`53`	Discontinued procedure	Use when phototherapy or a related procedure is started but terminated due to circumstances that prevent completion.
`59`	Distinct procedural service	Use to indicate a separate, distinct service on the same day not usually reported together with `S9098`.
`62`	Two surgeons	Unlikely for home phototherapy; use only if two qualified providers share responsibility as defined by payor policy.
`76`	Repeat procedure by same provider	Use when a repeat of a distinct procedure or service is performed by the same provider within a global period or same day and payer requires reporting.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Not typical; include only if the visit involves assistant-at-procedure billing per payer rules.
`QK`	Medical direction of two, three, or four qualified health care professionals	Use when the physician medical directs multiple allied health professionals delivering home services and payer demands QK reporting.
`QX`	Qualified nonphysician practitioner with modifier `QK`	Use when the nonphysician practitioner performs services under medical direction as specified.
`QY`	Attestation of medical direction of one qualified health care professional	Use when physician medical direction of one allied professional is documented per payer rules.
`SH`	Speech-language pathology services provided in part by assistant	Not typical for phototherapy; use only if speech services are a component of the visit.

Taxonomy Code	Specialty	Notes
`251S00000X`	Neonatal-Perinatal Medicine	Specialists who may order and oversee home phototherapy for neonates.
`251B00000X`	Pediatrics	Pediatricians who commonly authorize and coordinate home phototherapy.
`367A00000X`	Registered Nursing	Home health RNs who deliver phototherapy, perform blood draws, and provide nursing care.
`363L00000X`	Nurse Practitioner	NPs who evaluate, order, and manage home phototherapy services.
`363A00000X`	Physician Assistant	PAs who may participate in assessment, ordering, and oversight of home phototherapy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`P59.9`	Neonatal jaundice, unspecified	Primary indication for phototherapy in newborns when bilirubin levels are elevated.
`P55.0`	Hemolytic disease of fetus and newborn due to ABO isoimmunization	Hemolysis increases bilirubin production and often necessitates phototherapy.
`P57.9`	Neonatal hyperbilirubinemia due to other and unspecified causes	Used when a specific cause is not identified but phototherapy is required.
`P58.9`	Neonatal jaundice associated with preterm infant of unspecified gestational age	Preterm infants frequently require lower treatment thresholds and home phototherapy may be arranged.
`R17`	Unspecified jaundice	Symptom code that may support the clinical reason for phototherapy when neonatal-specific codes are not used.
`E88.2`	Gilbert syndrome	Rare in neonates but included when hyperbilirubinemia has metabolic causes; phototherapy may be considered based on bilirubin levels.
`P59.1`	Newborn jaundice due to prematurity	Explicit code reflecting prematurity-related hyperbilirubinemia often managed with phototherapy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36415`	Collection of venous blood by venipuncture	Commonly performed during home visits to obtain serum bilirubin for monitoring phototherapy effectiveness.
`82950`	Blood bilirubin; total	Laboratory test used to quantify total serum bilirubin levels to guide phototherapy initiation and cessation.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	May be used by clinician for telephonic or face-to-face evaluation related to ongoing management; not usually billed in addition to a per diem home health service unless payer allows.
`99507`	Home visit for the evaluation and management of a patient, typically 15 minutes	Home health E/M codes that may be performed by non-physician clinicians in coordination with per diem services where payer policy requires separate reporting.
`99070`	Supplies and materials (e.g., bandages, supplies), used during the visit, billed additionally	May be reported when specific disposable supplies used during the visit are not included in the per diem and payer permits separate billing.

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