Summary & Overview
HCPCS S9338: Home Immunotherapy Infusion Pharmacy and Administrative Services
HCPCS Level II code S9338 represents per diem administrative and professional pharmacy services for home-based immunotherapy infusion, including care coordination and necessary supplies and equipment (with drugs and nursing visits billed separately). Nationally, this code matters as home infusion grows as an alternative to facility-based infusion, affecting payer coverage policies, care coordination practices, and pharmacy service models. Payers commonly involved in coverage and payment decisions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
This publication provides a concise national overview of code definition and clinical context, payer presence, and the operational elements tied to home immunotherapy infusion. Readers will find benchmarks and coverage considerations, typical sites of service and service types, and practical details on billing scope and separable charges for drugs and nursing. The content also highlights areas where policy updates and payer guidance commonly affect claims processing and reimbursement pathways. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code S9338 describes home infusion therapy administrative and professional pharmacy services for immunotherapy, billed on a per diem basis. The code covers professional pharmacy services, care coordination, and all necessary supplies and equipment associated with immunotherapy infusion provided in the home setting; drugs and nursing visits are coded separately.
Service Type: Home infusion therapy — immunotherapy administrative and professional pharmacy services
Typical Site of Service: Patient home (home health/home infusion setting)
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult receiving home-based immunotherapy infusion for an autoimmune disorder (for example, immune-mediated inflammatory conditions) or subcutaneous/intravenous biologic therapy requiring professional pharmacy oversight and care coordination. The patient has had a physician order for home infusion, prior authorization completed by the home infusion provider, and an initial nursing assessment in the clinic or via a home visit. The home infusion therapy day includes pharmacy administrative services (drug compounding and dispensing managed by the specialty pharmacist), care coordination with the prescribing clinician and insurer, supply delivery, and oversight of infusion scheduling. Drugs (biologics or immunomodulators) and nursing visits are billed separately; S9338 is billed as a per diem for the administrative and coordination services supporting the home immunotherapy regimen. Typical workflow: physician prescribes the biologic and orders home infusion; pharmacy performs benefit investigation and prepares medication; nursing executes infusion or trains patient/caregiver on administration; pharmacist and care coordinator manage adverse event reporting, infusion supplies, documentation, and communication with payors such as Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |