HCPCS S9347: Home Infusion Therapy, Long-Term Controlled-Rate - OpenPayer

Summary & Overview

HCPCS S9347: Home Infusion Therapy, Long-Term Controlled-Rate

HCPCS Level II code S9347 covers per diem administrative and pharmacy professional services, care coordination, and required supplies and equipment for uninterrupted, long-term controlled-rate intravenous or subcutaneous home infusion therapy (for example, epoprostenol), with drugs and nursing visits billed separately. This code matters nationally as home infusion grows for chronic therapies that require continuous delivery and complex coordination; S9347 captures the non-drug, programmatic component of such care.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code represents, payer inclusion, and the clinical and service context for home-based continuous infusion. The publication summarizes typical sites of service and service type, outlines common billing modifiers provided in the input, and identifies gaps where data was not provided (for example, specific payer rates, taxonomies, ICD-10 pairings, and detailed service lines). The content is intended to inform billing administrators, payers, and policy analysts about the scope and administrative purpose of S9347 in national home infusion programs.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareS9347HCPCS Level IIhome infusioninfusion therapyper diem servicescare coordinationpharmacy servicescontinuous infusion

Billing Code Overview

HCPCS Level II code S9347 represents home infusion therapy, uninterrupted, long-term, controlled rate intravenous or subcutaneous infusion therapy (e.g., epoprostenol) provided on a per diem basis. The code covers administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment; the actual drug products and any nursing visits are coded and billed separately.

Service type: Long-term home infusion therapy with continuous controlled-rate IV or subcutaneous infusion.

Typical site of service: Patient's home (home health/home infusion setting).

Data not available in the input for payers-specific reimbursement rates, associated taxonomies, ICD-10 diagnoses, related codes, or service line details.

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient with pulmonary arterial hypertension (PAH) is discharged from the hospital to continue long-term continuous intravenous epoprostenol infusion at home. The patient has a tunneled central venous catheter placed during hospitalization and requires uninterrupted, controlled-rate infusion delivered via a programmable ambulatory infusion pump. A home infusion pharmacy coordinates drug preparation and delivery, provides the infusion pump and supplies, arranges nursing visits for catheter care and pump teaching, and performs ongoing clinical monitoring and care coordination with the prescribing pulmonologist and the patient’s primary care clinician. Documentation includes the medication order, infusion pump settings, catheter assessment, teaching logs, nursing visit notes, and communication notes with the prescriber.

Typical workflow:

Initial home care set-up visit by home infusion nurse to confirm pump programming, line integrity, and patient/caregiver competence.
Daily or per-diem administrative and clinical services provided by the pharmacy and care coordination team (scheduling deliveries, remote monitoring, insurance authorization, troubleshooting pump alarms) billed under S9347 per diem; drug product and nursing visits billed separately using appropriate HCPCS/CPT and supply/drug codes.
Routine periodic nursing visits for site/catheter assessment, dressing changes, and documentation; emergency nursing or clinician contact managed as needed.
Ongoing interdisciplinary communication among pulmonology, pharmacy, home health nursing, and payer case management to maintain uninterrupted infusion and address adverse events or device issues.

Coding Specifications

HCPCS S4022: Assisted Oocyte Fertilization, Case Rate

HCPCS-S3645-HIV1-ANTIBODY-ORAL-MUCOSAL-TRANSUDATE-TESTING

HCPCS S3645: HIV-1 Antibody Testing of Oral Mucosal Transudate

HCPCS-S9335-HOME-HEMODIALYSIS-ADMINISTRATIVE-CARE-COORDINATION

HCPCS S9335: Home Hemodialysis Administrative and Care Coordination

HCPCS-S9442-BIRTHING-CLASSES-NON-PHYSICIAN-PER-SESSION

HCPCS S9442: Birthing Classes, Non-Physician Provider, Per Session

HCPCS-S9497-HOME-INFUSION-ANTIMICROBIAL-THERAPY-PER-DIEM

HCPCS Level II S9497: Home Infusion Antimicrobial Therapy, Per Diem

HCPCS-S9379-HOME-INFUSION-ADMINISTRATIVE-PHARMACY-SERVICES

HCPCS S9379: Home Infusion Administrative and Pharmacy Services

HCPCS-S0109-METHADONE-ORAL-5MG

HCPCS Level II S0109: Methadone, Oral, 5 mg

HCPCS-S9453-SMOKING-CESSATION-CLASSES-NON-PHYSICIAN-SESSION

HCPCS S9453: Smoking Cessation Classes, Non-Physician, Per Session

HCPCS-S3846-GENETIC-TESTING-HEMOGLOBIN-E-BETA-THALASSEMIA

HCPCS S3846: Genetic Testing for Hemoglobin E Beta-Thalassemia

HCPCS-S9152-SPEECH-THERAPY-REEVALUATION

HCPCS S9152: Speech Therapy Re-evaluation

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Modifier	Description	When to Use
`22`	Increased procedural services	When unusual complexity or extra administrative effort for home infusion coordination significantly increases resources beyond typical per diem services.
`26`	Professional component	When reporting only the professional component of a service related to medication management or clinical oversight distinct from supplies/equipment.
`52`	Reduced services	When the full scope of per diem services in `S9347` is partially reduced (for example, interrupted short-term) and payment should reflect reduced service.
`59`	Distinct procedural service	When distinguishing `S9347` from another service on the same day that is not normally reported together (ensure clinical documentation supports distinct service).
`76`	Repeat procedure by same physician	When the same ordering clinician or pharmacy provider bills multiple separate per-diem episodes requiring documentation of repeated setup or re-initiation.
`78`	Return to OR for related procedure	Rarely used; when a related procedure requiring inpatient surgical intervention affects home infusion services and billing needs to reflect the return to OR context.
`KX`	Requirements specified in policy are met	When payer-required clinical criteria, documentation, or prior authorization conditions for long-term home infusion are satisfied.
`QX`	Ordering physician not certified under Medicare ESRD program	Applicable when regulatory ordering/certification limitations affect billing relationships (use per payer rules).
`QY`	Medical direction of two, three, or four concurrent anesthesia procedures	Generally not applicable for infusion per diem but included for cases where anesthesia services intersect with infusion initiation during inpatient-to-home transitions.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services under Medicare Part B	When advanced practice clinicians provide qualifying professional services related to infusion management and billing requires this modifier.
`CO`	Copayment waived by payer	When the payer or employer contract design waives patient cost sharing for this service.
`CQ`	Service furnished under a prospective payment system waiver	When services are billed under special waiver or demonstration programs affecting payment methodology.
`QK`	Patient-mounted external infusion pump supplied by DMEPOS supplier other than the home infusion provider	When the infusion pump or durable medical equipment is billed separately by a different supplier.
`TG`	Service rendered under a primary care exception	When the service is furnished under a payer-specific primary care exception affecting supervision requirements.

Taxonomy Code	Specialty	Notes
363LG0200X	Pulmonology	Pulmonologists commonly prescribe continuous intravenous therapies such as epoprostenol for pulmonary arterial hypertension and provide clinical oversight.
3336P0800X	Cardiology (Pulmonary Hypertension)	Cardiologists with pulmonary hypertension focus manage diagnosis and long-term medication regimens and coordinate with home infusion services.
1835P0800X	Pharmacy	Clinical pharmacists and home infusion pharmacy specialists manage drug preparation, stability, and delivery logistics for continuous IV therapies.
251B00000X	Nursing — Home Health	Home health nurses perform catheter care, pump setup, patient education, and routine monitoring in the home setting.
207RG0300X	Internal Medicine	Primary care physicians provide longitudinal care coordination and comorbidity management for patients receiving long-term home infusion.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I27.0`	Primary pulmonary hypertension	Primary indication for continuous intravenous therapies such as epoprostenol to reduce pulmonary vascular resistance.
`I27.2`	Other secondary pulmonary hypertension	Secondary causes of pulmonary hypertension that may require continuous prostacyclin infusion when severe.
`I27.20`	Pulmonary hypertension, unspecified	Used when specific subtype is not yet fully classified but continuous infusion is clinically indicated.
`I27.21`	Pulmonary hypertension due to left heart disease	Patients with complex cardiopulmonary disease who may require specialized infusion management.
`I50.9`	Heart failure, unspecified	Concomitant heart failure may complicate infusion management and monitoring needs for continuous IV therapies.
`J96.00`	Acute respiratory failure, unspecified whether with hypoxia or hypercapnia	Potential acute complication that could precipitate or interrupt home infusion requiring close coordination.
`B37.89`	Other candidal infections	Catheter-related bloodstream infections including candidemia are relevant risks requiring vigilance during long-term central access.
`Z45.2`	Encounter for adjustment and management of vascular access device	Used for visits focused on catheter management, dressing changes, and access device troubleshooting in the home setting.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	May be used for in-clinic or facility-based bolus or intermittent IV infusions preceding or supplementing ongoing home continuous infusion when billed during transition of care.
`96366`	Intravenous infusion, each additional hour (List separately in addition to code for primary procedure)	Used to report additional hours of monitored infusion in facility settings when documenting transition care prior to home per-diem billing.
`36415`	Collection of venous blood by venipuncture	Performed during baseline or periodic lab monitoring required for medication dosing and safety assessments prior to or during home infusion therapy.
`36561`	Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump, age 5 years or older	Procedure that may have been performed inpatient to provide long-term central venous access for continuous infusion; its presence is necessary for home epoprostenol therapy.
`99406`	Smoking and tobacco-use cessation counseling, intermediate, greater than 3 minutes up to 10 minutes	Example of typical E/M–adjunct counseling services that may occur in longitudinal management visits while coordinating home infusion care.

If additional CPT codes are needed for nursing visits, home health billing, or specific infusion pump management, those services are billed separately per payer policy and documentation.

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