Summary & Overview
HCPCS S9351: Home Infusion Anti-Emetic Therapy, Per Diem
HCPCS Level II code S9351 designates a per diem payment for administrative and professional pharmacy services associated with home infusion therapy of continuous or intermittent anti-emetic medications. This code matters nationally as home infusion expands care options for patients requiring ongoing anti-emetic support, enabling coordinated pharmacy administration, supply management, and care coordination separate from drug and visit charges.
Key payers commonly involved in coverage for home infusion services include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. These payers influence prior authorization, benefit design, and coverage policies that affect patient access to home infusion anti-emetic regimens.
Readers will find an overview of the clinical and billing context for S9351, a summary of payer coverage considerations, and guidance on what to expect in benchmarking and policy language. The publication outlines the service components represented by the code, typical sites of service, and where to look for rules that separate per diem administrative/pharmacy services from separately billed drug and visit items. Data not available in the input will be noted where applicable.
Billing Code Overview
HCPCS Level II code S9351 describes home infusion therapy for continuous or intermittent anti-emetic infusion. The code covers administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment provided on a per diem basis. Drugs and visits are coded separately and are not included in this per diem description.
Service type: Home infusion therapy — anti-emetic infusion administration, per diem professional and administrative services
Typical site of service: Patient residence / home infusion setting
Clinical & Coding Specifications
Clinical Context
A common scenario for S9351 involves an adult oncology patient with chemotherapy-induced nausea and vomiting (CINV) uncontrolled by oral or intermittent antiemetics who requires continuous or intermittent subcutaneous or intravenous anti-emetic infusion at home. The patient typically has frequent emesis despite oral agents, orthostatic symptoms from dehydration, and a central venous catheter or peripheral IV access placed during an earlier inpatient stay or outpatient infusion center visit. A specialty pharmacy coordinates delivery of infusion pumps, tubing, and anti-emetic drug vials; a home health or infusion nurse teaches pump operation, performs initial setup and competency checks, and provides routine visits for line care and infusion troubleshooting. Professional pharmacy services include compounding, dose verification, medication counseling, 24/7 clinical support, and care coordination with the oncology team. Drugs and individual nursing visits are billed separately; S9351 reimburses the per diem administrative and supply bundle for continuous or intermittent home anti-emetic infusion therapy. Typical site of service is the patient’s residence (home infusion).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard reporting when no specific modifier applies |