Summary & Overview

HCPCS S9361: Home Infusion Diuretic IV Therapy — Administrative and Pharmacy Services

HCPCS Level II code S9361 denotes the per‑diem administrative and professional pharmacy services component of home intravenous diuretic therapy, including care coordination and necessary supplies and equipment; drugs and nursing visits are billed separately. This code matters nationally as home infusion services expand as alternatives to inpatient or clinic‑based care, affecting utilization, care coordination models, and payer coverage policies.

Key payers in scope include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of billing context, common payer considerations, and the clinical and operational setting where S9361 applies. The publication summarizes benchmark coverage patterns, reimbursement considerations, common modifiers used with HCPCS Level II codes, and implications for home infusion program workflows.

The content is organized to help billing managers, pharmacists, and policy staff quickly identify the code's purpose, typical sites of service, and areas where payer policy and documentation practices commonly affect claims. Data not provided in the input (for example, specific rates, taxonomies, or ICD‑10 pairings) is noted as not available in the input.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareS9361HCPCS Level IIhome infusiondiuretic therapypharmacy servicescare coordinationper diemhome health

Billing Code Overview

HCPCS Level II code S9361 describes home infusion therapy for diuretic intravenous therapy and covers administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment on a per diem basis. Drugs and nursing visits associated with the infusion are coded separately.

Service type: Home infusion therapy administrative and professional services

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

Clinical & Coding Specifications

Clinical Context

A 72-year-old patient with chronic heart failure and persistent volume overload is discharged from the hospital but requires ongoing intravenous diuretic therapy at home to manage refractory edema and prevent readmission. The home infusion provider schedules per diem services to deliver administrative oversight, professional pharmacy services, care coordination, and to supply necessary non-drug supplies and equipment. A visiting nurse or home health agency administers the IV diuretic (the drug and nursing visits are billed separately) while the infusion pharmacy manages ordering, stability review, compounding if required, patient education, prior authorization, and coordination with the prescribing cardiologist or primary care provider.

Typical clinical workflow:

Referral from hospital or cardiology clinic to a home infusion pharmacy for ongoing IV diuretic therapy.
Pharmacy verifies the order, reviews patient history and allergies, completes prior authorization and insurance verification, and prepares medication or arranges acquisition.
A nurse visits the patient’s home to establish or maintain IV access, administer the diuretic per protocol, monitor vital signs and fluid status, and document response.
The infusion pharmacy provides administrative and professional services under the per diem S9361 to cover care coordination, quality oversight, and supply/equipment management; separate claims are submitted for the IV drug product and nursing visits.
Ongoing communication occurs between the pharmacy, nursing provider, and the prescribing clinician to adjust therapy and arrange follow-up or escalation if needed.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when services required substantially greater resources or complexity for the home infusion administrative component (requires documentation).
`26`	Professional component	Use when billing only the professional component of a split service, if applicable to a supervising pharmacist professional service.
`32`	Unrelated service by the same physician during a postoperative period	Use if the home infusion administrative service is unrelated to a prior surgical postoperative global period.
`52`	Reduced services	Use when the per diem administrative services were partially furnished and reduced in scope.
`53`	Discontinued service	Use if therapy was started but discontinued due to patient condition before full administration period.
`59`	Distinct procedural service	Use to indicate a distinct service separate from other billable services on the same day (e.g., separate from nursing visit or drug charge).
`76`	Repeat procedure or service by same provider	Use if the per diem administrative service is billed again for a repeated episode on the same day.
`80`	Assistant at surgery	Rarely used; include only if an assistant at surgery is relevant to a related inpatient procedure coordination.
`82`	Assistant at surgery when a qualified resident is not available	See `80`; rarely applicable but included for completeness when surgical assistants are involved in coordination.
`QK`	Medical direction of two or more CRNAs	Use only if anesthesia-related coordination is provided and the medical direction rules apply.
`QX`	CRNA service with medical direction by a physician	See `QK`; only applicable in rare anesthesia-related home infusion contexts.
`QY`	Medical direction of one CRNA by an anesthesiologist	As above, applicable only when anesthesia services intersect with home infusion care coordination.
`KX`	Requirements specified in the medical policy are met	Use when payer-specific medical necessity documentation is met per policy for home infusion IV diuretics.
`TG`	Service furnished under a primary care exception for telehealth originating site facility	Use when telehealth coordination meets specific payer rules and this modifier is required.

Taxonomy Code	Specialty	Notes
`3336S0002X`	Pharmacist, Infusion/Parenteral Therapy	Pharmacists in home infusion pharmacy managing compounding, stability, and medication management.
`163W00000X`	Home Health Agency	Agencies providing nursing visits and direct patient care for infusion administration.
`208000000X`	Cardiovascular Disease (Cardiologist)	Prescribing clinician managing heart failure and IV diuretic regimen.
`251B00000X`	Registered Nurse	Nurses providing hands-on IV administration and monitoring in the home.
`203L00000X`	Internal Medicine	Primary care physicians coordinating overall outpatient management and referrals.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I50.32`	Chronic diastolic (congestive) heart failure	Common indication for outpatient IV diuretic therapy to manage chronic volume overload.
`I50.33`	Chronic combined systolic and diastolic heart failure	Reflects advanced heart failure requiring intensified diuresis in the home setting.
`I50.23`	Acute on chronic systolic (congestive) heart failure	Patients with acute decompensation after hospitalization may receive home IV diuretics to prevent readmission.
`R60.0`	Localized edema	Symptom management when edema is refractory and requires IV diuresis.
`N18.3`	Chronic kidney disease, stage 3 (moderate)	CKD affects diuretic response and dosing; close coordination is required for home IV therapy.
`E86.0`	Dehydration	Monitoring is required during diuretic therapy; may be a complication or a reason to adjust therapy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	Nursing-administered IV diuretic infusion episodes in the home may be reported using this code for the initial infusion period when billed separately from the per diem administrative services.
`96366`	Intravenous infusion, each additional hour (List separately in addition to code for primary infusion)	Use for extended infusion times beyond the initial hour when nursing time is billed separately from `S9361`.
`96446`	Chemotherapy administration into peripheral vein, push technique, initial substance or drug;	Not typically used for diuretics but included when complex infusion techniques overlap; generally not applicable to routine IV diuretic therapy.
`99211`	Office or other outpatient visit for the evaluation and management of an established patient, usually 5 minutes	May be used by supervising clinicians for brief evaluation or care coordination contacts related to home infusion when applicable.
`99070`	Supplies and materials (except spectacles), noncovered items, used for patient, each supply	Use for separately billable durable supplies not included in the per diem when payer rules permit; most supplies are included in `S9361` per its description.