Summary & Overview
HCPCS S9365: Home Infusion TPN, 1 Liter/Day Per Diem
HCPCS Level II code S9365 represents a per diem payment for home infusion therapy delivering total parenteral nutrition (TPN) at a one-liter-per-day regimen. The code covers administrative and professional pharmacy services, care coordination, and necessary supplies and equipment, while excluding nursing visits and nonstandard drugs that must be billed separately. This code matters nationally as home-based TPN supports patients with chronic intestinal failure or other conditions requiring long-term parenteral nutrition, shifting care from inpatient settings to home and affecting utilization, care coordination, and pharmacy workflows.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn which services are bundled under the per diem, how the code is typically used in home-infusion programs, and common billing considerations tied to supplies and pharmacy professional services. The publication provides national benchmarks and policy context related to home infusion coverage and reimbursement, clarifies reporting boundaries (what is included vs billed separately), and outlines implications for clinical and administrative teams responsible for home TPN delivery and billing. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code S9365 describes home infusion therapy for total parenteral nutrition (TPN) provided on a per diem basis for a regimen of one liter per day. The code encompasses administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment, including standard TPN formula elements such as lipids and specialty amino acid formulas. Drugs that are not part of the standard formula and nursing visits are reported separately.
Service Type: Home infusion therapy — total parenteral nutrition (TPN)
Typical Site of Service: Patient's home (home infusion setting)
Clinical & Coding Specifications
Clinical Context
A 58-year-old female with severe Crohn disease complicated by short bowel syndrome is discharged from the hospital to receive home infusion total parenteral nutrition (TPN). The patient requires one liter per day of TPN to maintain nutrition and fluid balance because oral and enteral routes are insufficient. Home health nurses arrange central venous access care and infusion setup; a specialty pharmacy prepares individualized TPN admixtures (standard formula with lipids or modified amino acid mixtures as indicated). The home infusion per diem covers professional pharmacy services, care coordination, medication compounding and dispensing, delivery and disposal of supplies, and administration oversight. Nursing visits for catheter care and direct infusion setup are billed separately. The typical workflow includes physician order for home TPN, insurance authorization, pharmacy compounding and delivery, nursing education at initiation, daily infusion monitoring, and periodic laboratory monitoring for electrolytes, liver function, and micronutrients. Communication occurs between the ordering physician (often a gastroenterologist or general surgeon), the home infusion pharmacy, home health nursing, and the insurer for ongoing authorization and care coordination.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When unusually complex pharmacy compounding or care coordination significantly increases resources beyond typical per diem services |