Summary & Overview
HCPCS Level II S9497: Home Infusion Antimicrobial Therapy, Per Diem
HCPCS Level II code S9497 denotes per-diem home infusion therapy for antibiotic, antiviral, or antifungal treatment administered every three hours, including administrative, professional pharmacy, care coordination services, and necessary supplies and equipment (drugs and nursing visits billed separately). This code matters nationally as home infusion expands care outside hospitals, supports antimicrobial therapy continuity, and affects payer coverage, utilization management, and payment policies.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for frequent antimicrobial infusions in the home, expected billing scope tied to the per-diem administrative and pharmacy services, and where this code intersects with broader home health and infusion payment practices.
The publication provides benchmarks and policy context relevant to national payers, clarifies which elements are included in the S9497 per-diem charge versus separately billed items (drugs and nursing visits), and outlines common payer considerations affecting authorization and reimbursement. Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and detailed payer-specific rates.
Billing Code Overview
HCPCS Level II code S9497 describes home infusion therapy for antibiotic, antiviral, or antifungal therapy, provided on a schedule of once every 3 hours. The code covers administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment on a per diem basis; the actual medications and nursing visits are billed separately.
Service Type: Home infusion therapy — antimicrobial administration and associated professional/pharmacy services
Typical Site of Service: Patient home (home health/home infusion setting)
Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 62-year-old man recently discharged from the hospital after treatment for a complicated Gram-negative bacteremia secondary to a urinary tract source. He requires ongoing intravenous antibiotic therapy at home every 3 hours via a peripherally inserted central catheter (PICC). Home infusion nursing coordinates daily line care and teaching; a pharmacist provides professional services including dose verification, stability checks, and drug compounding. Administrative services include scheduling, care coordination with the physician, prior authorization, delivery of supplies, and documentation. The workflow: physician orders home infusion antibiotic with frequency every 3 hours; home infusion pharmacy triages the order, obtains prior authorization from payors, compounds medication and ships or delivers supplies (infusion pump, tubing, dressings), schedules nursing visits for line insertion education and periodic assessments, and provides ongoing telephone and care coordination. Drugs and nursing visits are billed separately; S9497 covers per diem administrative, professional pharmacy services, care coordination, and supplies/equipment (excluding medication and nursing services).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Default when no specific modifier applies |