CurrentAlaska MedicaidPolicy N/A

Home Infusion Therapy Services — Reimbursement and Authorization

This policy governs coverage, service authorization, and maximum allowable reimbursement rates for Home Infusion Therapy services and supplies under Alaska Medicaid for covered recipients and providers.

Policy Summary

PayerAlaska Medicaid

PolicyHome Infusion Therapy Services — Reimbursement and Authorization

Policy CodePolicy N/A

Change TypeMinor/no material changes

Effective DateJul 1, 2025

Next Review DateN/A

Key ActionObtain prior (FA) authorization for all Home Infusion Therapy services and supplies before billing.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

All services require prior authorizationauthorization requirement

80+line-item rates

$3,722.10example highest device rate

$168.75example per-diem

Coverage and Authorization Conditions

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Services are reimbursed via an itemized fee schedule; each listed CPT/HCPCS has a specified maximum allowable amount.

Prior authorization requirement: All Home Infusion Therapy services and supplies require service authorization (FA Authorization = Y indicated on line items).

Per-line indications: Each fee-schedule line item indicates whether FA Authorization is required and provides reduced payment amounts for second and third concurrent infusion therapy (Modifier SH and SJ) when applicable.

Service scope included in the fee schedule: nursing visits (99601, 99602), infusion supplies and pump-related supplies (A4221, A4222, A4224), infusion pumps (E0781), device repair and catheter care/insertion kits (S5036, S5498, S5501, S5502, S5517, S5518, S5520, S5521), and per-diem therapeutic infusion codes (S9326–S9376, S9379, S9490, S9497, S9500–S9504).

Concurrent infusion payment adjustments: For applicable per-line items the fee schedule specifies second-concurrent (Modifier SH) and third-concurrent (Modifier SJ) reduced payment amounts (examples shown on line items, e.g., S5036 SH=$64.00, SJ=$60.00; S9365 MA=$168.75, SH=$135.00, SJ=$126.56).

Reimbursable Codes and Rates

Listed reimbursable codes and descriptionsmixedCovered

99601-99602	HOME NFS VISIT <2 HRS; HOME NFS VISIT EACH ADDL HR
A4221,A4222,A4224	SUPP NON-INSULIN INF CATH/WK; INFUSION SUPPLIES WITH PUMP; SUPPLY INSULIN INF CATH/WK
E0781	EXTERNAL AMBULATORY INFUS PU
S5036,S5498,S5501,S5502,S5517,S5518,S5520,S5521	HIT DEVICE REPAIR; HIT SIMPLE CATH CARE; HIT COMPLEX CATH CARE; HIT INTERIM CATH CARE; HIT DECLOTTING KIT; HIT CATH REPAIR KIT; HIT PICC INSERT KIT; HIT MIDLINE CATH INSERT KIT
S9326-S9376,S9379,S9490,S9497,S9500-S9504	Per-diem infusion service codes (HIT CONT PAIN PER DIEM; HIT INT PAIN PER DIEM; HIT PAIN IMP PUMP DIEM; HIT CONT CHEM DIEM; HIT INTERMIT CHEMO DIEM; multiple therapeutic per-diem codes including S9365 TPN 1 LITER DIEM; HIT NOC PER DIEM; HIT CORTICOSTEROID/DIEM; HIT ANTIBIOTIC Q3H/Q6H/Q24H/Q12H/Q8H/Q4H DIEM, etc.)

Per-line maximum allowable amounts

99601Maximum Allowable = $170.00

E0781Maximum Allowable = $3,722.10

S9365Maximum Allowable = $168.75

Authorization & Billing Actions for Providers

Prior Authorization

Prior authorization required

All Home Infusion Therapy services and supplies require service authorization.

Documentation Required

Line-item authorization flags

Each listed HCPCS/CPT line item in the fee schedule identifies whether it requires prior (FA) authorization with the field 'Requires FA Authorization = Y'.

Example: 99601, Requires FA Authorization = Y (line-item flag).
Example: S5520, Requires FA Authorization = Y (line-item flag).
Example: S9365, Requires FA Authorization = Y (line-item flag).

Definitions and Modifier Guidance

Second/Third Concurrent Infusion Therapy modifiers

Modifier SHSecond Concurrent Infusion Therapy payment adjustments shown per line (example: S5036 SH = $64.00; S9326 SH = $63.00; S9365 SH = $135.00)

Modifier SJThird Concurrent Infusion Therapy payment adjustments shown per line (example: S5036 SJ = $60.00; S9326 SJ = $59.06; S9365 SJ = $126.56)

Applies toMost listed HCPCS/CPT line items include SH/SJ reductions where applicable

Requires FA Authorization

FA Authorization = YIndicates the service requires prior/FA authorization before payment (applies to all listed Home Infusion Therapy line items)

ScopeAuthorization requirement covers Home Infusion Therapy services and supplies

Line-item flaggingIndividual HCPCS/CPT entries explicitly show 'Requires FA Authorization = Y' when authorization is required