CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPO19

Infusion Services (Home Infusion Therapy Coding and Reimbursement)

Defines coding and reimbursement guidance for home infusion therapy S-codes, included supplies/equipment, and related billing practices affecting providers submitting claims to Blue Cross Blue Shield - Oklahoma.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyInfusion Services (Home Infusion Therapy Coding and Reimbursement)

Policy CodePolicy CPCPO19

Change TypeScope broadenedclarifications

Effective DateJul 18, 2025

Next Review Date

Key ActionWhen billing CPT 99601/99602 for home infusion visits, ensure a qualified healthcare professional administers the service.

SourceLink

POLICY UPDATE CHANGES

Policy revised to include broader scope of infusion services not limited to home setting and title revised; new definitions and terms added and verbal edits for cassette/reservoir change/refill, POS codes, Nursing Services, and Prescribed therapy UOS updated.

Clarification added to the Reimbursement Information section, second paragraph; Cassette/Reservoir Change/Refill section.

~80+unique S- and HCPCS codes listed

multipleTPN volume-specific codes

Supply listSupply/equipment codes bundled

07/18/2025

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Coverage Criteria and Bundling Rules

Bundling of supplies/equipment

Supplies, equipment, and certain DME items listed below are included in the home infusion S-code per diem and are not eligible for separate reimbursement.

ALL of the following

Examples
- DME items such as infusion pumps (stationary or ambulatory), pump accessories, IV poles, and infusion pump components.
- Implantable access catheters, ports/reservoirs, external access catheters, and related catheter components.
- Disposable drug delivery systems and disposable delivery systems (flow rate distinctions noted in source list).
- Short peripheral vascular access devices, needles, sterile tubing, catheters, dressing kits, and other necessary supplies for administration of infusion or nutrition therapies.
- Miscellaneous DME supplies and accessories listed by miscellaneous HCPCS (e.g., A9270, A9999) when used in support of an S-code per diem.
- Select injectable/infusion-related supply codes such as J1642 (heparin lock flush) when integral to infusion administration, and IV solutions (J7030–J7060) depending on concurrent use or whether they are incidental to a drug infusion.
ALL of the following
- ANY of the following
  - A4206 — Medical and surgical supplies.
  - A4300/A4301/A4305/A4306 — Implantable access catheters, ports/reservoirs, and disposable drug delivery systems.
  - A9270 / A9999 — Miscellaneous DME supply or accessory codes.
  - E0776, E0779, E0780, E0781–E0786 — IV poles and ambulatory/implantable infusion pumps (mechanical, electric/battery, programmable/non-programmable).
  - J1642 — Injection, heparin sodium (heparin lock flush), per 10 units; J7030–J7060 — IV solutions (billing dependent on clinical use).

Provider and code-use restrictions

Billing and code-use rules for infusion visits and professional pharmacy services:

ALL of the following

When billing CPT codes 99601 (HOME INFUSION VISIT 2 HRS) and 99602 (HOME INFUSION EACH ADDITIONAL HR), a qualified healthcare professional must administer the service.
S9810 (professional pharmacy services, per hour) must not be used with any per diem S-code; S9810 is described as per hour and the policy states 'do not use this code with any per diem code.'
Operational notes
- Do not report S9810 in addition to an S-code per diem for the same day of service; S9810 is intended for hourly professional pharmacy services separate from per diem S-codes.
- Ensure documentation demonstrates a qualified healthcare professional administered the billed 99601/99602 visit(s) consistent with the policy requirement.

Covered Codes, Supply Bundles, and TPN Coding

Home infusion S-codes (selected examples)HCPCSCovered

S9330	Home infusion therapy, chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment; (drugs and nursing visits coded separately)_per diem
S9331	Home infusion therapy, intermittent (less than 24 hrs) chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment; (drugs and nursing visits coded separately)_per diem
S9340	Home infusion therapy, enteral nutrition; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment; (enteral formula and nursing visits coded separately)_per diem
S9364	Home infusion therapy, total parenteral nutrition (TPN); administrative services including standard TPN formula; per diem (do not use with S9365-S9368 using daily volume scales)
S9365	Home infusion therapy, TPN; one liter per day; administrative services and supplies; per diem
S9366	Home infusion therapy, TPN; >1L to <=2L per day; administrative services and supplies; per diem
S9367	Home infusion therapy, TPN; >2L to <=3L per day; administrative services and supplies; per diem
S9368	Home infusion therapy, TPN; >3L per day; administrative services and supplies; per diem
S9494	Home infusion therapy, antibiotic/antiviral/antifungal therapy; administrative services; per diem (do not use with hourly dosing codes S9497-S9504)
S9497	Home infusion therapy, antibiotic/antiviral/antifungal therapy; once every 3 hours; per diem

1–10 of 11

1/2

Supply and equipment HCPCS/J-codes commonly bundled in S-codesmixedNot Covered

A4206	Medical and surgical supplies
A4300	Implantable access catheter, venous; external access
E0780	Ambulatory infusion pump, single or multiple channels, electric or battery operated
J1642	Injection, heparin sodium (heparin lock flush), per 10 units

TPN volume coding guidance

Standard TPN vs volume-specific TPNUse S9364 for standard TPN per diem; do not report S9364 together with the volume-specific codes S9365–S9368.

One-liter TPNUse S9365 for total parenteral nutrition when the patient receives approximately one liter per day (per diem).

>1–2 L TPNUse S9366 for total parenteral nutrition when the patient receives more than 1 liter but no more than 2 liters per day (per diem).

>2–3 L TPNUse S9367 for total parenteral nutrition when the patient receives more than 2 liters but no more than 3 liters per day (per diem).

>3 L TPNUse S9368 for total parenteral nutrition when the patient receives more than 3 liters per day (per diem).

Provider Requirements and Billing Actions

Billing Rule

Qualified provider required for CPT 99601 / 99602

Billing CPT codes 99601 (Home infusion visit — up to 2 hours) and 99602 (each additional hour) requires that the infusion be administered by a qualified healthcare professional. Ensure documentation verifies the qualified provider performed the service when submitting claims for these codes to avoid denial.

Affected codes: CPT 99601, 99602
List 99602 separately in addition to the primary procedure when billing for each additional hour
Document the qualified provider's name, credentials, and signature in the medical record

Definitions and Included Items

Supplies and equipment typically included in S-code per diem

Included supply/equipment typesS-code per diems include pumps and accessories, nutrition administration supplies, equipment maintenance and repair (excluding member‑owned equipment), short peripheral vascular access devices, needles, gauze, sterile tubing, catheters, dressing kits, and other necessary supplies for safe administration of infusion and nutrition therapies.

Ambulatory and parenteral pumpsAmbulatory infusion pumps (stationary or portable) and parenteral infusion pumps are typically included in the S-code bundle and not separately reimbursable.

Vascular access and catheter suppliesImplantable/external access catheters, short peripheral vascular access devices, and associated dressing kits are included in the per diem S-code.

Ancillary disposablesNeedles, gauze, non‑implanted sterile tubing, and other disposables required for drug or nutrition administration are included in the S-code.

Specific HCPCS/J examplesCommonly seen codes that are part of the supply set include A4206 (medical and surgical supplies), A4300 (implantable access catheter, venous; external access), E0780 (ambulatory infusion pump), and J1642 (heparin flush), which are not separately reimbursed when billed with an S-code per diem.