Multiple Procedure Reduction — Home Infusion Therapy Per Diem
Defines Florida Blue's reimbursement methodology when multiple home infusion therapy per diem HCPCS codes are billed on the same date of service for the same patient and applies to all lines of business and providers of service.
No material clinical or coverage changes in this revision.
Multiple Procedure Reduction Rules
Multiple procedure reduction rules
When multiple Home Infusion Therapy Per Diem codes from the same therapeutic category are reported on the same date of service for the same patient, reimbursement reductions apply as follows.
Tiered multiple-procedure reduction
- First or highest-valued procedure reimbursed at 100% of the fee schedule amount.
- Second procedure reimbursed at 50% of the fee schedule amount.
- All subsequent procedures reimbursed at 25% of the fee schedule amount.
Therapeutic categories subject to tiered reductions
- Chemotherapy
- Antibiotics/Antifungals/Antivirals
- Pain Management
Categories excluded from multiple-procedure reductions
- Hydration — multiple procedure reductions do not apply; only one Per Diem code allowed per day.
- Enteral Nutrition — multiple procedure reductions do not apply; only one Per Diem code allowed per day.
- Total Parenteral Nutrition (TPN) — multiple procedure reductions do not apply; only one Per Diem code allowed per day.
- Specialty Therapy — multiple procedure reductions do not apply.
Claim submission and units
- Submit a separate line item for each Per Diem for each date of service to facilitate claims administration.
- Bill one unit per Per Diem line (one unit should be billed for each line).
Home Infusion Per Diem Codes & Reimbursement Tiers
| S9494 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy, per diem (do not use this code with codes for hourly dosing schedules S9497 S9504). |
| S9497 | Home infusion therapy, antibiotic/antifungal/antiviral therapy, per diem. |
| S9500 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy, once every 24 hours, per diem. |
| S9501 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy, once every 12 hours, per diem. |
| S9502 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy, once every 8 hours, per diem. |
| S9503 | Home infusion therapy, antibiotic, antiviral, or antifungal therapy, once every 6 hours, per diem. |
| S9504 | Home infusion therapy, antibiotic/antifungal/antiviral therapy, per diem (hourly dosing schedule). |
| S9329 | Home infusion therapy, chemotherapy infusion, per diem. |
| S9330 | Home infusion therapy, continuous (24 hours or more) chemotherapy infusion, per diem. |
| S9331 | Home infusion therapy, intermittent (less than 24 hours) chemotherapy infusion, per diem. |
Provider Notice and Billing Implications
Policy notice — not a guarantee of payment
This payment policy is not an authorization, certification, explanation of benefits, or guarantee of payment; benefits are determined by the group contract and member benefit booklet.
Key Terms
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.