New Home Infusion Therapy Payments Under Part B: Know the Rules

Posted on Monday, February 8, 2021

Effective: January 1, 2021

Home Infusion Therapy (HIT) Part B benefit for Medicare patients

A new Medicare Part B benefit became effective on January 1, 2021. This new benefit covers the professional services, including nursing services, furnished in accordance with the plan of care for the provision of home infusion drugs administered by a qualified home infusion therapy supplier. Home Infusion Therapy services are for professional services for certain drugs and biologicals administered intravenously or subcutaneously to a patient in their home through a pump. The infusion pump and supplies, including infusion drugs, are covered under the DME benefit.

Professional services include infusion activities, training, education, and monitoring and remote monitoring within the following parameters:

  • The therapy must be infused using a pump under a plan of care.
  • The HIT provider must be accredited as a Home Infusion Therapy provider and bill under Part B. The service may be subcontracted to a credentialed service provider.
  • Qualified HIT suppliers can only bill for HIT services for days on which a professional is physically present in the patient’s home and an infusion drug is being administered.
  • Pharmacy services, drugs, biologics, equipment, and supplies will continue to be billed under the DME benefit. This DME benefit is separate from the HIT benefit.

A beneficiary is not required to be homebound to be eligible for HIT.  Part B copayments may apply. Medicare has a list of approved drugs and biologics that are included in the benefit. Accredited HIT suppliers may subcontract with pharmacies, DME suppliers or nursing services to provide the direct home infusion professional services.

Home Health Agencies will no longer be able to bill for home infusion services under Part A if the drug or biologic is included in the new HIT benefit. If the patient’s skilled care is only related to the infusion services, it must be billed under the HIT benefit. For homebound patients receiving other services, it is possible that an HHA may bill separately for two incidents of care, even within the same day: one for homebound skilled service and a different billing for the infusion.

The HIT benefit does not extend to insulin or drugs on the self-administered drug exclusion list. It includes 3 categories of drugs, biologicals or parenterally administered drugs that are infused intravenously or subcutaneously for at least 15 minutes through a pump.

For more guidance and information on the new Home Infusion Therapy Part B billing rules, contact us at Corridor.


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