Prolonged Drug and Biological Infusions Using an External Pump

In some situations, a hospital outpatient department or physician office may purchase a drug for a medically reasonable and necessary prolonged drug infusion, begin the drug infusion in the care setting using an external pump, send the patient home for a portion of the infusion, and have the patient return at the end of the infusion period. In this case, bill your A/B MAC for the drug or biological and the administration.

Note: Because prolonged drug and biological infusions started incident to a physician's service using an external pump should be treated as an incident to service, it cannot be billed on suppliers’ claims to DME MACs.

Posted 3/26/2024