Home Infusion Therapy

The Medicare Home Infusion Therapy Benefit and Home Health Agencies

If you are a HHA that wants to provide and bill Medicare HIT professional services starting in CY 2021, you are required to enroll with the Part B Medicare Administrative Contractor (A/B MAC) in your state. HHAs will no longer be able to bill professional HIT services on standard 837/CMS-1450 (UB-04) institutional claims form with their professional home health services.

Effective 1/1/2021, Section 5012(d) of the 21st Century Cures Act (Pub. L 114-255) amended sections 1861(s)(2) and 1861(iii) of the Social Security Act (the Act), requiring the Secretary to establish a new Medicare HIT services benefit. The Medicare HIT services benefit covers the professional services, including nursing services, furnished in accordance with the plan of care, patient training and education (not otherwise covered under the DME benefit), remote monitoring and monitoring services for the provision of home infusion drugs furnished by a qualified HIT supplier (suppliers must have specialty code D6).

MLN 11954 and related CR number 11954 informs MACs of the policies and procedures for enrolling HIT suppliers in Medicare. Payments will begin for dates of service on or after 1/1/2021.

HHAs, that enroll as qualified HIT suppliers, will need to continue submitting a standard 837/CMS-1450 institutional claims form for the professional home health services to the A/B MAC (HHH) and a separate 837P/CMS-1500 professional and supplier claims form for the professional HIT services to the A/B MAC.

During the HIT Services Temporary Transitional Payment period and prior to CY 2021, an HHA was not considered an eligible home infusion supplier and therefore could not bill for the home infusion therapy services temporary transitional payment. However, if a patient was considered homebound and was under a Medicare home health plan of care, the HHA may have continued to furnish the professional services related to the administration of transitional home infusion drugs. This was in accordance with the Home Health CoPs and other regulations, as home health services and bill for such services as home health services under the Medicare home health benefit.

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Reviewed 8/28/2024