SPECIAL BULLETIN COVID-19 #26: Expansion of Home Infusion Therapy Drug Categories; Clinical Policy Modification 3H-1

Effective March 30, 2020 NC Medicaid is temporarily modifying the Home Infusion Therapy Clinical Coverage Policy No.: 3H-1 to better enable the delivery of remote care to Medicaid members. These temporary changes will end the earlier of the cancellation of the North Carolina state of emergency declaration or when this policy is rescinded. This expansion of home infusion therapy serves to allow beneficiaries to receive services in the home rather than in a dedication infusion center to reduce potential exposure to COVID-19.

Providers can bill for allowed services as described in this Medicaid Bulletin beginning March 30, 2020 for dates of service on or after March 30, 2020. NC Medicaid will continue to release policy revisions and will continue to evaluate this policy throughout the state of emergency period.

There are two additional drug categories referenced within this policy Bulletin: Immunotherapy (S9338) and Hydration (S9376 and S9377).

Immunotherapy approved drugs: Cuvitru, Hizentra, Gamunex, Gammagard, and Hyqvia.

PLACE OF SERVICE:

Claims should be filed with: Place of Service 12 (HOME)

• Codes
  • The provider shall report the most specific billing code that accurately and completely describes the procedure, product or service and use CPT, HCPCS and UB-04 Data specifications Manual (for complete listing of Revenue codes) and any subsequent editions in effect at the time of service. Providers shall refer to the applicable edition for the code description, as it is not documented in the policy.
  • If no such CPT or HCPCS codes exist, the provider shall report the procedure, product, or service using the appropriate unlisted procedure or service code.
    • HCPCS:
      Immunotherapy: S9338 Home Infusion Therapy - uninterrupted, long-term, controlled rate intravenous or subcutaneous infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem.
    • Hydration: S9376 Home Infusion Therapy - Hydration, more than 2 liters but no more than 3 liters per day; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem.
    • Hydration: S9377 Home Infusion Therapy - Hydration, more than 3 liters per day; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem.
      The nurse component HCPCS code must be billed with the therapy code for correct reimbursement of the per diem.
      • T1030 Nursing care, in home, by registered nurse, per diem.
• Modifiers
  • The provider shall follow applicable modifier guidelines.
    • SH: Indicated the second concurrently administered infusion therapy,
    • SJ: Indicates the third concurrently administered infusion therapy.
•  Billing
  • Refer to March 15, 2019 Clinical Coverage Policy No.:3H-1 Attachment B, Billing for HIT Services.

Questions about HIT billing should be referred to GDIT 800-688-6696. Questions regarding the temporary changes in this bulletin may be sent to Medicaid.COVID19@dhhs.nc.gov.