New Billing Guidelines for Home Infusion, Enteral and Parenteral Therapies Home Infusion Fee Schedule Effective July 1, 2009

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1 STAT Bulletin PO Box 80 Buffalo, New York May 12, 2009 Volume 15:Issue 18 To: All Home Health Care and Home Infusion Therapy Providers Contracts Effected: All Lines of Business New Billing Guidelines for Home Infusion, Enteral and Parenteral Therapies Home Infusion Fee Schedule Effective July 1, 2009 Since the publication of our Billing Guidelines and Program Requirements for Home Infusion, Enteral and Parenteral Therapies in August of 2002, new Healthcare Common Procedure Coding System (HCPCS) codes have been developed that are specific to services you provide. Below are the additional HCPCS codes that you may bill in accordance to the guidelines. The new codes are listed within each category and are italicized. You may view the 2002 Billing Guidelines on our secure provider web site. Reimbursement for Infusion Drugs In October 2007, we implemented a corporate drug fee schedule that is based on reasonable market acquisition cost plus any handling fee. Reimbursement will be based on the fee schedule in effect at the time of service. You may view our fee schedule by visiting our secure provider web site. Anti-Infective Therapies These include home infusion therapy, antibiotic, antiviral or antifungal therapy (as outlined below), administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drug and nursing visits coded separately), per diem. For services with no specific dosing schedule S9494 (do not use with S9497-S9504) $ corporate drug fee schedule Every 3 hours S9497 $ corporate drug fee schedule Every 4 hours S9504 $ corporate drug fee schedule Every 6 hours S9503 $ corporate drug fee schedule Every 8 hours S9502 $ corporate drug fee schedule Every 12 hours S9501 $ corporate drug fee schedule Every 24 hours S9500 $ corporate drug fee schedule - over B-2088 WNYHomeInfusion.doc.DocAuto CC 1520 A Division of HealthNow New York Inc. An Independent Licensee of the BlueCross BlueShield Association C9013

2 Chemotherapy This includes home infusion therapy, intermittent chemotherapy infusion (as outlined below), administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drug and nursing visits coded separately), per diem. For services with no specific S9329 (do not use dosing schedule with S9330, S9331) $ corporate drug fee schedule Chemotherapy, intermittent S9331 $ corporate drug fee schedule Chemotherapy, continuous S9330 $ corporate drug fee schedule Enteral Nutrition This includes home therapy, enteral nutrition, administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem. Via gravity S9341 $ corporate drug fee schedule Via pump S9342 $ corporate drug fee schedule Via bolus S9343 $ corporate drug fee schedule For services with no specific route of administration S9340 $ corporate drug fee schedule Enteral Nutrition Product Classification Fee Schedules Per SADMERC (1 unit = 100 calories) B Codes Enteral and parenteral codes reimbursement will be based on current prevailing Medicare rates, if applicable, or fee schedule in effect at time of service. Hydration Therapy This includes home infusion therapy, hydration therapy (as classified below) administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drug and nursing visits coded separately), per diem. 1.0 liter of solution S9374 $ corporate drug fee schedule >1.0 liters to 2.0 liters S9375 $ corporate drug fee schedule >2.0 liters to 3.0 liters S9376 $ corporate drug fee schedule >3.0 liters S9377 $ corporate drug fee schedule For services with no specific volume S9373 $ corporate drug fee schedule 2

3 Pain Management This includes home infusion therapy, pain management infusion (as classified below), administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drug and nursing visits coded separately), per diem. Continuous S9326 $ corporate drug fee schedule Intermittent S9327 $ corporate drug fee schedule Implanted pump S9328 $ corporate drug fee schedule For services with no specific route of administration S9325 (do not use with S9326, S9327, S9328) $ corporate drug fee schedule Total Parenteral Nutrition This includes home infusion therapy, Total Parenteral Nutrition (TPN), administrative services, professional pharmacy services and all necessary supplies and equipment (nursing visits coded separately), per diem. Also included are all non-specialty amino acids; concentrated dextrose; sterile water; electrolytes; lipids; trace elements (e.g., chromium, cooper, iodine, manganese, selenium, zinc); standard multi-trace element solutions; and standard multivitamin solution. Specialty amino acids (renal, hepatic, stress formulas); added non-standard vitamins (e.g., folic acid, vitamin C, vitamin K); or products serving non-nutritional purposes (insulin, iron dextran, Pepcid, Sandostatin, Zofran) are reimbursable separately. TPN 1 liter of solution S9365 $ corporate drug fee schedule TPN > 1 liter 2 liters S9366 $ corporate drug fee schedule TPN > 2 liters 3 liters S9367 $ corporate drug fee schedule TPN > 3 liters S9368 $ corporate drug fee schedule For TPN services with no specific volume S9364 (do not use with S9365-S9368) $ corporate drug fee schedule *see below for Managed Medicaid rate Lipids HCPCS Code Reimbursement Parenteral Sol, per 10 gram, Lipids B4185 Prevailing Medicare * For Managed Medicaid patients, Medicaid Fee-for-Service covers the cost of drugs, enteral and parental therapies provided in the home. BlueCross BlueShield covers the cost of nursing visits and infusion-related equipment and supplies. For drug and enteral therapies, BlueCross BlueShield will reimburse medically necessary nursing visits and a therapy-specific per diem rate to cover equipment, supplies and administrative services. For Medicaid parenteral therapy patients, BlueCross BlueShield will reimburse TPN-related supplies at $30 per day. 3

4 Miscellaneous Infusion Therapies This includes home infusion therapy, infusion therapy as classified below, administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drug and nursing visits coded separately), per diem. Therapy HCPCS Code Reimbursement Continuous anti-coagulants S9336 $ corporate drug fee schedule Peritoneal dialysis S9339 $ corporate drug fee schedule Transfusional blood products per unit S9538 Negotiated on an individual basis Anti-hemophilic factors S9345 $ corporate drug fee schedule Chelation therapy S9355 $60.00 (if not considered experimental/investigational) + corporate drug fee schedule Immunotherapy S9338 $ corporate drug fee schedule Corticosteroid S9490 $ corporate drug fee schedule Long term controlled rate, IV or subcutaneous S9347 $ corporate drug fee schedule Inotropic S9348 $ corporate drug fee schedule Tocolytic infusion therapy S9349 $60.00 (if not considered experimental/investigational) + corporate drug fee schedule Alpha-1 proteinase inhibitor S9346 $ corporate drug fee schedule Continuous anti-emetic therapy S9351 $ corporate drug fee schedule Enzyme replacement S9357 $ corporate drug fee Anti-tumor necrosis factor S9359 $ corporate drug fee Anti-spasmotic agents S9363 $ corporate drug fee schedule Diuretics S9361 $ corporate drug fee schedule Continuous insulin S9353 $ corporate drug fee schedule Miscellaneous infusion therapy S9379 $ corporate drug fee schedule Delivery/service to high risk areas requiring escort or extra protection S9381 Reimbursement included in per diem rate Pumps Pumps HCPCS Code Reimbursement Stationary pump N/A Included in per diem rate Ambulatory pump E0779, E0780, E0781 Included in per diem rate Disposable pump A4305, A4306 Included in per diem rate Service or repair of pump S5035, S5036 Included in per diem rate Miscellaneous Non-Infusion Therapies This includes home infusion therapy, injectable therapy as classified below, administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drug and nursing visits coded separately), per diem. 4

5 Therapy HCPCS Code Reimbursement Intermittent anti-emetic S9370 $ corporate drug fee schedule Intermittent anti-coagulant S9372 $ corporate drug fee schedule Blood component stimulating factors (Epo, Neupo) S9537 $ corporate drug fee schedule Growth hormone S9558 $ corporate drug fee schedule Interferon S9559 $ corporate drug fee schedule Hormonal therapy S9560 $ corporate drug fee schedule Miscellaneous injectable therapy S9542 $ corporate drug fee schedule Catheter Care Home infusion therapy, catheter care/maintenance, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drug and nursing visits coded separately), per diem. Used when catheter care is provided as a stand-alone therapy or during days not covered under per diem by another therapy. Simple (single lumen) S5498 $12.00 per day Complex (more than one lumen) S5501 $25.00 per day Supplies for restoration of catheter patency/declotting S5517 $30.00 Supplies for catheter repair S5518 $20.00 PICC Line insertion kit S5520 $ Midline insertion kit S5521 $80.00 Catheter care/maintenance S5497 $13.00 per day Catheter care/maintenance S5502 $25.00 per day These supplies are included in the daily Catheter Care rate (codes S5498 and S5501) and are not separately payable. Per Diem Code Modifiers Description Modifier % Discount Second therapy, concurrently or same day -SH 40% (payable at 60%) Third therapy, concurrently or same day -SJ 40% (payable at 60%) Modifiers to be used for patients receiving multiple concurrent therapies from the infusion fee schedule. Infusion Nursing Services Nursing Services Code Reimbursement Home infusion/specialty drug administration, per visit (up to 2 hours) $82.50 Each additional hour (use in conjunction with code 99601) $40.00 Home infusion/specialty drug administration, per visit (up to 2 hours) use to identify same day, separate visit * $82.50 Each additional hour (use in conjunction with code ) use to identify same day, separate visit $40.00 * units billed cannot exceed "1" 5

6 Preauthorization Please be advised that some of our Administrative Services Only (ASO) groups do require preauthorization for home infusion services. Please contact customer service to validate benefit and preauthorization requirements. Some drugs also require preauthorization. A current list of drugs requiring preauthorization appears below. This list changes often, and it is your responsibility to confirm the most current list of drugs that require preauthorization when rendering services Respiratory syncytial virus immune globulin (RSV-IgIM), for intramuscular use, 50 mg each J0585 Botulinum Toxin Type A, per unit [Botox] J0587 Botulinum Toxin Type B, per 100 units [Myobloc] J1566 Injection, immune globulin, intravenous, lyophilized (e.g., powder), 500 mg [Carimune NF, Panglobulin NF] J1568 Injection, immune globulin, (Octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg J1569 Injection, immune globulin, (Gammagard), intravenous, non-lyophilized, (e.g., liquid), 500 mg J1572 Injection, immune globulin, (Flebogamma), intravenous, non-lyophilized (e.g., liquid), 500 mg, (Flebogamma) J1745 Injection, Infliximab, 10 mg [Remicade] J1825 Injection, Interferon Beta-1a, 33 mcg [Avonex] J1830 Injection, Interferon Beta-1b, 0.25 mg [Betaseron] J1950 Injection, Leuprolide Acetate (for Depot Suspension), per 3.75 mg [Lupron Depot] J2323 Injection, natalizumab, 1 mg (Tysabri) J2357 Injection, Omalizumab, 5 mg [Xolair] J2503 Injection, pegaptinib sodium, 0.3 mg [Macugen] J2778 Injection, ranibizumab, 0.1 mg (Lucentis) J2941 Injection, Somatropin, 1 mg J3487 Injection, Zoledronic Acid, 1 mg [Zometa] J3488 Injection, zoledronic acid (Reclast), 1 mg (Reclast) J7321 Hyaluronan or derivative, Hyalgan or Supartz, for intra-articular injection, per dose (Hyalgan, Supartz) J7322 Hyaluronan or derivative, Synvisc, for intra-articular injection, per dose (Synvisc) J7323 Hyaluronan or derivative, Euflexxa, for intra-articular injection, per dose (Euflexxa) J7324 Hyaluronan or derivative, Orthovisc, for intra-articular injection, per dose (Orthovisc) J9035 Injection, Bevacizumab, 10 mg [Avastin] J9213 Interferon Alfa-2a, Recombinant, 3 million units [Roferon-A] J9214 Interferon Alfa-2b, Recombinant, 1 million units [Intron-A] J9215 Interferon Alfa-n3, Human Leukocyte Derived, 250,000 IU [Alferon N] J9216 Interferon Gamma-1B, 3 million units [Actimmune] J9310 Rituximab, 100 mg [Rituxan] Q4097 Injection, immune globulin (Privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg (Privigen) We recently advised you that we are requiring electronic funds transfer (EFT) and electronic remittance advice (ERA) effective July 1, 2009; this is a free service which provides a safer and quicker method of payment. To sign up, go to Your registration code appears on your paper vouchers. You will need your bank account and routing numbers in order to sign up for EFT. 6

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