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May 2011
Clinical Practice Management
Coding for Outpatient Infusion Therapy with Portable Pumps

IDSA has learned that some ID practices outfit Medicare patients with preprogrammed portable pumps to administer antibiotic therapy, using current procedural terminology (CPT) code 96521.  Use of this code may be a legitimate way that some practices provide outpatient therapy to Medicare beneficiaries, given the Centers for Medicare and Medicaid Services’ (CMS) lack of coverage for home infusion services. 

However, IDSA has received reports that while some Medicare Administrative Contractors pay for intravenous antibiotic therapy services billed in this way, others are denying payment.

Last year, the Society sought clarification from the Medicare contactor that oversees the National Correct Coding Initiative (NCCI) on how these services should be billed but did not receive a definitive answer on the issue. As this remains a gray area under current Medicare payment policy, IDSA recommends caution in using the 96521 code for IV antibiotic therapy.

It is important to note that a denial of payment from Medicare for a service associated with this code could lead to not only the recovery of payment for that service and associated medication “J” codes, but also for past services billed and medications provided.

IDSA has long championed extending coverage of home infusion therapy to Medicare beneficiaries and will continue to monitor this issue. The Society and other advocates believe that these services reduce hospital stays, decrease costs, and keep patients out of the hospital, putting them at less risk for hospital-acquired infections. See IDSA’s website for more information.
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