NHIA secures coding changes to modernize benefit 

ALEXANDRIA, Va. - The National Home Infusion Association has successfully petitioned CMS to secure a new billing code for injectable immunotherapies and revise an existing code to facilitate administration of a wider range of monoclonal antibodies for respiratory syncytial virus (RSV). 

The request is part of a broader effort to modernize the Healthcare Common Procedure Coding System used by commercial health plans, including some Medicare Advantage and Medicaid programs, to reimburse for infusion services.  

“NHIA appreciates that CMS is acknowledging the broader range of medications being administered in the home setting by creating this new code,” said NHIA President and CEO Connie Sullivan, BSPharm. “Payors and providers should work to incorporate these changes into their home and alternate site infusion contracts.”   

CMS has established a new HCPCS Level II code, S9563, “Home injectable therapy, immunotherapy, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem.”   

It has also revised the HCPCS Level II code S9562, “Home injectable therapy, palivizumab, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem” to read “Home injectable therapy, palivizumab or other monoclonal antibody for RSV, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem.”   

The NHIA says without a code to use for newly approved therapies, providers were forced to use “not otherwise classified,” or NOC codes, which have several disadvantages for both providers and payers. 

“The association plans to submit additional code requests in the future to ensure that coding and claims practices accurately reflect the services delivered by home and alternate site infusion providers,” said Bill Noyes NHIA’s senior vice president of reimbursement policy.