Infusion Pump Billing Update
- September 16, 2016
- No responses
CMS recently provided additional clarification to MACs and providers regarding reimbursement for prolonged
drug and biological infusions that are started in the office or outpatient hospital and are associated with care that is
billed incident to a physician service using an external pump. In order for Medicare to pay for a drug or biological,
the physician or hospital (respectively) must incur a cost for the drug or biological. In the case where the infusion
is started in the office/hospital and the patient is sent home with an external pump, the drug or biological continues
to be covered and is billable to the A/B MAC even though the entire administration of the drug or biological did
not occur in the physician’s office or the hospital outpatient department.
In order for physicians and hospital outpatient departments to receive reimbursement for cost incurred for the
services above the instructions listed below should be followed.
Part B physician services
* Please continue to bill any applicable CPT or HCPCS codes for the drug or biological, and its administration.
* To bill for the use of the external pump, please submit using unlisted CPT code 96379 for a daily reimbursement
of the service.
* CPT code 96379 should be billed on a single line with a FROM and TO date and the corresponding number of
units (days) indicated in the appropriate field.
* The word “pump” must be notated in block 19 on the CMS-1500 claim form or the equivalent segment for
electronic claims submissions.
* If you have previously billed the drug and administration and are now needing to bill for the pump, bill only the
pump as a new claim. You do not need to rebill the administration and drug codes.
Part A hospital outpatient department
* Please continue to bill any applicable CPT® or HCPCS codes for the drug or biological, and its administration.
* To bill for the use of the external pump, please submit using unlisted CPT® code 96379 for a daily reimbursement of the service.
* CPT® code 96379 should be billed according to the date of receipt of the pump with the corresponding number of days indicated in the “Units” field.
* The word “pump” must be notated on page 07 and page 33 as the remark in the fiscal intermediary standard system.
* If adjusting a processed claim within timely filing period follow the normal adjustment process. Part A hospital outpatient department
The complete information can be found in MLN Matters® SE1609