HCPCS code S9338: Home infusion therapy, immunotherapy, administrative services, per diem

Learn more about HCPCS code S9338, its documentation and billing requirements, for proper use and billing.

## **What is HCPCS code S9338?** The HCPCS code description of S9338 is as follows: Home infusion therapy, immunotherapy, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem. It is a temporary national code used to bill for home infusion therapy specifically for immunotherapy. It's a "per diem" code, meaning it covers a day's worth of services, not a specific duration of time. The code bundles together several services and supplies, including: - **Administrative services**: These include a wide range of activities, from patient admission and medical record management to verifying insurance eligibility and obtaining prior authorizations. - **Professional pharmacy services**: This covers the pharmacist's role, such as setting up the medication profile, monitoring for drug interactions, and compounding medications. - **Care coordination**: This includes communicating with the patient, their family, other healthcare professionals, and case managers. - **All necessary supplies and equipment**: This encompasses items like infusion pumps, IV catheters, medication bags, and sterile supplies. It's important to note that S9338 does not cover the drug itself or nursing visits, which must be billed separately using their own specific codes. It is a non-Medicare code, meaning it is not used for Medicare billing.

## **HCPCS code S9338 documentation requirements** Thorough and accurate documentation is essential for billing HCPCS code S9338 and ensuring a smooth claims process. Key documentation requirements include: - **Original medication order**: The claim must be supported by the physician's order for the specific immunotherapy. - **Plan of care/treatment plan**: A detailed plan outlining the patient's treatment, including dosages, frequency, and monitoring requirements. - **Pharmacy order preparation notes**: Records from the pharmacy detailing how the medication was prepared, compounded, and a drug utilization review was conducted. - **Medication Administration Records (MARs)**: A log showing when the medication was administered, who administered it, and any notes on the patient's reaction. - **Delivery/shipment information**: If applicable, documentation of the delivery of supplies and equipment to the patient's home. - **Care coordination records**: Notes on communications with the patient and other healthcare providers regarding care coordination and patient education.

## **S9338 billing requirements** Proper billing for HCPCS S9338 involves adhering to the following specific guidelines to avoid claim denials: - **Place of service (POS)**: Claims for home infusion therapy must be billed with the place of service code for a patient's home (POS code 12). - **Per diem basis**: This code is billed on a per diem basis, meaning you can only bill it on days when an actual drug infusion is administered. - **Separate billing**: Remember to bill for the drug and nursing visits separately. S9338 is only for the administrative and supply-related components. - **Prior authorization**: Many private payers and some state Medicaid programs require prior authorization for S9338, as it is a specialty service. - **Modifiers**: Depending on the specific circumstances, modifiers may be used. For example, some payers may require the use of specific modifiers like "-SD" for specialized, high-tech services, or "-SS" if a service is performed in an ambulatory infusion suite.

## **Other related codes** - **S9336**: Home infusion therapy for continuous anticoagulant infusion - **S9345**: Home infusion therapy for anti-hemophilic agent infusion

Frequently asked questions

No. HCPCS S codes are part of the Temporary National Codes and are generally used by private insurance companies and state Medicaid programs. Medicare has its own set of codes (G-codes) for home infusion therapy services.

The code is a bundled service that covers the administrative, pharmacy, and care coordination services, as well as the supplies and equipment needed for a day of home infusion immunotherapy. It does not include the drug or the nursing visit.

Yes. The nursing visit and the drug are billed separately from S9338. The HCPCS S9338 code covers the administrative and supply-related per diem costs. The nursing visit would be billed using the appropriate CPT or HCPCS code.