HCPCS Code S9500: Home Infusion Therapy, Antibiotic, Antiviral, or Antifungal Therapy; Once Every 24 Hours

If you're getting a lot of S9500 denials, read our guide, complete with billing and documentation tips. Get paid for every claim.

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## **What is HCPCS Code S9500?** The official long descriptor for HCPCS code S9500 is "Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 24 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem". It includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment, though the drugs and nursing visits are coded separately. This code is used on a per diem basis, covering the overall management and coordination aspects of home infusion therapy rather than the medication or nursing care directly. Notably, S9500 is recognized under the Home Therapy Services category. Use S9500 only in certain circumstances when the payer accepts S-codes; for Medicare beneficiaries, use the HIT G-codes (e.g., G0068–G0070) instead. However, it is important to note that Original Medicare (Part B) does not accept S-codes (including S9500) on professional claims. However, since Jan 1, 2021, Medicare pays for Home Infusion Therapy (HIT) services via Medicare-specific G-codes (e.g., G0068–G0070) for the professional services component. Drugs and most supplies are billed separately under their respective codes. S9500 remains a commercial/Medicaid per-diem code, not a Medicare Part B code.

## **HCPCS code S9500 documentation requirements** - Clinical documentation must show evidence of the infusion therapy, including the prescribed drug and frequency (once every 24 hours). - Documentation must support the administrative and professional services billed, such as care coordination activities and pharmacy services. For Medicare beneficiaries, do not use S9500—document and bill the Home Infusion Therapy (HIT) professional services using Medicare’s G-codes (e.g., G0068–G0070) instead; drugs and most supplies/equipment are billed separately under their own codes. - Records should clearly distinguish nursing visits and drug administration coded separately to avoid billing overlap. - Detailed clinical notes and coordination logs are required to justify medical decision-making complexity.

## **HCPCS code S9500 billing requirements** HCPCS code S9500 is indeed a per diem code for home infusion services involving antibiotic, antiviral, or antifungal drugs provided once every 24 hours. - The code covers administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment; notably, drugs and nursing visits are billed separately. - S9500 is part of the Temporary National Codes for Home Therapy Services and primarily designed for commercial payers, Medicaid, and government plans with explicit home infusion coverage. Medicare generally does not reimburse S9500. For Medicare HIT professional services, bill the appropriate Medicare G-codes (e.g., G0068–G0070) rather than S9500; bill drugs and most supplies/equipment separately per Medicare policy. - Claims must adhere to the specific fee schedules and payer agreements or regulations for these codes. - Accurate application of modifiers and appropriate place of service codes (e.g., POS 12 for home) is necessary per individual payer rules. Medicare HIT professional services use Medicare-specific G-codes and associated Medicare billing rules; S9500 and related S-codes are not payable by Original Medicare.

## **Other relevant codes** Here are relevant HCPCS codes related to HCPCS code S9500 with accurate descriptions: - **S9501**: Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 12 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem - **S9502**: Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 8 hours, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem - **S9503**: Home infusion therapy, antibiotic, antiviral, or antifungal; once every 6 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem - **S9497**: Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 3 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem - **S9345**: Home infusion therapy, anti-hemophilic agent infusion therapy (e.g., factor VIII); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem - **S9368**: Home infusion therapy, total parenteral nutrition (TPN); more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula (lipids, specialty amino acid formulas, drugs other than in standard formula and nursing visits coded separately), per diem - **S9810**: Home therapy; professional pharmacy services for provision of infusion, specialty drug administration, and/or disease state management, not otherwise classified, per hour (do not use this code with any per diem code) These codes represent different frequencies and types of home infusion therapies, covering administrative and professional pharmacy services, care coordination, supplies, and equipment (drugs and nursing visits are billed separately). They fall under Home Therapy Services HCPCS codes.

Frequently asked questions

HCPCS code S9500 is for home infusion therapy involving antibiotic, antiviral, or antifungal therapy provided once every 24 hours. It covers administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment, with drugs and nursing visits billed separately. This code is used per diem for home therapy services and indicates a high level of service complexity.

Medicare does not cover HCPCS code S9500. However, since January 1, 2021, Medicare pays for Home Infusion Therapy (HIT) professional services using Medicare-specific G-codes (e.g., G0068–G0070). Under Medicare, S9500 is not billable; instead, bill the HIT G-codes for the professional component and bill the drug and most supplies/equipment separately under their own codes.

HCPCS code S9500 is for home infusion therapy antibiotic, antiviral, or antifungal therapy provided once every 24 hours, including all necessary supplies and services. S9501 is similar but covers therapy administered once every 12 hours, reflecting a higher frequency of service.