(Medicare Claims Processing Manual)

Table 1 shows  the time increments  providers  should report  visit length in  15-minute  increments  (15 minutes  = 1 unit). See  the table  below  for the  rounding of units:   Table  1: Time  Increments   Unit Time  1 <23 minutes  2 = 23 minutes  to <38  minutes  3 = 38 minutes  to <53  minutes  4 = 53 minutes  to <68  minutes  5 = 68 minutes  to <83  minutes  6 = 83 minutes  to <98  minutes  7 = 98 minutes  to <113  minutes  8 = 113 minutes  to <128  minutes  9 = 128 minutes  to <143  minutes  10 = 143 minutes  to <158  minutes   Table 2 shows the  use of the  three G-codes  established  for the  home  infusion therapy  benefit,  and reflects the  therapy  type and complexity of the drug administration.   Table  2: Payment  Categories  for Home  Infusion  Therapy  Professional  Services  (G-Codes)    Category  1 Category  2 Category  3 Description    G-Code  Intravenous anti -infective,  pain management, chelation, pulmonary hypertension,  inotropic, and other certain intravenous  infusion drugs  Subcutaneous  immunotherapy and other certain  Subcutaneous infusion drugs  Chemotherapy and other certain  highly complex intravenous  drugs  Initial  Visit  G0088  G0089  G0090  Subsequent  Visit  G0068  G0069  G0070   Table 3 provides  a list of  J-codes  associated  with the home  infusion drugs  that fall within  each category.   Table  3: Payment  Categories  for Home  Infusion  Drugs  (J-Codes)   Category  1 J-Code  Description  J0133  Injection,  acyclovir,  5 mg J0285  Injection,  amphotericin  b, 50 mg J0287  Injection,  amphotericin  b lipid complex,  10 mg J0288  Injection,  amphotericin  b cholesteryl  sulfate  complex,  10 mg J0289  Injection,  amphotericin  b liposome,  10 mg J0895  Injection,  deferoxamine  mesylate,  500 mg J1170  Injection,  hydromorphone,  up to 4 mg J1250  Injection,  dobutamine  hydrochloride,  per 250 mg J1265  Injection,  dopamine  hcl, 40 mg J1325  Injection,  epoprostenol,  0.5 mg J1455  Injection,  foscarnet  sodium,  per 1000  mg J1457  Injection,  gallium  nitrate,  1 mg J1570  Injection,  ganciclovir  sodium,  500 mg  J2175  Injection,  meperidine  hydrochloride,  per 100 mg J2260  Injection,  milrinone  lactate,  5 mg J2270  Injection,  morphine  sulfate,  up to 10 mg  J3010  Injection,  fentanyl citrate,  0.1 mg J3285  Injection,  treprostinil,  1 mg Category  2 J-Code  Description  J1551 JB  Injection, immune globulin (cutaquig), 100mg  J1555  JB Injection,  immune  globulin  (cuvitru),  100 mg J1558  JB Injection,  immune  globulin  (xembify),  100mg  J1559  JB Injection,  immune  globulin  (hizentra),  100mg  J1561  JB Injection,  immune  globulin,  (gamunex -c/gammaked),  non-lyophilized  (e.g. liquid),  500 m J1562  JB Injection,  immune  globulin  (vivaglobin),  100 mg J1569  JB Injection,  immune  globulin,  (gammagard  liquid), non -lyophilized,  (e.g.,  liquid),  500 mg J1575  JB Injection,  immune  globulin/hyaluronidase,  (hyqvia),  100 mg immune  globulin  J7799  JB This NOC  code  may be used to identify  the subcutaneous  immune  globulin (cutaquig)  Category  3 J-Code  Description  J9000  Injection,  doxorubicin  hydrochloride,  10 mg J9039  Injection,  blinatumomab,  1 microgram  J9040  Injection,  bleomycin  sulfate,  15 units  J9065  Injection,  cladribine,  per 1  mg J9100  Injection,  cytarabine,  100 mg  J9190  Injection,  fluorouracil,  500 mg J9360  Injection,  vinblastine  sulfate,  1 mg J9370  Injection,  vincristine  sulfate,  1 mg  The payment category may be determined by the contractor for any new home infusion drug additions to the Local Coverage Determination (LCD) for External Infusion Pumps as identified by the following not- otherwise- classified (NOC)  codes :  - J7799 - Not otherwise classified drugs, other than inhalation drugs, administered through DME  - J7999 - Compounded drug, not otherwise classified   411.4 - Billing and Payment Requirements  (Rev. 10269, Issued: 08-07-2020, Effective: 01- 01-2021, Implementation: 01-04-2021)  Contractors shall accept and pay for home infusion therapy services to eligible home infusion therapy suppliers (new specialty D6 ) effective for claim lines with dates of service on or after January 1, 2021 using the one of the following G codes and applicable J codes listed in section 411.3 of this chapter. Claims for the home infusion therapy service G -codes are billed to the A/B MACs and are payable to home infusion therapy suppli ers; this service is no longer payable to DME suppliers.  The applicable J codes are billed to the DME MACs by the DME supplier.  Contractors shall use Type of Service (TOS) Code 1 for all six G -codes.  Contractors shall pay only one of the G -codes per line item date of service when one of the drugs from the applicable category is billed with the same line item date of service or a d ate of service within 30 days prior to the G -code visit.    NOTE:   The fees associated with the G -codes on the MPFSD fee file will be a per day rate; therefore, the units on the line should not be multiplied by the rate.  The drug remains separately payable from the G -code line item  Home infusion therapy suppliers will report the following HCPCS G -codes associated with the payment categories for the professional services furnished in the individuals home and on an infusion drug administration calendar day.    Because the home infusion therapy services are contingent upon a home infusion drug J -code, home infusion therapy suppliers must ensure that the appropriate drug associated with the visit is billed no more than 30 days prior to the visit. In the event that multiple visits occur on the same date of service, or multiple drugs, which are not all ass igned to the same payment category, are administered on the same infusion drug administration calendar day, a single payment would be made that is equal to the highest payment category. Suppliers must only bill for one visit and should report the highest paying visit with the applicable drug.    To differentiate the first visit from all subsequent visits, h ome infusion therapy suppliers may only bill one of the initial visit G -codes to indicate an visit for a new patient who had previously received their last home infusion therapy service visit more than 60 days prior to the new initial home infusion therapy service visit.    Home infusion therapy suppliers should report visit length in 15- minute increments (15 minutes=1 unit). See the Table 1 below for the rounding of units.      Table 1: Time Increments   Unit  Time  1 <23 minutes  2 = 23 minutes to <38 minutes  3 = 38 minutes to <53 minutes  4 = 53 minutes to <68 minutes  5 = 68 minutes to <83 minutes  6 = 83 minutes to <98 minutes  7 = 98 minutes to <113 minutes  8 = 113 minutes to <128 minutes  9 = 128 minutes to <143 minutes  10 = 143 minutes to <158 minutes    Table 2 shows the use of the G-codes established for the home infusion therapy benefit, and reflects the therapy type and complexity of the drug administration.   Table 2: Payment Categories for Home Infusion Therapy Professional Services (G-Codes)     Category 1  Category 2  Category 3  Description     G-Code  Intravenous anti- infective, pain management, chelation, pulmonary hypertension, inotropic, and other certain intravenous infusion drugs  Subcutaneous immunotherapy and other certain Subcutaneous infusion drugs  Chemotherapy and other certain highly complex intravenous drugs Initial Visit  G0088  G0089  G0090  Subsequent Visit  G0068  G0069  G0070    G0068: Professional services for the administration of anti- infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each infusion drug administration calendar day in the individuals home, each 15 minutes  Short Descriptor: Adm IV infusion drug in home   G0069: Professional services for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes  Short Descriptor: Adm SQ infusion drug in home    G0070: Professional services for the administration of intravenous chemotherapy or other intravenous highly complex drug or biological infusion for each infusion drug administration calendar day in the individual's home, each 15 minutes.   Short Descriptor: Adm of IV chemo drug in home    G0088: Professional services, initial visit, for the administration of anti- infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biologic al) for each infusion drug administration calendar day in the individuals home, each 15 minutes.   Short Descriptor:  Adm IV drug 1st home visit     G0089: Professional services, initial visit, for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes.   Short Descriptor:  Adm SubQ drug 1st home visit    G0090: Professional services, initial visit, for the administration of intravenous chemotherapy or other highly complex infusion drug or biological for each infusion drug administration calendar day in the individual's home, each 15 minutes.   Short Descriptor:  Adm IV chemo 1st home visit   411.5  Claim Adjustment Reason Codes, Remittance Advice Remark Codes, Group Codes, and Medicare Summary Notice Messages  (Rev. 10269, Issued: 08- 07-2020, Effective: 01 -01-2021, Implementation: 01- 04-2021)   Contractors shall deny the CWF rejected claim if a new G -code is received for the same date of service as a previous claim was paid for the same line item date of service.   NOTE: The provider should submit an adjustment to the original claim to receive the higher payment.     Contractors shall use the following CARC/RARC codes when denying claims:   CARC 97 -  The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.   RARC N111 -  No appeal right except duplicate claim/service issue. This service was included in a claim that has been previously billed and adjudicated.   Claim Adjustment Group Code -  CO (Contractual Obligation)   MSN message: 41.14: This service/item was billed incorrectly. 41.14-  Este servicio o artculo fue facturado incorrectamente.   Contractors shall deny the CWF rejected G -code line when the claim has recycled three times without finding the associated drug J -code claim and use the following messages: