Infusion Procedures for Pain Management, Oncology / Chemotherapy, Cardiovascular Inpatient Procedures, and Related DME
Pain Management Infusions
- Ketamine infusions
- Continuous epidural spinal infusion
Genetic Testing to Establish Eligibility for Monoclonal Antibody Infusions
Laboratory results including genetic testing to ascertain eligibility for oncology treatments including Keytruda which may be administered for patients receiving infusion treatments.[1]
Example: MSI-High genetic testing.[2], [3]
Physician Ordered Infusion Procedures Market and Expertise
Physician Orders in 2019 for Infusion Procedures for the U.S. totaled approximately $1 billion for Medicare insureds alone. Some of the top billed procedures where we have expertise:
| CPT / HCPCS Code(s) | Description | Number of Medicare Local Coverage Determinations (Medicare LCD s), Articles, and National Coverage Determinations (NCDs) |
| 96413 | Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug[4] |
LCDs = 6 [5] Articles = 25 NCDs = 0 |
| 96415 | CHEMO IV INFUSION ADDL HR | |
| 96360 | HYDRATION IV INFUSION INIT | |
| 96361 | HYDRATE IV INFUSION ADD-ON | |
| 62362 | IMPLANT SPINE INFUSION PUMP | |
| 96369 | SC THER INFUSION UP TO 1 HR | |
| 64463 | PVB THORACIC CONT INFUSION | |
| 96371 | SC THER INFUSION RESET PUMP | |
| J7120 | Ringers lactate infusion | |
| 96370 | SC THER INFUSION ADDL HR | |
| 64489 | TAP BLOCK BI BY INFUSION | |
| A4220 | Infusion pump refill kit | |
| 62365 | REMOVE SPINE INFUSION DEVICE | |
| J7070 | D5w infusion | |
| 64487 | TAP BLOCK UNI BY INFUSION |
Hospital Outpatient Infusion Procedures
Hospital outpatient procedures in 2019 for Infusion Procedures for the U.S. totaled approximately $5 billion for Medicare insureds alone. Some of the top billed procedures where we have expertise:
| HCPCS / CPT Code | Description |
| 96413 | Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug |
| 96361 | HYDRATE IV INFUSION ADD-ON |
| 96360 | HYDRATION IV INFUSION INIT |
| J7120 | Ringers lactate infusion |
| 96415 | CHEMO IV INFUSION ADDL HR |
| M0239 | Bamlanivimab-xxxx infusion |
| C1772 | Infusion pump, programmable |
| 62362 | IMPLANT SPINE INFUSION PUMP |
| C2626 | Infusion pump, non-prog,temp |
| 62361 | IMPLANT SPINE INFUSION PUMP |
| 62365 | REMOVE SPINE INFUSION DEVICE |
| 96369 | SC THER INFUSION UP TO 1 HR |
| J7070 | D5w infusion |
| M0245 | Monoclonal antibody infusions Bamlan and etesev infusion |
| 96370 | SC THER INFUSION ADDL HR |
| 62360 | INSERT SPINE INFUSION DEVICE |
| 96422 | CHEMO IA INFUSION UP TO 1 HR |
| C1891 | Infusion pump,non-prog, perm |
| 36262 | REMOVAL OF INFUSION PUMP |
| 96425 | CHEMOTHERAPY INFUSION METHOD |
| A4220 | Infusion pump refill kit |
| E0783 | Programmable infusion pump |
| 64489 | TAP BLOCK BI BY INFUSION |
| A4222 | Infusion supplies with pump |
| 64463 | PVB THORACIC CONT INFUSION |
| 64487 | TAP BLOCK UNI BY INFUSION |
Hospital Inpatient Infusion Procedures
Inpatient procedures billed using DRGs and ICD-10 PCS Codes
| ICD-10 PCS Code | ICD-10 PCS Procedure Code Description |
| 02HV33Z | Insertion of Infusion Device into Superior Vena Cava, Percutaneous Approach |
| 02H633Z | Insertion of Infusion Device into Right Atrium, Percutaneous Approach |
| 05HY33Z | Insertion of Infusion Device into Upper Vein, Percutaneous Approach |
| 05HM33Z | Insertion of Infusion Device into Right Internal Jugular Vein, Percutaneous Approach |
| 06HY33Z | Insertion of Infusion Device into Lower Vein, Percutaneous Approach |
| 05HB33Z | Insertion of Infusion Device into Right Basilic Vein, Percutaneous Approach |
| 05HC33Z | Insertion of Infusion Device into Left Basilic Vein, Percutaneous Approach |
| 06HM33Z | Insertion of Infusion Device into Right Femoral Vein, Percutaneous Approach |
| 00HU33Z | Insertion of Infusion Device into Spinal Canal, Percutaneous Approach |
| 05HN33Z | Insertion of Infusion Device into Left Internal Jugular Vein, Percutaneous Approach |
| 05H933Z | Insertion of Infusion Device into Right Brachial Vein, Percutaneous Approach |
| 02PY33Z | Removal of Infusion Device from Great Vessel, Percutaneous Approach |
| 02PYX3Z | Removal of Infusion Device from Great Vessel, External Approach |
| 05HA33Z | Insertion of Infusion Device into Left Brachial Vein, Percutaneous Approach |
| 03HB33Z | Insertion of Infusion Device into Right Radial Artery, Percutaneous Approach |
| 05PYX3Z | Removal of Infusion Device from Upper Vein, External Approach |
| 06HN33Z | Insertion of Infusion Device into Left Femoral Vein, Percutaneous Approach |
| 05H533Z | Insertion of Infusion Device into Right Subclavian Vein, Percutaneous Approach |
| 06H033Z | Insertion of Infusion Device into Inferior Vena Cava, Percutaneous Approach |
| 05HD33Z | Insertion of Infusion Device into Right Cephalic Vein, Percutaneous Approach |
| 03HC33Z | Insertion of Infusion Device into Left Radial Artery, Percutaneous Approach |
| 05HF33Z | Insertion of Infusion Device into Left Cephalic Vein, Percutaneous Approach |
| 0WPG03Z | Removal of Infusion Device from Peritoneal Cavity, Open Approach |
| 05H633Z | Insertion of Infusion Device into Left Subclavian Vein, Percutaneous Approach |
| 04HK33Z | Insertion of Infusion Device into Right Femoral Artery, Percutaneous Approach |
| 05H733Z | Insertion of Infusion Device into Right Axillary Vein, Percutaneous Approach |
| 05PY33Z | Removal of Infusion Device from Upper Vein, Percutaneous Approach |
| 02PAX3Z | Removal of Infusion Device from Heart, External Approach |
| å05H833Z | Insertion of Infusion Device into Left Axillary Vein, Percutaneous Approach |
| 02PA33Z | Removal of Infusion Device from Heart, Percutaneous Approach |
[1] According to Specialty Infusion and Pharmaceutical Guidelines: “The difference between an infusion and injection is the period of administration. On the one hand, injections are often done within minutes. On the other hand, infusions can take anywhere between 30 minutes to several hours.” See https://specialtyinfusion.com/2020/08/27/infusion-vs-injection/ and https://www.pharmaguideline.com/2018/08/difference-between-injection-and-infusion.html
[2] According to a now retired Article from Palmetto GBA, MAC Region I “FDA Approval of Keytruda (pembrolizumab) for Treatment of Unresectable or Metastatic Melanoma (A53794)”: “The U.S. Food and Drug Administration (FDA) has approved KEYTRUDA® (pembrolizumab) at a dose of 2 mg/kg every three weeks for the treatment of patients with unresectable melanoma or metastatic melanoma and disease progression following ipilimumab and, if BRAF V600 mutation positive, a BRAF inhibitor. KEYTRUDA® is a humanized monoclonal antibody that works by increasing the ability of the body’s immune system to fight advanced melanoma. KEYTRUDA blocks the interaction between PD-1 and its ligands, PD-L1 and PD-L2, and may affect both tumor cells and healthy cells. To bill Keytruda services, submit the following codes/information:
Submit HCPCS code J9999 Not Otherwise Specified, chemotherapy
CPT code 96413; Chemotherapy administration intravenous infusion technique up to one hour
ICD-9 Diagnoses code: 172.0-172.9
Drug name, the National Drug Code (NDC) number and total dosage must be indicated, along with the statement “ unresectable melanoma and progressive and previously treated with ipilimumab if BRAF positive.” For Paper claims, the documentation must be in Block 19. For electronic claims, effective with version 5010 implementation, Loop/Element 2400 SV101-7 must be completed for Not Otherwise Classified (NOC) codes. The required documentation (name, dosage and NDC) may be submitted in Healthcare HIPAA Transaction EDI claim Loop/Element 2400 SV101-7. If additional space is needed, Loop 2400 NTE 02 may be utilized in addition to SV101-7.”
[3] Pembrolizumab, sold under the brand name Keytruda, is a humanized antibody used in cancer immunotherapy that treats melanoma, lung cancer, head and neck cancer, Hodgkin lymphoma, stomach cancer, and cervical cancer. It is given by slow injection into a vein.
[4] An intravenous infusion of a chemotherapy substance or drug is administered for treatment of a malignant neoplasm. An intravenous line is placed into a vein, usually in the arm, and the specified chemotherapy agent is administered. The physician provides direct supervision of the administration of the chemotherapy agent and is immediately available to intervene should complications arise. The physician provides periodic assessments of the patient and documentation of the patient’s response to treatment. Use medical billing code code CPT 96413 for an intravenous infusion up to one hour of a single or initial chemotherapy substance or drug. Use add-on code 96415 for each additional hour of the chemotherapy substance or drug. Use 96416 for prolonged chemotherapy intravenous infusion of more than eight hours requiring the use of a portable or implantable pump. Use add-on CPT medical billing code code 96417 for an additional sequential infusion of a different substance or drug for up to one hour.
[5] Examples of Medicare Local Coverage Determinations pertaining to procedure code CPT 96413 “Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug” from Medicare Administrative Contractors Cigna and CGS Administrators.
- Medicare Local Coverage Determination L5861 Remicade ® (Infliximab)
- Medicare Local Coverage Determination L5957 Rituximab (Rituxan)
- Medicare Local Coverage Determination L9686 Remicade (Infliximab)
- Medicare LCD L12191 Remicade (Infliximab ®)
- Medicare LCD L12204 Rituximab (Rituxan ®)
- Medicare LCD L18591 Rituximab (Rituxan)
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