CMS Clarifies Coding for Injection and Infusion Services

on Wednesday, 05 January 2011. All News Items

The 2011 CPT manual provided new guidance on the billing of drug administration (injection and infusion) services, specifically related to the billing of “initial” codes and date of service. In the January 2011 Update of the Outpatient Prospective Payment System (Transmittal 2130, CR 7271), CMS clarified that for billing Medicare, providers are to continue to follow existing drug administration rules as noted in the Medicare Claims Processing Manual, chapter 4, section 230.2. These rules state that:

  • Drug administration services are to be reported with a line-item date of service on the day the services are provided, and
  • Only one initial injection / infusion service should be reported per encounter (per vascular access site); all other injections and infusions through the same vascular access are to be reported with sequential, concurrent, or additional hour codes.

 It is unknown at this time which requirements payors other than Medicare will follow. MMP, Inc. will provide information to our clients as it becomes available.

Please feel free to contact us if you need additional information or have questions.

 MMP, Inc. contacts for Outpatient Services are:
Karen Northcutt          This email address is being protected from spambots. You need JavaScript enabled to view it.
Jeff Gordon                This email address is being protected from spambots. You need JavaScript enabled to view it.
Denise Weaver           This email address is being protected from spambots. You need JavaScript enabled to view it.
Debbie Rubio              This email address is being protected from spambots. You need JavaScript enabled to view it.

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