Home Parenteral Nutrition
(1)Codes that have “PA” indicated require prior authorization. Codes with “BR” indicated are covered by report.
(2)Standard Total Parenteral Nutrition (TPN):
(a)Bill using Healthcare Common Procedure Coding System (HCPCS) codes S9365 through S9368;
(b)Home infusion for stand TPN includes the following drugs and products in the per diem rate:
(A)Non-specialty amino acids (e.g., aminosyn, freeamine, travasol)
(B)Concentrated dextrose (e.g., D10, D20, D40, D50, D60, D70)
(D)Electrolytes (e.g., CaC12, KCL, KPO4, MgSo4, NaAc, NaCl, NaPO4);
(E)Standard multi-trace elements (e.g., MTE4, MTE5, MTE7);
(F)Standard multi-vitamin solutions (e.g., MVI-13).
(c)The following items are not included in the per diem and should be billed separately:
(A)Specialty amino acids for renal failure, hepatic failure or for high stress conditions (e.g., aminess, aminosyn-RF, nephramine, RenAmin, HepatAmine, Aminosyn-HBC, BranchAmin, FreeAmine HBC, Trophamine);
(B)Specialty amino acids with concentrations of 15% and above when medically necessary for fluid restricted patients (e.g., Aminosyn 15%, Novamine 15%, Clinisol 15%);
(D)Added trace elements, vitamins not from standard multitrace element or multivitamin solution;
(E)Products serving non-nutritional purposes (e.g., heparin, insulin, iron dextran).
(2)Parenteral Nutrition Solutions:
(a)Bill using HCPCS codes B4164 through B5200. See HCPCS book for description.
(b)Note: Reimbursement for compounding, admixture and administrative fees is included in the unit price.
(3)Parenteral Supply Kits/Supplies — Procedure Codes
(4)Parenteral Nutrition Equipment — Procedure Codes — Table 0280-1.
(5)Not Otherwise Classified (NOC) — B9999, NOC For Parenteral Supplies — PA/BR.
Rule 410-148-0280 — Home Parenteral Nutrition,