OAR 410-148-0280
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)

(C)

Sterile water;

(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%);

(C)

Lipids

(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.
[ED. NOTE: Tables referenced are available from the agency.]

Source: Rule 410-148-0280 — Home Parenteral Nutrition, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=410-148-0280.

Last Updated

Jun. 8, 2021

Rule 410-148-0280’s source at or​.us