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2025 HCPCS code S5523

Nursing services for inserting a midline venous catheter; excludes supplies and catheter.

Refer to CMS guidelines and payer-specific policies for home healthcare and infusion therapy for precise coding and reimbursement requirements.

Modifiers may be applicable depending on the circumstances of service. Consult the official HCPCS codebook and payer guidelines for appropriate modifier usage.

The medical necessity for a midline catheter and home infusion therapy should be documented in the patient's medical record, based on the patient's condition, clinical presentation, and need for prolonged infusion of medications or nutrients.

Registered Nurse or other qualified healthcare professional experienced in vascular access procedures.

IMPORTANT:S5521 (Home infusion therapy, all supplies including catheter, necessary for midline catheter insertion) should be used for supplies and the catheter itself.

In simple words: This code covers the nurse's work to place a special tube (catheter) into a vein for giving medicine or fluids over several weeks at home. The cost of the tube and other supplies are not included.

This HCPCS code encompasses the nursing services required to insert a midline venous catheter.A midline catheter provides access for medium-term (1-8 weeks) infusion therapy.The insertion site may be a vein on the back of the hand, inner elbow, or shoulder region; the catheter tip should not extend beyond the axillary vein.This code only covers nursing services; supplies and the catheter itself are billed separately.

Example 1: A 65-year-old patient with recurrent CLL requires long-term chemotherapy administration at home.S5523 is used to bill for the nurse's services to insert the midline catheter., A pediatric patient with a nutritional deficiency needs home parenteral nutrition.S5523 covers the nurse's insertion of the midline catheter used for this treatment., An adult patient receiving antibiotic therapy for osteomyelitis at home needs a midline venous catheter. S5523 is used to bill for the insertion of the catheter by a certified home health nurse.

* Patient's medical record indicating the need for a midline catheter and home infusion therapy.* Documentation of the nurse's assessment, procedure notes for catheter insertion, and verification of the catheter's correct placement.* Physician's order for the procedure and any post-insertion instructions.

** This code is for nursing services only.Always refer to the most current HCPCS codebook and payer-specific guidelines for precise coding.

** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.

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