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2025 HCPCS code S9328

Home infusion therapy for implanted pump pain management, including administrative, pharmacy, and coordination services, but excluding drugs and nursing visits (coded separately), per diem.

This HCPCS code is not payable by Medicare.Consult payer-specific guidelines for reimbursement policies and specific requirements.Drugs and nursing visits must be billed separately.

Modifiers may be applicable depending on the circumstances. Consult payer-specific guidelines.

Medical necessity for S9328 is established by a documented need for continuous or intermittent pain management via an implanted pump at home, and appropriate clinical justification for the use of the pump as part of the patient's overall care plan.

The clinical responsibility for this code rests with the physician overseeing the pain management plan and the home infusion therapy team. This includes ordering the therapy, monitoring the patient's response, and adjusting the medication regimen as needed.

IMPORTANT:Related codes include S9326 (continuous infusion) and S9327 (intermittent infusion) for pain management via home infusion therapy.These codes should not be used concurrently with S9328.

In simple words: This code covers the daily costs of managing pain with a surgically implanted pump that delivers medicine directly into your bloodstream at home.It doesn't include the cost of the medicine itself or the nurses' visits; those are billed separately.

This HCPCS code, S9328, encompasses home infusion therapy services for managing pain via an implanted infusion pump.It includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment.However, it explicitly excludes the cost of drugs and nursing visits, which require separate coding. The service is billed per diem.

Example 1: A patient with chronic back pain receives an implanted pump for continuous pain management at home. S9328 is used daily for the administrative and supply aspects of the therapy., A cancer patient undergoing palliative care uses an implanted pump for end-of-life pain relief. The daily cost of the implanted pump and associated services are billed using S9328., A patient recovering from major surgery uses an implanted pump for postoperative pain management.S9328 is used to bill for the daily administrative, pharmacy, and care coordination support associated with the therapy at home.

Comprehensive documentation is required, including the patient's pain management plan, details of the implanted pump system, and daily logs reflecting the amount of medication delivered and the patient's response.Physician orders, nursing notes, and pharmacy records should be included.

** S codes are temporary codes established by BCBSA and HIAA for private payer use and are not valid or payable by Medicare.Always verify payer-specific coding guidelines and reimbursement policies before submitting claims.

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