2025 HCPCS code S9326
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Home Healthcare - Home Infusion Therapy Temporary National Codes (Non-Medicare) Feed
Home infusion therapy, continuous (24 hours or more) for pain management; includes administrative, pharmacy, coordination services, supplies, and equipment (drugs and nursing visits are coded separately), per diem.
Modifiers may apply depending on circumstances (e.g.,different providers involved). Consult local payer guidelines.
Home infusion therapy must be medically necessary for the patient's condition, and continuous infusion must be clinically indicated.Documentation should support that alternative methods of pain control were unsuccessful or inappropriate.The patient's medical status needs to justify the need for home infusion therapy versus other treatment modalities.
The clinical responsibility for this code rests primarily with the physician overseeing the patient's pain management plan, along with the home infusion therapy provider responsible for the administration of the medications and overall care coordination.
In simple words: This code covers the daily cost of a special type of home treatment where pain medicine is given continuously through a tube for 24 hours or more. It includes costs for planning, pharmacy services, supplies, and equipment.The cost of the medicine itself and nurse visits are billed separately.
This HCPCS code encompasses all aspects of daily home infusion therapy services for pain management that is continuous for 24 hours or more.The code includes administrative services, professional pharmacy services, care coordination, and all medically appropriate and necessary supplies and equipment.It does not cover drugs and nursing visits, which are coded separately.Infusion refers to medication administration via gravity drainage through a catheter. This therapy may be used for end-of-life pain relief, postoperative pain management, or chronic pain management to improve quality of life.The code is used for each day of continuous home infusion therapy for pain management.
Example 1: A 78-year-old patient with metastatic cancer is receiving continuous home infusion of morphine sulfate for pain management. Code S9326 is reported each day of the continuous therapy.The morphine itself is reported separately., A 55-year-old patient has undergone major abdominal surgery. For the first few days following surgery, they require continuous home infusion of fentanyl for severe postoperative pain. Code S9326 is reported for each day of continuous infusion. Medications are reported separately. , A 42-year-old patient with chronic back pain is receiving continuous home infusion of a pain medication cocktail. Code S9326 is reported for each day of the continuous infusion. The medication and nursing visits are billed under separate codes.
Physician orders specifying the medication, dosage, and infusion rate.Patient's medical history and reason for home infusion therapy.Daily progress notes documenting the infusion administration and patient's response to therapy.Documentation of all supplies and equipment used.Records of any medication adjustments made.Nursing notes and visit documentation (coded separately).
** This code is not payable by Medicare.Private payers and Medicaid may have specific requirements for use and reimbursement.Always refer to the most up-to-date payer guidelines and coding manuals.
- Global Days: Per diem billing; one code per day of continuous infusion.
- Payment Status: Active (Non-Medicare)
- Specialties:Pain Management, Oncology, Palliative Care, Anesthesiology, Surgery
- Place of Service:Home