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2025 HCPCS code S9497

Home infusion therapy for antibiotic, antiviral, or antifungal therapy administered every 3 hours, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem.

Certain insurances and Medicaid use S codes for supplies and services. Medicare does not recognize S codes. Check with individual payers for reimbursement requirements.

Medical necessity for this code must be supported by documentation justifying the need for home infusion therapy, the specific medication being administered, and the frequency of administration. The documentation must support that the patient's condition requires ongoing monitoring and care coordination, and that home infusion is a medically appropriate and cost-effective alternative to inpatient or other care settings.

This service involves a qualified physician who prescribes the medication, a closed-door pharmacy that prepares the medication, and nursing staff who may administer the medication or train the patient for self-administration. The care coordination ensures all aspects of the therapy are managed effectively.

IMPORTANT:For other home infusion therapies, see codes S9338 to S9368 and S9373 to S9379. For related provider visits such as nursing visits, see codes such as 99601 (Home infusion or specialty drug administration, per visit, up to 2 hours) and 99602 (Home infusion or specialty drug administration, per visit, up to 2 hours; each additional hour). Do not use with code S9494 (Home infusion therapy, antibiotic, antiviral, or antifungal therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment, drugs and nursing visits coded separately, per diem).

In simple words: This code covers the costs of setting up and managing home infusion therapy for infections, including the administrative, pharmacy, and coordination services, and the equipment needed to give the medicine through a needle or catheter every 3 hours at home. The cost of the medicine itself and nurse visits are billed separately.

This code covers home infusion therapy for the administration of antibiotic, antiviral, or antifungal medications every three hours. It includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment.The drugs themselves and nursing visits for administration are billed separately.This therapy is for complex infections requiring frequent administration of anti-infective medications.

Example 1: A patient with a severe bone infection requires long-term intravenous antibiotic therapy every 3 hours, which is administered at home., A patient with a compromised immune system develops a viral infection requiring antiviral medication every 3 hours, and home infusion is deemed the safest and most effective delivery method., A patient with a persistent fungal infection needs antifungal medication administered intravenously every 3 hours, and home infusion allows for better management of their condition outside of a hospital setting.

Documentation should include the physician's order for home infusion therapy, the type and frequency of medication administration, the plan for care coordination, and all necessary supplies and equipment provided.Nursing visit documentation, if applicable should also be included.

** This code is not recognized by Medicare and is primarily used by other payers, such as private insurance and Medicaid.Always check with individual payers for their specific coverage and reimbursement policies.

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