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2025 HCPCS code S9504

Home infusion therapy for antibiotic, antiviral, or antifungal drugs administered every 4 hours, including administrative, pharmacy, and care coordination services (drugs and nursing visits billed separately), per diem.

This code is for non-Medicare payers. 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 S9504 must be supported by documentation demonstrating that the patient requires long-term, frequent (every 4 hours) administration of anti-infective medication, and that this therapy is safely and effectively administered in the home setting.

This service involves a qualified physician prescribing the medication, a closed-door pharmacy preparing it, and nursing staff administering or training the patient for self-administration.

IMPORTANT:For other home infusion therapies, see codes S9338-S9368 and S9373-S9379.For nursing visits, see codes like 99601 and +99602. Do not use with S9494.

In simple words: This code covers the behind-the-scenes services to provide medicine through a needle or tube at home for infections, every four hours. It includes the planning, pharmacy preparation, and coordination of care, along with any necessary supplies.The medicine itself and nurse visits are billed separately.

This code covers the administrative, professional pharmacy, and care coordination services associated with home infusion therapy for antibiotic, antiviral, or antifungal drugs administered every four hours.It includes all necessary supplies and equipment for the therapy.The drug itself and nursing visits for administration are billed separately.

Example 1: A patient with a severe bone infection requires long-term intravenous antibiotics every 4 hours, administered at home., A patient with a compromised immune system develops a viral infection requiring antiviral medication every 4 hours via a catheter at home., A patient with a persistent fungal infection receives antifungal medication every 4 hours via home infusion.

Documentation should include the physician's order for home infusion therapy, the type and frequency of medication, the pharmacy compounding record, the plan of care, and any instructions for self-administration or nurse visits.The diagnosis necessitating home infusion should also be clearly documented.

** This code is specific to the administrative, pharmacy, and coordination aspects of home infusion therapy.It does not include the cost of the drug, supplies, equipment, or nursing services, which must be coded separately. Be sure to confirm coverage and reimbursement policies with individual payers, as S-codes are not universally recognized.

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