The Medicare Home Infusion Therapy (HIT) Benefit and Home Health Agencies

If you are a home health agency (HHA) that wants to provide and bill the Medicare Home Infusion Therapy (HIT) professional services listed in MLN Matters Number: MM11880 in calendar year (CY) 2021 and beyond, you are required to enroll with the Part B Medicare Administrative Contractor (A/B MAC) in your state. HHAs will no longer be able to bill the professional HIT services listed in MM11880 on standard 837/CMS-1450 (UB-04) institutional claims form with their professional home health services.

Effective January 1, 2021, Section 5012(d) of the 21st Century Cures Act (Pub. L 114-255) amended sections 1861(s)(2) and 1861(iii) of the Social Security Act (the Act), requiring the Secretary to establish a new Medicare Home Infusion Therapy (HIT) services benefit. The Medicare HIT services benefit covers the professional services, including nursing services, furnished in accordance with the plan of care, patient training and education (not otherwise covered under the durable medical equipment benefit), remote monitoring, and monitoring services for the provision of home infusion drugs furnished by a qualified HIT supplier (suppliers must have specialty code D6).

MLN 11954 and related Change Request (CR) number 11954 informs MACs of the policies and procedures for enrolling HIT suppliers in Medicare. Payments will begin for dates of service on or after January 1, 2021.

HHAs, that enroll as qualified HIT suppliers, will need to continue submitting a standard 837/CMS-1450 institutional claims form for the professional home health services to the A/B MAC (HHH) and a separate 837P/CMS-1500 professional and supplier claims form for the professional HIT services to the A/B MAC.

During the HIT Services Temporary Transitional Payment period and prior to CY 2021, a home health agency was not considered an eligible home infusion supplier and therefore could not bill for the home infusion therapy services temporary transitional payment. However, if a patient was considered homebound and was under a Medicare home health plan of care, the HHA may have continued to furnish the professional services related to the administration of transitional home infusion drugs, in accordance with the Home Health Conditions of Participation (CoPs) and other regulations, as home health services and bill for such services as home health services under the Medicare home health benefit.

Resources

• MLN Matters Number: MM11880 – Billing for Home Infusion Therapy Services on or After January 1, 2021 (PDF, 240 KB)
• MLN Matters Number: MM11954 – Update to Chapter 10 of Publication (Pub.) 100-08 - Enrollment Policies for Home Infusion Therapy (HIT) Suppliers (PDF, 202 KB)
• Home Infusion Therapy Services Temporary Transitional Payment: Frequently Asked Questions (FAQs) (PDF, 103 KB)