Home Infusion Billing Guidelines

If Blue Cross and Blue Shield of Nebraska (BCBSNE) is Primary:

When providing any services related to home infusion (enteral or IV therapy), the home infusion or HME provider must bill the appropriate S code. Because S codes include supplies and equipment and are paid on a per diem basis, providers must not line itemize or bill separately for any supplies or equipment. Equipment that is part of the per diem reimbursement includes, but is not limited to, pumps, poles, tubing and dressings for the IV site.

Home medical equipment or home infusion providers can line itemize any drugs or enteral formula on the same claim as the S code services. Nursing visits must be billed by the home health agency on a UB-04. 

If a home medical equipment, home infusion or pharmacy provider sends supplies or medications to a physician’s office that are dispensed to the member, they must have a financial arrangement with the physician’s office to obtain reimbursement from them.    

If Medicare is primary and BCBSNE is secondary (secondary plan or Medicare Supplement):

B codes are acceptable.

A home medical equipment provider who dispenses wheelchairs, canes, walkers, oxygen, etc. must bill these items with the appropriate HCPC code and modifier (-NU or –RR). 

The S (per diem) codes are payable regardless of whether the enteral nutrition is payable or not. 

The appropriate S code is billed in addition to the enteral nutrition codes as separate line items. 

If there is no appropriate code for a specific enteral formula, the product should be billed using the NDC number and an appropriate unlisted HCPCS code and number of cans (as units). Formulas with a specific HCPCS code should be billed using that code. Units should be calculated based on the description of the HCPCS code (e.g., 100 calories = one unit). 

All S code per diem charges must have the appropriate date span and units. Billing one date of care with multiple units will result in the claim being returned. 

Specialty tubing for enteral feeding is payable outside of the S (per diem) code and must be billed using appropriate HCPC code. Nasogastric tubing and extension tubing are part of the per diem.