Menu
In addition to providing infusion therapy in patients’ homes, many infusion providers also operate a health care facility called the Ambulatory Infusion Suite, or AIS. Home infusion therapy providers offer infusion suite services to supplement home-based services to initiate a new therapy, facilitate learning self-administration, or when a patient prefers an office-type environment to receive their infusion. Insurance plans with site-specific coverage are another reason patients may choose to receive care in an infusion suite.
An AIS is owned and operated by a home infusion pharmacy. Clinical care, provided pursuant to physician orders, is managed and performed by registered nurses and pharmacists who are highly skilled in provision of infusion/specialty drug administration.
Due to the cost-effectiveness of this care model and its appropriateness for use with certain patient-therapy situations, the number of new AIS facilities is growing. In its 2020 Trends Report, the National Home Infusion Foundation found that 71% of infusion pharmacy locations have a suite. The number of chairs managed varied from 1 to 20 per location with an average of 3.4 chairs. NHIF believes this trend is being driven by the growth in specialty drugs such as monoclonal antibodies, enzyme therapies, and biosimilars, which are conducive to a suite model due to their shorter infusion times, intermittent administration schedules, and the ability to maximize nursing efficiency.1
1 National Home Infusion Association (NHIA). Infusion Industry Trends 2020. NHIA 2020, Alexandria, VA.
An AIC is an outpatient clinic that provides infusion therapy services as part of, or “incident to,” other services being provided by a physician or nurse practitioner.
When setting up an AIC, where a physician or nurse practitioner is the provider, the payor is contracting with the provider under their National Provider Number (NPI), not with the pharmacy. When it comes to billing, the AIC uses a place of service code 11 (physician’s office), and the services are provided under the supervision of the physician or nurse practitioner. Also, the services the AIC bills for consist of the drug and a CPT® administration code (instead of a per diem code as with traditional home infusion services).
The business structure of these entities is important because it dictates how services will be provided, billed, and reimbursed, however the services to the patient are essentially the same in terms of drug administration.
While infusion services provided in the AIS and AIC can be billed to commercial insurance, Medicare only covers infusion services provided in the AIC as they are provided “incident to” a physician. For the AIS, Medicare may cover drug cost under Part D, but infusion equipment and supply costs are excluded and may need to be covered by the patient.
CMS defines “incident to” as: “Services or supplies that are furnished incident to a physician’s professional services when the services or supplies are furnished as an integral, although incidental, part of the physician’s personal professional services in the course of diagnosis or treatment of an injury or illness and services are performed in the physician’s office or in the patient’s home. To qualify for payment under the incident to rules, services must be part of the patient’s normal course of treatment, during which a physician personally performed an initial service and remains actively involved in the ongoing course of treatment.” 2
2 CMS Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 60. https://med.noridianmedicare.com/web/jeb/topics/incident-to-services
Resources
NHIA Reference for Ambulatory Infusion Suite (AIS) & Ambulatory Infusion Center (AIC) Coverage
This NHIA member only reference is intended to delineate the key differences between Ambulatory Infusion Suites and Ambulatory Infusion Centers from a structural and operational standpoint as well as variations in provider enrollment, coding, and payor coverage between each.
