Medicare’s fee-for-service program (Parts A, B and D) is the only major health plan in the country that does not offer comprehensive coverage for most infusions done in a patient’s home. Medicare coverage for home infusion is fractured across multiple contractors and benefits, each with its own rules and billing pathways. Although NHIA’s home infusion drug list includes more than 300 drugs, the Medicare DMEPOS benefit covers just over 35 DMEinfused drugs, a limited number of PN ingredients, and IVIG products—less than a quarter of the full list. With narrow coverage and very specific requirements, understanding Medicare’s policies is essential for accurate billing and successful reimbursement. Use this page to access quick code references, coverage guidance, and tools that simplify the Medicare billing process.
Guide for Billing Medicare Part B for Home Infusion Therapy Services G-Codes
Members Only
The Medicare Part B HIT Services is very limited in scope, applying only to a subset of the DME infused Supported by drugs covered under the external infusion pump benefit. While both are Part B benefits, the HIT services benefit is separate from the DMEPOS benefit, requiring different accreditation, enrollment, documentation, and billing procedures.
Guide for Billing Medicare Equipment and Supply Codes
Members Only
Per HIPAA regulation, providers and payers must use national standard codes and conform to HCPCS and CPT® code descriptions which may not be changed. While most infusion claims are billed with HCPCS per diem S-codes, others need to be billed using supply and equipment codes.
2026 Changes in Medicare
Members Only
Quick reference to the most important Medicare payment and pricing changes taking effect in 2026, including updated Medicare deductibles and premiums, current Home Infusion Therapy Services (HITS) professional payment rates (including initial visit and IVIG services), and a summary of the drugs selected for Medicare’s 2026 Drug Price Negotiation Program.
Medicare Advocacy Efforts
While Congress intended to create a comprehensive Medicare home infusion benefit for Part B DME drugs in the 21st Century Cures Act, flawed implementation by CMS has led to limited access for Medicare beneficiaries. The Preserving Patient Access to Home Infusion Act would restore congressional intent and promote access to home-based care by mirroring the successful model employed by nearly every U.S. commercial plan.
Currently under construction for updates and revisions
NHIA’s Payer Advocacy and Relations Committee (PAR) and the Medicare Contractors Advisory Committee (MCAC) is working to update the Medicare Resource Center and provide centralized information specific to Medicare Documentation, Appeals and Audits. The information and resources here are intended to assist NHIA members in understanding documentation requirements as well as how to prepare for and respond to various types of audits. If you have questions or comments please contact Bill Noyes at bill.noyes@nhia.org or 703-838-2661.
Medicare’s documentation policies are strict and are not all located in the same manual, or even the same web site. CMS has made it clear that suppliers “should know” what is required in relation to documentation. NHIA’s Payer Advocacy and Relations Committee (PAR) and the Medicare Contractors Advisory Committee (MCAC) is working to update the Medicare Resource Center. reorganize and provide information specific to Medicare Documentation, Appeals and Audits. The information and resources here are intended to assist NHIA members in understanding documentation requirements as well as how to prepare for and respond to various types of audits. If you have questions or comments please contact Bill Noyes at bill.noyes@nhia.org or 703-838-2661.