Working to Achieve Nationally Standardized, Sensible Electronic Claiming and Coding for Home Infusion
Standardized electronic claiming and coding for home infusion is one of NHIA’s top priorities and our hard work on this important issue brought about a significant victory in 2001 when the federal government’s HCPCS administrators published national standardized coding for home infusion therapy services effective in January of 2002. Since then, the HCPCS per diem S-code system has been widely adopted by commercial payers and some government payers throughout the nation. These codes are compliant with federal Health Insurance Portability and Accountability Act (HIPAA) regulations that mandate that all public and private payers use “approved” standardized coding for all of their health care transactions.
To help payers and providers of home infusion services comply with these requirements, in January 2002 NHIA released its first version of the educational resource, the NHIA National Coding Standard for Home Infusion Claims Under HIPAA.
The 2026 NHIA National Coding Standard has been updated to include new home infusion service codes and changes to the description of existing codes. These changes were a result of NHIAs ongoing efforts to modernize the home infusion code set to reduce the need to utilize not otherwise classified (NOC) codes by expanding the code set to account for newer drug therapies that have come to market since the S-code set was first introduced 20+ years ago. Significant changes from the previous version are highlighted in red within the document.
NHIA also offers downloadable coding references to our members.
Per Diem Definition
As related to reimbursement, the term “per diem” represents each day that a given patient is provided access to a prescribed therapy, beginning with the day the therapy is initiated and ending with the day the therapy is permanently discontinued. This definition is valid for per diem therapies of duration of up to and including every 72 hours. Therapies provided beyond this range (weekly, monthly, etc.) fall outside of the per diem structure, and should have separate reimbursement rates that are specified on a contractual or other basis.
NHIA Model Contract
Members Only
The NHIA Model Contract contains detailed contract language for proposing new contracts and renegotiating to improve existing contracts. It contains language that is highly specific for provision of home infusion therapy services and was developed to help providers:
Additional Tools and Resources
Members Only
