Or. Admin. Code § 410-148-0300 - Other Home IV and Enteral/ Parenteral Administration Services

(1) Codes that have "PA" indicated require prior authorization. Codes with "BR" indicated are covered by report.

(2) Catheter Care Kits. All catheter care kit allowable amounts are determined on a per diem basis (1 day = 1 unit):

(a) When performed as a stand alone therapy, or during days not covered under per diem by another therapy, bill using catheter care codes S5497 through S5521;

(b) The following supplies for non-routine catheter procedures may be billed separately from per diem reimbursement:

(A) S5517 Catheter declotting supply kit, 1 day = 1 unit;

(B) S5518 Catheter repair supply kit, 1 day = 1 unit;

(C) S5520 PICC insertion supply kit, 1 day = 1 unit;

(D) S5521 Midline insertion supply kit, 1 day = 1 unit.

(E) E0776 IV Pole -- Purchase.

(F) E0776 with modifier RR IV Pole -- Rental, 1 day = 1 unit

(3) Home Nursing Visits:

(a) When enteral/parenteral services are performed in the home, only a single provider of skilled home health nursing services may obtain authorization and/or bill for such services for the same dates of service;

(b) Requests made by providers for any intravenous or enteral/parenteral related skilled nursing services, either solely or in combination with any other skilled nursing services in the home are to be reviewed for prior authorization by the Division of Medical Assistance Programs (DMAP) Medical Unit;

(c) Procedure Codes:

(A) 99601, Home infusion/specialty drug administration, per visit (up to 2 hours). Modifier SS is used to indicate -- Home infusion services provided in the infusion suite of the IV therapy provider -- 1 visit = 1 unit -- PA;

(B) 99602, each additional hour. List separately in addition to code for primary procedure). Modifier SS is used to indicate -- Home infusion services provided in the infusion suite of the IV therapy provider. Use 99602 in conjunction with 99601 -- PA;

(C) T1001, Home Nursing Visit for Assessment -- 1 visit = 1 Unit.

(4) Not Otherwise Classified (NOC) -- S9379, NOC for Home IV Supplies -- PA/BR.

Notes

Or. Admin. Code § 410-148-0300

HR 26-1990, f. 8-31-90, cert. ef. 9-1-90; HR 46-1990, f. & cert. ef. 12-28-90; HR 26-1993, f. & cert. ef. 10-1-93; OMAP 7-1998, f. 2-27-98, cert. ef. 3-1-98; OMAP 29-2000, f. 9-29-00, cert. ef. 10-1-00; OMAP 46-2001, f. 9-24-01, cert. ef. 10-1-01, Renumbered from 410-121-0880; OMAP 22-2003, f. 3-26-03, cert. ef. 4-1-03; OMAP 63-2003, f. 9-5-03, cert. ef. 10-1-03; OMAP 15-2004, f. 3-11-04, cert. ef. 4-1-04; DMAP 11-2007, f. 6-14-07, cert. ef. 7-1-07

Stat. Auth.: ORS 413.042

Stats. Implemented: ORS 414.065