Home infusion therapy nursing guidelines clarified

This brief overview should help clarify our guidelines and exceptions for home infusion therapy providers’ nursing services.

The HIT benefit requires that:

• Nursing should be provided to all members who are HIT patients receiving home infusion therapy.
• BCBSM home infusion therapy nursing visits may only be provided by a registered nurse who has specialized education or training in home infusion therapy services.
• Licensed practical nurses are not eligible to provide home infusion therapy nursing.
• This requirement also applies when the nursing is subcontracted.
• RN availability also applies to patients who travel outside the home infusion or nursing agency service area.
• Nursing orders require a physician signature.

When reporting HIT visits:

• The HIT provider should use procedure code *99601 for the first two hours of each visit. Additional hours that same day can be reported under code *99602. However, this code can only be used if an RN stays longer than the initial two hours or if a separate nursing visit was conducted later the same day.
• BCBSM home infusion therapy allows payment for code *99602 only when the RN documents the visit start and stop time. In order to use this code, the additional time must be a minimum of 31 minutes and up to one hour beyond the initial two hours.
• HIT providers should not report more than four hours of nursing services per day and no more than 12 hours per week. Code *99602 can only be used in conjunction with code *99601.
• In addition, the benefits state that daily therapies require a minimum of one nursing visit per week, with a maximum of three visits per seven days.

BCBSM will consider paying for additional nursing visits if:

• There are catheter issues, including patency restoring, catheter repair, PICC and midline insertion, and peripheral restarts.
• The drug manufacturer recommends extended infusion time and continuous monitoring of the infusion by an RN.

The nursing documentation:

• Should include an evaluation of the patient’s response to the therapy relating to his or her diagnosis
• The HIT manual states: “The purpose of a nursing visit is to provide venous access, catheter care, assessment of the patient’s infusion technique and any education that is related to the infusion therapy during the nursing visit. Additionally, the nursing visits are to assess the patient’s progress, response to and changes in treatment, as well as documentation of any therapy that the RN administered during the visit.”
• The nursing assessment must have measureable outcomes

BCBSM may waive the nursing requirement if all the below apply:

• Patients consider themselves independent or no longer want or require nursing visits. But there must be documentation in the clinical record that the patient or caregiver is capable and willing to provide his or her own infusion-related care.
• The patient’s physician provides an order stating he or she is in agreement.
• The signed physician’s order contains a statement allowing an RN to visit the patient on an as-needed basis.
• Once an order is signed, it must be added to all future Certificates of Medical Necessity and will require renewal every 120 days.

For additional information about HIT nursing care, please read the HIT manual or participation agreement.