Reminder: How to apply catheter care coverage when infusion therapy is temporally on hold

The Blue Cross Blue Shield Michigan home infusion therapy benefit only covers catheter care when the infusion therapy, provided by the home infusion provider, is temporarily placed on hold.

This hold shouldn’t go beyond four weeks. There must be supporting documentation on why the therapy has been suspended and why the central line is being maintained. For example, the patient develops a rash from an antibiotic he or she is receiving. And you’re planning to evaluate the treatment and start a different antibiotic once the rash subsides.

The home infusion therapy benefit for central venous catheter care doesn’t apply when a patient has been discharged from the hospital with a central venous catheter and therapy wasn’t provided in the home setting. The Blue Cross home infusion therapy benefit for catheter care only applies when the home infusion therapy provider provides a therapy that can be later placed on hold. The catheter care ends when the infusion therapy is discontinued.

We’ve also observed that some providers are billing the durable medical equipment benefit for flushes and supplies, while billing the home infusion therapy benefit for catheter care. The DME benefit shouldn’t be billed at the same time as the home infusion therapy benefit for catheter care. The supplies and flushes are part of the catheter care S codes.