Ambulatory Infusion

An Ambulatory Infusion Suite (AIS) is an alternative care site to a home, physician office or hospital setting, where patients can receive infusion therapy of specialty drugs in a safe, monitored environment. Care is managed and performed by skilled nurses and clinical pharmacists pursuant to physician orders.

General AIS Billing Guidelines

Ambulatory Infusion Suite (AIS) services should be billed as follows:

• Per Diem
  • Use the appropriate "S" per diem code based on the type of infusion therapy performed.
  • Append Modifier SS
• Nursing Services
  • Use 99601 Home infusion/specialty drug administration, per visit (up to 2 hours).
  • Use 99602 Home infusion /specialty drug administration, each additional hour. 
  • Append Modifier SS
• Use Place or Service Code11 (Office Location, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, State or local public health clinic, or intermediate care facility (ICF), where the health professional routinely provides health examinations, diagnosis, and treatment of illness or injury on an ambulatory basis)

Medicare Only:

• Part D drugs administered at an AIS should be billed to HMSA’s Pharmacy Benefit manager (PBM), following Medicare guidelines for Part D drugs furnished by a pharmacy.

Commercial and Medicaid Only:

• Medical Specialty Infused Drug
  • For services rendered for our commercial members on or after 10/1/15, bill medical specialty drugs (including hemophilia products) using the unlisted HCPCS code such as J3490 and the NDC code of the specialty injectable drug even if there is a specific HCPCS code. Bill NDC units in both the NDC units field and the HCPCS units field for medical specialty drugs.
  • Use J3490 with the National Drug Code (NDC) number. Use drug units implicit in the NDC number (e.g., number of vials).
  • For services rendered for our QUEST Integration members on or after 1/1/19, bill medical specialty drugs (including hemophilia products) using the most specific HCPCS code and the NDC code of the specialty injectable drug. Bill NDC units in both the NDC units field and the HCPCS units field for medical specialty drugs. Please reference QUEST Integration - Claims Requiring Attachments or Documentation for more information.
  • Append Modifier SS
• Non-Medical Specialty Infused Drug
  • Use the most specific HCPCS code available and HCPCS units. If there is no specific HCPCS code for the drug, use an unlisted HCPCS code plus the NDC code of the drug. When billing with unlisted HCPCS codes and NDC codes, the NDC units must be used in both the HCPCS and NDC unit fields.
  • Append Modifier SS

Revision History