Part A outpatient infusion and hydration services

Outpatient hydration therapy refers to the intravenous (IV) administration of fluids (typically pre-packaged with saline fluid and/or electrolytes) without the addition of drugs or other therapeutic agents. 

• It is intended to correct or prevent dehydration or restore fluid balance.
• It is not used for the delivery of medications, flush IV lines, deliver or administer a drug/substance.
• It must be reasonable and necessary and clearly documented as such. 

Billing for outpatient hydration therapy

• CPT 96360 intravenous infusion hydration initial, 31 minutes to 1 hour.
• CPT +96361 report for each additional hour of hydration infusion intervals of greater than 30 minutes beyond 1-hour increments. 

Note: + sign indicates add-on code (AOC) 

There are times it is reasonable and necessary to include hydration in conjunction or before/after the administration of certain drugs/substance, this must be clearly documented as a separate service and support medical necessity. 

Outpatient infusion therapy refers to the intravenous (IV) administration of a drug or substance directly into the blood stream. 

Billing for outpatient IV infusions

• Billed based upon the CPT/HCPCS description of the service rendered.
• May bill for the total time of the infusion using add-on codes if the start and stop times are documented.
• To bill an IV infusion, a delivery of more than 15 minutes is required for safe and effective administration.

There are administration categories related to IV hydration and infusions.

• Initial: There is only one “initial” service per patient encounter, no matter how many drugs are administered.
  • The only exception is if two separate IV sites are necessary, or the patient returns for a separate and reasonable and necessary encounter on the same day.

Common CPT examples of initial services

• Sequential: Sequential infusion refers to the IV administration of a second or subsequent therapeutic, prophylactic, or diagnostic drug or substance that is an infusion or IV push of a new substance or drug following a primary or initial service.
• Concurrent: Concurrent infusion is the IV administration of multiple therapeutic, prophylactic, or diagnostic substances or drugs of a new substance through the same IV line at the same time as another substance or drug.

Add-on codes must be billed with the primary initial code.

Common CPT examples of an add-on service

Hierarchy rules apply to Part A outpatient hydration and infusion services

There are hierarchy rules associated with facility reporting of the initial service. If a patient receives two or more services, the highest-ranking service provided is considered the initial service.

The list below is the hierarchy for facility reporting. The highest rank is chemotherapy infusions the lowest rank is hydration services. 

• Chemotherapy infusions
• Chemotherapy IV pushes
• Chemotherapy injections
• Therapeutic / Prophylactic/Diagnostic infusions
• Therapeutic / Prophylactic/Diagnostic IV pushes
• Therapeutic / Prophylactic/Diagnostic injections
• Hydration

NOTE: Intermuscular injections (IM) are not included in the hierarchy

Hydration and infusion codes are time-based; therefore, proper documentation of start and stop times will help determine coding hierarchy. Document start and stop times for hydration and/or each drug / substance administered as well as patient name, medication/treatment record with date, drug, dosage, time, method of administration, and signature of administrator.

References

• CPT
• CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30.5 Payment for Codes for Chemotherapy Administration and Nonchemotherapy Injections and Infusions