Notification



Notification Issue Date:



Claim Payment Policy


Title:Intravenous (IV) Administration of Fluids as a Treatment of a Medical Condition or for the Preparation of Pharmaceuticals, Biologics, and other Substances

Policy #:00.01.45

This policy is applicable to the Company’s commercial products only. Policies that are applicable to the Company’s Medicare Advantage products are accessible via a separate Medicare Advantage policy database.

Application of Claim Payment Policy is determined by benefits and contracts. Benefits may vary based on product line, group or contract. Medical necessity determination applies only if the benefit exists and no contract exclusions are applicable. Individual member benefits must be verified.

In products where members are able to self-refer to providers for care and services, members are advised to use participating providers in order to receive the highest level of benefits.When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.

For more information on how Claim Payment Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.



Policy

INTRAVENOUS (IV) ADMINISTRATION OF FLUIDS FOR THE TREATMENT OF A MEDICAL CONDITION

Administration of IV fluids for the treatment of a medical condition (e.g., dehydration, prevention of dehydration or toxicity) is covered and eligible for reimbursement consideration by the Company. However, if the IV fluids for the treatment of a medical condition are infused during the same session for which IV fluids are also used to prepare the administration of pharmaceuticals, biologics, and other substances, only the fluids administered as a treatment for a medical condition are eligible for reimbursement consideration. In such cases, all of the following requirements must be met.
  • The IV fluids that are being used to treat a medical condition must be separately and sequentially (i.e., not concurrently) infused with the pharmaceuticals, biologics, and other substances.
  • This sequential administration of IV fluids for the treatment of a medical condition must be, in and of itself, medically necessary due to the fact that a concurrent IV fluid and medication administration is medically contraindicated.
  • This sequential IV fluid administration must not be performed as a means to obtain separate reimbursement.

IV FLUIDS USED FOR THE PREPARATION OF PHARMACEUTICALS, BIOLOGICS, AND OTHER SUBSTANCES

The Company covers the use of intravenous (IV) fluids for the preparation (dilution, reconstitution) of pharmaceuticals, biologics, and other substances for IV administration. However, such use is considered to be integral to the administration of the pharmaceutical, biologic, or other substance and is, therefore, not eligible for reimbursement. Participating providers may not bill members for this service.

ADMINISTRATION OF FLUIDS FOR MAINTENANCE OF VASCULAR ACCESS
The administration of an IV flush or other services that are necessary for maintenance of vascular access are not eligible for separate reimbursement from other procedures requiring vascular access.

REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to, the following: records from the health care professional's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.
Guidelines

This policy is consistent with Medicare's National Correct Coding Initiative (NCCI) Manual and the American Medical Association's (AMA) Current Procedural Terminology (CPT®) Guidelines for Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration.

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, intravenous (IV) administration of fluids for the treatment of a medical condition is covered under the medical benefits of the Company's products.

Description

Intravenous (IV) fluids may be administered for the treatment of a medical condition (e.g., dehydration, prevention of dehydration or toxicity) or used to prepare (e.g., dilute, reconstitute) pharmaceuticals, biologics, and other substances for IV administration. The medical conditions for which IV fluids may be administered as a treatment include, but are not limited to, fluid and electrolyte imbalances and other volume disturbances (e.g., dehydration). An example of a substance that may require dilution is IV administration of potassium chloride (KCl).
References


Ahlman, Jay T., Attale, Thilani, MS, et al eds. CPT® 2018 Current Procedural Terminology. Standard Edition. Chicago, IL: American Medical Association (AMA) Press; 2018: 472.

Centers for Medicare & Medicaid Services (CMS). National Correct Coding Initiative (NCCI) Policy Manual for Part B Medicare Carriers. Chapter I, Version 15.3: General Correct Coding Policies for National Correct Coding Initiative Policy Manual for Medicare Services. [CMS Web site]. 10/01/09. Available at: http://www.cms.hhs.gov/NationalCorrectCodInitEd/Downloads/NCCI_Policy_Manual.zip. (zip folder document: CHAP1final-gencodingprinciples_083109.pdf). Accessed June 11, 2018.

Centers for Medicare & Medicaid Services (CMS). National Correct Coding Initiative (NCCI) Policy Manual for Part B Medicare Carriers. Chapter XI, Version 15.3: Medicine: Evaluation and Management Services. [CMS Web site]. 10/01/09. Available at: http://www.cms.hhs.gov/NationalCorrectCodInitEd/Downloads/NCCI_Policy_Manual.zip. (zip folder document: CHAP1final-gencodingprinciples_083109.pdf). Accessed June 11, 2018.

McPhee SJ, Papadakis MA, Tierney LM, eds. Current medical diagnosis and treatment 2007. 46th ed. New York, NY: McGraw-Hill; 2007:887-917.




Coding

Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.

CPT Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD-10 Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD-10 Diagnosis Code Number(s)

N/A


HCPCS Level II Code Number(s)

N/A


Revenue Code Number(s)

N/A

Coding and Billing Requirements



Policy History

REVISIONS FROM 00.01.45:
08/29/2018The policy has been reviewed and reissued to communicate the Company’s continuing position on Reimbursement for Intravenous (IV) Administration of Fluids as a Treatment of a Medical Condition or for the Preparation of Pharmaceuticals, Biologics, and other Substances.

Effective 10/05/2017 this policy has been updated to the new policy template format.


Version Effective Date: 01/08/2010
Version Issued Date: 01/08/2010
Version Reissued Date: 08/29/2018

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