Commercial

Medical Policy

Notification

Reimbursement for the Administration of Drugs, Substances, and/or Biologic Agents

Notification Issue Date:

This policy will become effective on 01/18/2021.

The following new policy has been developed to communicate the Company’s coverage criteria for the reimbursement of administration services for drugs, substances, and/or biologic agents.

Title:

Reimbursement for the Administration of Drugs, Substances, and/or Biologic Agents

Policy #:

00.10.43f

Policy

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.

The administration of a drug, substance, and/or biologic agent when performed by a professional provider is covered and eligible for reimbursement consideration by the Company with the following exceptions:

The drug, substance, and/or biologic agent is not covered.
The drug, substance, and/or biologic agent is considered self-administered.

Administration of self-administered drugs by a professional provider is covered and eligible for reimbursement consideration when:

Drug is administered for treatment of an emergency condition.
The member/caregiver is unable to administer the drug (e.g., the member/caregiver has not been instructed on how to self-administer the drug, the caregiver is unable to provide administration due to a prolonged trip or absence).

The drug, substance, and/or biologic agent is not reported on the claim; however, the following exceptions may apply:

The drug, substance, and/or biologic agent is obtained directly by the individual.
The drug, substance, and/or biologic agent is supplied without charge (e.g., government supplied, manufactured supplied)
The drug, substance, and/or biologic agent is provided through the Company’s Direct Ship Injectables Program.

Administration services performed by a professional provider should be reported with a corresponding drug, substance, and/or biologic agent that is covered under the medical benefits unless identified as an exception listed above.

NOT ELIGIBLE FOR SEPARATE REIMBURSEMENT

The administration of an intravenous (IV) injection through the same access line as an IV infusion on the same date of service is not eligible for separate reimbursement.

When performed to facilitate an infusion or injection of a drug, substance, and/or biologic agent, the following are considered to be an integral component of the reimbursement for the administration services and are not eligible for separate reimbursement:

Use of local anesthesia
IV start
Access to indwelling IV, subcutaneous catheter, or port
Flush at initiation and conclusion of infusion
Standard tubing, syringes, and supplies
Preparation of chemotherapy agent(s)
Hydration

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: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.

Standard clinical practice is to document the actual start and stop infusion times in the individual's medical records. This would ensure that the times are accurate in the event there are interruptions or delays during the infusion process.

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.

BILLING REQUIREMENTS

National Correct Coding Initiative (NCCI) should be followed when reporting an evaluation and management (E&M) service provided on the same day as injection and infusion administration services. When a substantial diagnostic or therapeutic procedure is performed, or a major or even minor surgical/therapeutic procedure is performed, there is an inherent E&M service component included in the reimbursement for these procedures; therefore, the E&M service is not separately reimbursed. However, if the individual's presenting condition or symptoms required a significant, separately identifiable E&M service above and beyond the other service provided, then modifier 25 should be appended for separate reimbursement consideration. Documentation to substantiate the use of the modifier should be in the individual's medical record and available for review upon request.

Procedure codes 96372--96379 are not intended to be reported with evaluation and management (E&M) service codes by the professional provider in the facility setting with place of service codes 19, 21, 22, 23, 24, 26, 51, 52, and 61, regardless of whether a modifier is reported. Only the E&M service may be considered for reimbursement.

Chemotherapy administration procedure codes 96401–96549 apply to parenteral administration of nonradionuclide antineoplastic drugs; they additionally apply to antineoplastic agents provided for treatment of noncancer diagnoses (e.g., cyclophosphamide for autoimmune conditions) or to substances such as certain monoclonal antibody agents and other biologic response modifiers.

In the office setting, the initial administration service is the primary reason for the visit. For example, an individual comes in for chemotherapy, but also receives an antibiotic injection to supplement the chemotherapy. The primary reason for the visit is the chemotherapy so it is the initial administration service.

In the outpatient facility setting, there is a hierarchy to determine the initial administration service:
1. Chemotherapy infusions
2. Chemotherapy IV pushes
3. Chemotherapy injections
4. Therapeutic/Prophylactic/Diagnostic infusions
5. Therapeutic/Prophylactic/Diagnostic IV pushes
6. Therapeutic/Prophylactic/Diagnostic injections
7. Hydration

The highest-ranking service provided is considered the initial administration service. For example, an individual comes into a hospital outpatient department for an injection, but also receives a therapeutic infusion. The initial administration service is the therapeutic infusion because the therapeutic infusion ranks higher in the hierarchy than the injection.

REPORTING INFUSION TIMES

When reporting procedure codes for which infusion time is a factor, the actual time over which the infusion is administered should be used. Services leading up to the infusion and to conclude the infusion are included in the infusion service and not separately reported. These services include starting the IV and monitoring the individual postinfusion.

In infusion administration terms, “up to one hour" represents an infusion duration between 16 and 90 minutes. When an infusion exceeds 90 minutes, the professional provider can report the “each additional hour" code. “Each additional hour" represents increments greater than 30 minutes over the initial hour. Infusion with a duration of 15 minutes or less should be reported with an IV push administration procedure code (e.g., 96374, 96409).

For infusion intervals of greater than 30 minutes beyond 1-hour increments, the additional hour of chemotherapy administration procedure code 96415 should be reported. Procedure code 96415 should be reported in conjunction with the initial chemotherapy administration procedure code 96413. Procedure code 96411 should be reported in conjunction with 96409 or 96413 for intravenous push of additional drugs, substances, and/or biologic agents. Procedure code 96417 should be reported only once per sequential infusion in conjunction with 96413; procedure code 96415 may be reported for additional hour(s) of sequential infusion.

Providers should report the additional hour or additional sequential procedure code (e.g., 96366, 96367, 96375 or 96376 [as applicable]), to identify therapeutic, prophylactic, or diagnostic nonchemotherapy drug infusion or injection when provided as a secondary or subsequent service in association with chemotherapy administration procedure code 96413. Procedure code 96368 should be reported only once in conjunction with 96365, 96366, 96413, 96415, or 96416 for concurrent infusions via the same IV access but in separate bags.

REPORTING MULTIPLE INFUSIONS OR INJECTIONS

When administering multiple infusions, injections, or combinations, only one "initial" administration procedure code (e.g., 96365, 96369, 96374, 96409, 96413) should be reported per individual per day, unless protocol requires that two separate intravenous sites must be used. The professional provider should report the initial administration procedure code that best describes the primary reason for the encounter, and is reported irrespective of the order in which the infusions or injections occur.

If an injection or infusion is of a subsequent or concurrent nature, even if it is the first such service within that group of services, the subsequent or concurrent procedure code from the appropriate section should be reported (e.g., the first IV push given subsequently to an initial 1-hour infusion is reported using a subsequent IV push code [eg: 96375], even though the initial IV push code is not reported).

Separate procedure codes should be reported for each parenteral method of administration employed when therapy is administered by different techniques. Medications (e.g., antibiotics, steroidal agents, antiemetics, narcotics, analgesics) administered independently or sequentially as supportive management of chemotherapy or certain monoclonal antibody administration should be reported as appropriate. The specific service should be reported as well as code(s) for the specific drug, substance, and/or biologic agent provided.

There is no procedure code for concurrent administration of chemotherapeutic drugs. Multiple drugs given at the same session are considered to be sequential, rather than concurrent. The services are reported with procedure code 96411 for IV push administration of additional drugs, substances, and/or biologic agents at the same session and procedure code 96417 for IV infusion administration of additional drugs, substances, and/or biologic agents at the same session.

When administering a drug, substance, and/or biologic agent, a procedure code based on route of administration is reported by the same physician or other qualified healthcare professional on the same day. Each injection can be reported separately regardless whether the injection is subsequent for a new drug, substance, or biologic agent. The exception to this rule is the single preparation of the subcutaneous (sub-Q) or intramuscular (IM) dose that exceeds the volume safely injected at a single site. When the volume of an injected dose requires it to be split into two or more syringes, the professional provider may report only a single unit of service for procedure code 96372.

For example: If the professional provider administers two separate drugs, but uses three injections to administer the dosages, the professional provider would report two injection procedure codes, 96372 and 96372, with modifier 59 for distinct procedural service, and the drug, substance, and/or biological supply codes.

It is inappropriate to bill an intravenous injection in addition to an intravenous infusion on the same date of service when the injection is administered through the same access line as the intravenous infusion.

When an infusion consists of multiple substances in a single bag, it is not to be reported as separate infusion services.

For comprehensive guidelines on the reporting of initial and sequential injection and infusion codes, please refer to the guidelines outlined in the Current Procedural Terminology Manual in the section for Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and other Highly Complex Drug or Highly Complex Biologic Agent Administration.

Inclusion of a procedure code in this policy does not imply reimbursement. Procedure codes continue to be subjected to the Company claims adjudication logic, eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

Guidelines

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, reimbursement for the administration of injection and infusion is covered under the medical benefits of the Company's products.

This claim payment rationale applies only to the codes or applicable code combinations addressed in this policy and does not apply to any other code and/or code and modifier combinations. Claims are processed according to the statements in this policy. When a medical policy on this topic also exists, the medical necessity criteria listed in the medical policy must be met.

POLICY GUIDELINES

Chemotherapy administration procedure codes apply to parenteral administration of nonradionuclide antineoplastic drugs, and to antineoplastic agents provided for treatment of noncancer diagnoses (e.g., cyclophosphamide for autoimmune conditions) or to substances such as certain monoclonal antibody agents, and other biologic response modifiers.

The chemotherapy administration procedure codes may be reported when the clinical indication for the drug, substance, and/or biologic agent being administered satisfies the definition above.

The highly complex infusion of chemotherapy or other drug agent requires professional provider or other qualified healthcare professional work and/or clinical staff monitoring well beyond that of therapeutic drug agents because the incidence of severe adverse patient reactions is typically greater. These services can be provided by any professional provider or other qualified healthcare professional.

Chemotherapy services are typically highly complex and require direct supervision for any or all purposes of patient assessment, provision of consent, safety oversight, and intraservice supervision of staff. Typically, such chemotherapy services require advanced practice training and competency for staff who provide these services and special considerations for preparation, dosage, or disposal; commonly, these services entail significant patient risk and frequent monitoring. Examples are frequent changes in the infusion rate, prolonged presence of the nurse administering the solution for patient monitoring and infusion adjustments, and frequent conferring with the physician or other qualified healthcare professionals about these issues. When performed to facilitate the infusion or injection, preparation of chemotherapy agent(s), highly complex agent(s), or other highly complex drugs is included in the administration service and is not reported separately.

The administration of antianemia drugs and antiemetic drugs by injection or infusion for cancer patients is not considered chemotherapy administration.

The application of the on-body injector for timed subcutaneous injection is proprietary for the administration of Neulasta (pegfilgrastim). The device is designed to automatically administer the dose of Neulasta subcutaneously the next day.

Coverage for the drug, substance, and/or biologic agent is based on the individual’s condition, the appropriateness of the dose, and route of administration, based on the clinical condition and the standard of medical practice regarding the effectiveness of the drug, substance, and/or biologic agent for the diagnosis and condition, and the Company coverage position for the drug, substance, and/or biologic agent.

Description

Administration of a drug, substance, and/or biologic agent to an individual may be a necessary component of an individual's treatment plan. Such administration may occur through various routes (e.g., intradermal, intramuscular, intranasal, intravenous, percutaneous, or subcutaneous).

Administration of a drug, substance, and/or biologic agent typically requires direct supervision for any or all purposes of patient assessment, provision of consent, safety oversight, and intraservice supervision of staff. Typically, such infusions require special consideration to prepare, dose or dispose of, require practice training and competency for staff who administer the infusions, and require periodic patient assessment with vital sign monitoring during the infusion.

References

Centers for Medicare & Medicaid Services (CMS). (A53049) Billing and Coding: Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents. Available at: Local Coverage Article for Billing and Coding: Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents (A53049) (cms.gov). Date Accessed February 8, 2023.

Centers for Medicare & Medicaid Services (CMS). CMS Claims Processing Manual. Chapter 12 - Physicians/Nonphysician Practitioners. [CMS Web site].

Available at: http://www.cms.gov/manuals/downloads/clm104c12.pdf. Date Accessed February 8, 2023.

Centers for Medicare & Medicaid Services. How to Use the Medicare National Correct Coding Initiative (NCCI) Tools.

Available at: https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Version_Update_Changes. Date Accessed February 8, 2023.

Centers for Medicare & Medicaid Services (CMS). (A53127) Self-Administered Drug Exclusion List.

Available at: https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=53127&ver=88&name=331*1&UpdatePeriod=855&bc=AAAAEAAAAAAA&. Date Accessed February 8, 2023.

Company Benefit Contracts.

Coding

CPT Procedure Code Number(s)

11900, 11901, 11950, 11951, 11952, 11954, 20526, 20527, 20550, 20551, 20552, 20553, 30200, 54200, 54230, 64415, 64416, 64417, 64418, 64420, 64421, 64425, 64430, 64435, 64445, 64446, 64447, 64448, 64449, 64450, 64455, 64510, 64520, 67028, 67500, 67515, 68200, 96365, 96366, 96367, 96368, 96369, 96370, 96371, 96372, 96373, 96374, 96375, 96376, 96377, 96379, 96401, 96402, 96405, 96406, 96409, 96411, 96413, 96415, 96416, 96417, 96420, 96422, 96423, 96425, 96440, 96446, 96450, 96542, 99601, 99602

ICD - 10 Procedure Code Number(s)

N/A

ICD - 10 Diagnosis Code Number(s)

N/A

HCPCS Level II Code Number(s)

G0138 Intravenous infusion of cipaglucosidase alfaatga, including provider/supplier acquisition and clinical supervision of oral administration of miglustat in preparation of receipt of cipaglucosidase alfa-atga

G0498    Chemotherapy administration, intravenous infusion technique; initiation of infusion in the office/clinic setting using office/clinic pump/supplies, with continuation of the infusion in the community setting (e.g., home, domiciliary, rest home or assisted living) using a portable pump provided by the office/clinic, includes follow up office/clinic visit at the conclusion of the infusion

Q0083    Chemotherapy administration by other than infusion technique only (e.g., subcutaneous, intramuscular, push), per visit

Q0084    Chemotherapy administration by infusion technique only, per visit

Q0085    Chemotherapy administration by both infusion technique and other technique(s) (e.g. subcutaneous, intramuscular, push), per visit

S9061    Home administration of aerosolized drug therapy (e.g., Pentamidine); administrative services, professional pharmacy services, care coordination, all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9325    Home infusion therapy, pain management infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment, (drugs and nursing visits coded separately), per diem (do not use this code with S9326, S9327 or S9328)

S9326    Home infusion therapy, continuous (24 hours or more) pain management infusion; administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9327    Home infusion therapy, intermittent (less than 24 hours) pain management infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9328    Home infusion therapy, implanted pump pain management infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9329    Home infusion therapy, chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code with S9330 or S9331

S9330    Home infusion therapy, continuous (24 hours or more) chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9331    Home infusion therapy, intermittent (less than 24 hours) chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9336 Home infusion therapy, continuous anticoagulant infusion therapy (e.g., Heparin), administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9338    Home infusion therapy, immunotherapy, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9345 Home infusion therapy, antihemophilic agent infusion therapy (e.g., Factor VIII); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9346 Home infusion therapy, alpha-1-proteinase inhibitor (e.g., Prolastin); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9347 Home infusion therapy, uninterrupted, long-term, controlled rate intravenous or subcutaneous infusion therapy (e.g., epoprostenol); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9348    Home infusion therapy, sympathomimetic/inotropic agent infusion therapy (e.g., Dobutamine); administrative services, professional pharmacy services, care coordination, all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9351 Home infusion therapy, continuous or intermittent antiemetic infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and visits coded separately), per diem

S9353 Home infusion therapy, continuous insulin infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9355    Home infusion therapy, chelation therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9357 Home infusion therapy, enzyme replacement intravenous therapy; (e.g., Imiglucerase); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9359 Home infusion therapy, antitumor necrosis factor intravenous therapy; (e.g., Infliximab); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9361 Home infusion therapy, diuretic intravenous therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9363    Home infusion therapy, antispasmotic therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9370 Home therapy, intermittent antiemetic injection therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9372 Home therapy; intermittent anticoagulant injection therapy (e.g., Heparin); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code for flushing of infusion devices with Heparin to maintain patency)

S9379 Home infusion therapy, infusion therapy, not otherwise classified; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9490    Home infusion therapy, corticosteroid infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9494 Home infusion therapy, antibiotic, antiviral, or antifungal therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code with home infusion codes for hourly dosing schedules S9497-S9504)

S9497    Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 3 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9500    Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 24 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9501    Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 12 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9502    Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 8 hours, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9503    Home infusion therapy, antibiotic, antiviral, or antifungal; once every 6 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9504    Home infusion therapy, antibiotic, antiviral, or antifungal; once every 4 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9537    Home therapy; hematopoietic hormone injection therapy (e.g., erythropoietin, G-CSF, GM-CSF); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9538    Home transfusion of blood product(s); administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (blood products, drugs, and nursing visits coded separately), per diem

S9542    Home injectable therapy, not otherwise classified, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9558    Home injectable therapy; growth hormone, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9559    Home injectable therapy, interferon, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9560    Home injectable therapy; hormonal therapy (e.g., leuprolide, goserelin), including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9562 Home injectable therapy, palivizumab or other monoclonal antibody for rsv, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9563 Home injectable therapy, immunotherapy, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9590 Home therapy, irrigation therapy (e.g., sterile irrigation of an organ or anatomical cavity); including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

S9810 Home therapy; professional pharmacy services for provision of infusion, specialty drug administration, and/or disease state management, not otherwise classified, per hour (do not use this code with any per diem code)

Revenue Code Number(s)

N/A

MPMiscCodesNarrativesPub

Coding and Billing Requirements

Cross Reference

Policy History

Revisions From 00.10.43f:

04/16/2025	The policy has been reviewed and reissued to communicate the Company’s continuing position on Reimbursement for the Administration of Drugs, Substances, and/or Biologic Agents.
04/01/2024	This policy has been identified and updated for the CPT Code Updates effective 04/01/2024. The following HCPCS code has been added to this policy: G0138 Intravenous infusion of cipaglucosidase alfaatga, including provider/supplier acquisition and clinical supervision of oral administration of miglustat in preparation of receipt of cipaglucosidase alfa-atga

Revisions From 00.10.43e:

01/02/2024

This policy has been identified and updated for the CPT Code Updates effective 01/02/2024.

The following CPT code narrative has been revised in this policy:

96446

Revisions From 00.10.43d:

07/01/2023

This policy becomes effective 07/01/2023. The policy will continue to communicate the Company’s position on Reimbursement for the Administration of Drugs, Substances, and/or Biologic Agents.

The following CPT codes have been added to this policy:

11950, 11951, 11952, 11954

Revisions From 00.10.43c:

04/01/2023

This policy has been identified and updated for the CPT Code Updates effective 04/01/2023.

The following HCPCS code narrative has been revised in this policy:

S9562

The following HCPCS code narrative has been added to this policy:

S9563

Revisions From 00.10.43b:

01/01/2023

This policy has been identified and updated for the CPT Code Updates effective 01/01/2023.

The following CPT code narratives have been revised in this policy:

64415, 64416, 64417, 64445, 64446, 64447, 64448

Revisions From 00.10.43a:

07/19/2021

This policy becomes effective 07/19/2021. The intent of this policy remains unchanged, however, the policy has been updated to further clarify current language.

The notable differences in the updated version of this policy include clarification within the policy criteria.

Revisions From 00.10.43:

01/18/2021

The following new policy has been developed to communicate the Company’s coverage criteria for the reimbursement of administration services for drugs, substances, and/or biologic agents.

Version Effective Date:

4/1/2024

Version Issued Date:

4/1/2024

Version Reissued Date:

4/16/2025