Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Medical Services)
Infusion Therapy Infusion therapy as described below excludes chemotherapy. For
prolonged intravenous or subcutaneous infusions performed in the
office or clinic, submit CPT codes 96365-96371 for the
administration and the appropriate HCPCS Level II code for the
drug. When billing a higher dosage than listed in the HCPCS
Manual, use the units field to indicate the higher dosage. The CPT
code includes the administration and supplies. Submit code J3490
with a narrative indicating the drug name, dosage and NDC if a
specific HCPCS code for the drug does not exist. Only a unit of
one (1) should be reported when submitting an unlisted drug code.
Injection and Infusion
Services Restrictions
Codes 96365-96371 typically require direct physician supervision
for any or all purposes of patient assessment, provision of consent,
safety oversight, and intra-service supervision of staff.
Professional charges for infusion therapy should not be submitted
when the service is administered by the hospital or the home health
agency personnel. Do not use these codes to indicate intradermal,
subcutaneous, intramuscular, or routine IV injections, or
chemotherapy.
Blue Cross will not allow professional 837P charges for
therapeutic, prophylactic, diagnostic injection and infusion CPT®
codes (96360-96379) when rendered in certain places of service.
Professional services (837P) submitted with a facility place of
service (such as 21, 22 or 23), will deny as provider liability.
Dispensing Fees Drug dispensing fees, Q0510-Q0514, are non-covered and will
deny as provider liability. Coverage may be allowed for our
Medicare members.
Interpreter Services Interpreter services are not separately billable or reimbursed for
most members.
Transfusion—Blood
and Blood Products
11-34
Refer to the Public Programs section of this chapter for interpreter
service guides for Public Program members.
Transfusion of blood and/or blood products is submitted with code
36430 when administered by a physician or qualified assistant
employed by and under the supervision of a physician. Preparation
of blood and blood products is included in the service for
administration of the agent.
Professional charges/codes for the transfusion of blood or blood
products should not be submitted when administered by hospital or
home health agency personnel. Bill the blood separately with the
appropriate HCPCS code.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (06/20/12)