# Billing S9500 rejected by Medicare clearinghouse



## latoshac (Nov 30, 2016)

I am billing home IV infusion for a patient with Medicare primary and BCBS supplement Plan F.  Medicare does not cover home infusion services (S9500) but the patient's supplemental plan will pay for home infusion services.  Our problem is we can't even get the S9500 code to pass the clearinghouse so we can get a denial to forward to the secondary plan.  I have added the GY modifier which states that this is not a medicare covered service.  Anyone have a suggestion how we can get these charges through the medicare e-rejections?


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## CodingKing (Nov 30, 2016)

Medicare will not accept S codes even if its not covered. I'm shocked a Medicare supplement would accept codes that are not accepted by Medicare. Aren't there regular CPT codes you can bill such as 99601/99602


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## thomas7331 (Nov 30, 2016)

Medicare does cover home infusion under certain circumstances.  Skilled home health services for Medicare patients are generally paid by the part A contractor and are billed on a UB form using revenue codes.  S9500 is a code specific to commercial payers - you won't be able to use that code, or bill that service on a professional claim form, for a Medicare patient.


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## latoshac (Nov 30, 2016)

99601/99602 are for home visits for infusion, which would not apply since we are only providing the medications and supplies for self-infusion by the patient.


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## thomas7331 (Dec 1, 2016)

If you're only providing supplies and medications, the supplies would be billable to Part B through the DME contractor.  The drugs may be covered by the Part B or Part D benefits.  You might find this memorandum helpful - see the two attachments at the end which detail what plan would cover which component of this:  https://www.cms.gov/Medicare/Prescr...tra/Downloads/HomeInfusionReminder_031006.pdf


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## kcarlyle (Dec 5, 2016)

We bill A4223 GY instead of S9500 GY for the Medicare denial from the part B contractor (not DME) for the PR-204 denial when the secondary will cover as the primary payer.


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