Claims Filing Information
Please use the codes listed below when submitting claims.
Anti-Microbial therapy
| Description | Code |
| Anti-microbial therapy | S9494, S9497, S9500, S9501, S9502, S9503, S9504 |
| Nursing care | 99601, 99602 |
Billing drugs administered
Identify the drug administered using the specific HCPCS code when available. Use the unlisted HCPC code (J3490) and NDC number only when a specific HCPC code is not available. For specialty pharmacies, please see the Billing for Injectable Drugs (Non-Vaccines) page.
Nursing services (CPT codes 99601 and 99602) are covered and do not require precertification. Nursing services may be billed separately and are not included in the per diem for IV therapy.
Example
The patient is receiving treatment for cellulitis and abscess. The attending physician has prescribed 1 g of cefazolin sodium, intravenously, every eight hours for two weeks.
The provider bills the per diem charge for the therapy (S9494) on the first service line.
S9494 x 14 units
On the second and third service lines, the provider bills for weekly nursing visits.
99601 x 1 unit
99601 x 1 unit
The drug is billed on the fourth service line, using HCPCS code J3490 and the NDC number for the drug. The units (column 24G) are calculated as follows:
- One gram every eight hours is three grams a day.
- Three grams times 14 days is 42 grams.
J3490 NDC: 0002-7266-25 x 42 units
Billing for Multiple Anti-Micorbial Drugs
When billing the per diem charge for an additional antibiotic administered on the same day, code a second service line with the appropriate per diem code and modifier code SH. Bill each anti-microbial agent separately, being sure to note the correct NDC number for each agent.
For more information, please see Intravenous (IV) Anti-Microbial Therapy medical policy and Billing for Injectable Drugs (Non-Vaccines).
