Special Consideration
Providers should be in compliance with the American Society for Parenteral and Enteral Nutrition (ASPEN) standards for home nutrition support.
Claims Filing Information
Please use the codes listed below when submitting claims.
Parenteral Nutrition Therapy
| Description | Code |
| Home TPN Therapy | S9364, S9365, S9366, S9367, S9368 |
| Nursing care | 99601, 99602 |
| Identify TPN formula using HCPCS "B" codes | B4164-B4180, B4185-B4199, B4216 |
| Identify renal solution using HCPCS "B" code | B5000 |
| Identify hepatic solution using HCPCS "B" code | B5100 |
| Identify stress solution using HCPCS "B" code | B5200 |
| Parenteral formulas that cannot be identified with specific HCPCS “B” code(s), use B9999 and the NDC number. | B9999 and the NDC number |
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. For specialty pharmacies, please refer to Billing for Injectable Drugs (Non-Vaccines).
Example
The patient has malignant neoplasm of the esophagus. The attending physician has ordered total parenteral nutrition solution with 50 g of protein and 100 mL of lipids per day for one month.
The provider should bill the per diem charge for TPN therapy on the first service line.
S9364 x 31 units
Two nursing visits were performed during the month. The provider should bill for the visits on separate service lines.
99601 x 1 unit
99601 x 1 unit
On the last service line, the provider billed for the parenteral solution using the appropriate HCPCS code. For the solution, the provider calculated the units based on one unit per day.
B4189 x 31 units
Because TPN requires precertification, a precertification number appears in block 23 of the CMS 1500 claim form.
Precertification is required. To precertify, please complete HMSA's Precertification Request -Home IV Therapy and mail or fax the form as indicated. For more information, please refer to the Home Total Parenteral Nutrition for Adults medical policy.
Please be sure to use the most up-to-date industry-standard procedure, revenue, and diagnosis codes from the current CPT ®, HCPCS Level II, and ICD-10-CM manuals, as recommended by the American Medical Association (AMA), the Centers for Medicare & Medicaid Services (CMS), and the American Hospital Association (AHA).
- Codes may not be all inclusive as the AMA and CMS code updates may occur more frequently.
