Home Infusion
General Information
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» Total parental Nutrition
» Antibiotics
» Pain Management
» Inotropic Therapy
» Enteral Feedings
» IV Immune Globulin
» Desferal
» Corticosteroids
» Remicade
» Chemotherapy
For the home infusion therapies listed above, Reeves-Sain furnishes all the medications, supplies and equipment. Due to the specialized nature of our services, we may work in conjunction with a Home Health (Nursing) Agency to provide your care. The Home Health Agency’s registered nurse is also available on a 24 hour, 7 day/week basis.
Infusion – Frequently Asked Questions
Medicare Coverage Guidelines for TPN Therapy
To request more information about this topic, contact us at InfoInfusion@reevessain.com.
Areas of Service
In many instances, we are able to service the entire state. Please call 615-895-0186 for information.
Bedford
Cannon
Cheatham
Clay
Coffee
Davidson
Dekalb
Dickson
Franklin
Giles
Grundy
Hickman
Houston
Humphreys
Jackson
Lawrence
Lewis
Lincoln
Macon
Marion Marshall
Maury
Montgomery
Moore
Overton
Perry
Putnum
Robertson
Rutherford
Sequatchie
Smith
Stewart
Summer
Trousdale
Van Buren
Warren
Wayne
White
Williamson
Wilson
Insurance Contracts
Aetna HMO
Aetna PPO
BCBS Preferred Care
BCBS State and Federal
BCBS Select
BCBS Classic
(No HMO BCBS)
Cigna PPO
Healthspring
Medicare
Medicaid
One Health Plan
PHCS
Prudential
TennCare Select
Tenncare – Americare
Tenncare – Amerigroup
TriCare
United Healthcare
Aerosolize Medical Program
If your patient requires a prescription for aerosolized medications and is a Medicare recipient, let Reeves-Sain provide him or her with the convenience of never leaving home. We specialize in providing consistent, high-quality, professional care and exemplary customer service to each and every inhalation medication customer.
Benefits of using Reeves-Sain Infusion Services
We bill patient’s secondary insurance for 20% co-pay when applicable.
We provide free home delivery for Medicare patients who qualify for aerosolized medications.
Same day service provided when necessary at no additional cost.
Pharmacist counseling provided upon request.
Covered Diagnosis
A diagnosis with ICD-9 codes ranging from 491 to 505 and 786.4 (Abnormal Sputum) qualifies a patient for aerosolized medications.
Covered Medications
Ipratropium Bromide 0.02% 0.5/2.5ml (unit dose)
Albuterol 0.083% 2.5 mg/3ml (unit dose)
Albuterol 0.5% 5mg/ml (dropper bottle)
Cromolyn Sodium 20mg/ml
Inotropic Therapy
Patients who often benefit from the Reeves-Sain Home Inotropic Program are clinically stable but require infusion therapy services to address specific medical needs including:
» Congestive heart failure
» Infectious endocarditis
» Organ rejection / immunosuppression
» Fluid or electrolyte imbalance
Our Home Inotropic Program is designed specifically to maintain congestive heart failure (CHF) patients at home with:
» A decreased need for hospital care
» Patient outcomes that are positive
» Increased quality of life for longer periods of time
» Reduced healthcare expenditures because of decreased morbidity and fewer emergency medical and hospital visits.
The staff at Reeves-Sain makes our CHF treatment approach an excellent alternative to hospitalization. An individualized care plan is developed for each patient. Goals are then established to minimize complications, improve dietary compliance, increase physical exercise and manage stress.
Features of the Program include:
» Comprehensive Care plan developed for each patient
» All IV inotropic options available
» IV and specialty line care (Registered Nurse on staff)
» Screening for drug interactions
» Nutritional Assessments (Registered Dietician on staff)
» Reimbursement management
» Communication with cardiac team
Download the “Home Parenteral Inotropic Therapy: Data Collection Form”
Enteral Feedings
1. Diagnosis
Enteral nutrition therapy must be ordered by a physician. The patient must have:
a. Permanent non-function or disease of the structures that normally permit food to reach or be absorbed from the small bowel, and
b. Require tube feedings to provide sufficient nutrients to maintain weight and strength. These questions are #7 and #8 on the Certificate of Medical Necessity (CMN) and must be answered ‘Yes’ for Medicare to cover.
2. Calorie Justifications
Calories must fall in the range of 20-35 kcals/kg/BW unless appropriately justified and documented by ordering physician.
3. Product Justifications
Specialized products must be accompanied by an appropriate diagnosis.
4. Test of Permanence
Physician must feel patient’s condition will warrant tube feeding for at least 90 days. It is not appropriate to order tube feeding for 1-2 week period with plans to remove tube.
5. Pump Justification
Use of an enteral pump requires a secondary diagnosis to support the medical necessity.
Examples of Appropriate Pump Diagnosis include:
Home tube feeding is an excellent alternative to hospitalization or long-term care. Reeves-Sain has a registered dietitian on staff that clinically monitors each enteral patient. Calls are made monthly by the dietitian to assess the patient’s weight and tolerance of the feeding. From this assessment our staff will determine the appropriate monthly supplies to be delivered.
Chronic reflux
Gastroenteritis
Aspiration Pneumonia
Diarrhea
Diabetes Mellitus
CHF
Jejunal Feeding
Dumping Syndrome
Flow rate< 100cc/hr
Please note: Medicare Guidelines do not always apply to Private Insurance Companies.
Information needed for Enteral Referral:
Patient Demographics
Height
Weight
Diagnosis
History
Physical
Feeding plan including formula, method of feeding (bolus, gravity, or pump), rate, and type of tube
Signed Physician’s Order
Primary Care Physician
Primary and secondary insurance with policy number and name of insurer if other than patient
IV Immune Globulin
Neurological Diseases in which IVIG is an effective treatment include:
» Multiple Sclerosis (MS)
» Guillain – Barre (GB) Syndrome
» CIDPN
» Idiopathic Thrombocytopenia
» Multifocal Motor Neuropathy (MMN)
» Clinical Expertise
» Clinical staff including pharmacist and registered nurse, with extensive experience with IVIG
» Patient education provided for each patient
» Screening for drug interactions
» Communication with physician for the best treatment plan possible
» Comprehensive care plan developed for each patient
» Complete inventory of all IVIG brands
» 24 hour, 7 day a week on call pharmacist
Reimbursement Expertise:
Facilitate reimbursement providing maximum financial protection to patients
Aggressively engage insurers in obtaining approval for treatments provided
The staff at Reeves-Sain is committed to making the patient referral process as efficient as possible. We are dedicated and experienced professionals who will coordinate all necessary homecare services. Thank you for allowing us the opportunity to serve you.
Intravenous Immune Globulin – New Benefit
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 provides a new benefit for intravenous immune globulin (IVIG) administered in the home setting effective for dates of service on or after January 1, 2004. In order for the IVIG to be covered, all of the following criteria must be met:
1. It is an approved pooled plasma derivative for the treatment of primary immune deficiency disease
2. The patient has a diagnosis of primary immune deficiency disease (ICD-9 codes 279.04, 279.05, 279.06, 279.12, 279.2); and
3. The IVIG is administered in the home; and
4. The treating physician has determined that administration of the IVIG in the patient’s home is medically appropriate.
If all of the criteria are not met and the IVIG is not administered with an infusion pump, the IVIG will be denied as non-covered– no benefit category. If the criteria are not met and the IVIG is administered with an infusion pump, the general criteria in the External Infusion Pump LMRP will be applied. If it is determined that the criteria for an infusion pump are not met, the pump, related supplies and the IVIG will be denied as not medically necessary.
Coverage under this benefit is limited to the IVIG itself, not to related supplies and services. If the IVIG is not administered with an infusion pump, related supplies will be denied as non-covered– no benefit category.
The IVIG must be dispensed and billed by a pharmacy or other entity licensed to dispense drugs. If the IVIG meets the coverage criteria for this benefit but it is not dispensed by an entity licensed to dispense drugs, it will be denied as not medically necessary. Suppliers must bill as an assigned claim. Beneficiaries are ineligible to receive payment for the drug.
HCPCS cods for IVIG are J1563 (Injection, immune globulin, intravenous, 1 gram) or J1564 (Injection, immune globulin, 10mg). If the dose administered is 500 mg or more, HCPCS code J1563 must be used. If the IVIG is not administered through an infusion pump and if supplies are billed, HCPCS code A9270 (non-covered item or service) must be used for the supplies. If the IVIG is administered through an infusion pump, the HCPCS codes A4221 and A4222 are used for the related supplies.
Claims for IVIG administered in the home are DMERC jurisdiction with the following exception. Home health agencies dispensing IVIG would bill the fiscal intermediary.
Please contact us if you have any questions regarding coverage criteria.
Downloadable Forms
Click on the links below to download the appropriate forms.
Home Parenteral Inotropic Therapy: Data Collection Form
Medical Coverage Guidelines for TPN Therapy
Infusion Services: Pharmacy Care Plan
