OAR 410-148-0280: Home Parenteral Nutrition

(1) Codes that have "PA" indicated require prior authorization. Codes with "BR" indicated are covered by report. (2) Standard Total Parenteral Nutrition (TPN): (a) Bill using Healthcare Common Procedure Coding System (HCPCS) codes S9365 through S9368; (b) Home infusion for stand TPN includes the following drugs and products in the per diem rate: (A) Non-specialty amino acids (e.g., aminosyn, freeamine, travasol) (B) Concentrated dextrose (e.g., D10, D20, D40, D50, D60, D70) (C) Sterile water; (D) Electrolytes (e.g., CaC12, KCL, KPO4, MgSo4, NaAc, NaCl, NaPO4); (E) Standard multi-trace elements (e.g., MTE4, MTE5, MTE7); (F) Standard multi-vitamin solutions (e.g., MVI-13). (c) The following items are not included in the per diem and should be billed separately: (A) Specialty amino acids for renal failure, hepatic failure or for high stress conditions (e.g., aminess, aminosyn-RF, nephramine, RenAmin, HepatAmine, Aminosyn-HBC, BranchAmin, FreeAmine HBC, Trophamine); (B) Specialty amino acids with concentrations of 15% and above when medically necessary for fluid restricted patients (e.g., Aminosyn 15%, Novamine 15%, Clinisol 15%); (C) Lipids (D) Added trace elements, vitamins not from standard multitrace element or multivitamin solution; (E) Products serving non-nutritional purposes (e.g., heparin, insulin, iron dextran). (2) Parenteral Nutrition Solutions: (a) Bill using HCPCS codes B4164 through B5200. See HCPCS book for description. (b) Note: Reimbursement for compounding, admixture and administrative fees is included in the unit price. (3) Parenteral Supply Kits/Supplies — Procedure Codes (4) Parenteral Nutrition Equipment — Procedure Codes — Table 0280-1. (5) Not Otherwise Classified (NOC) — B9999, NOC For Parenteral Supplies — PA/BR. [ED. NOTE: Tables referenced are available from the agency.]