Coding & Billing
Coding guidelines, modifiers, rebilling, and practical CPT, HCPCS, and ICD-10 application.
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Home Infusion
Counsel for home infusion pharmacies and nursing providers on coverage, per-diem and drug billing, nursing visits, and audits.
Home infusion is not a home health episode and not a simple pharmacy claim. Drugs, supplies, equipment, and nursing often bill on different paths, and a coverage rule for one does not cover the others. Rivet Health Law advises infusion providers when those paths are denied, audited, or changed.
Reviewed by Joseph Rivet · September 30, 2026
The Challenge
Split the claim before you defend it
A home infusion course can produce a drug claim, a supply or equipment claim, and a nursing claim. Reviewers deny one of those and suppliers answer with the file for a different one. The response has to match the line that was denied.
Which benefit carries the drug, the supplies, and the nursing
Learn morePer-diem, administration, and drug claim construction
Learn moreNursing visit documentation
Learn moreProof that the drug was delivered and administered
Learn moreBilling-instruction changes that hit the next set of claims
Learn moreAudit and overpayment response
Learn more
Who We Help
Who this work is for
Infusion disputes are claim-construction disputes. The firm looks at which benefit was billed, whether the drug and the administration were both supported, and whether a billing instruction changed before the claims in question. Joseph Rivet’s reimbursement background is the starting point, not a general pharmacy practice.
- Home infusion pharmacies
- Providers that furnish infusion nursing in the home
- Agencies that also run a home health line and are mixing the claims
- Teams answering a documentation request on infusion claims
Our Process
First steps you can take today
These steps organize the file. They are not a substitute for counsel.
- 1
Pick one denied patient and list every claim that went out for that course of therapy.
- 2
Mark each claim as drug, nursing, or supplies.
- 3
Match the denied line to the order, the delivery record, and the visit note.
- 4
Check whether a recent billing change explains a sudden cluster of denials.
Home health certification does not automatically cover the infusion. An agency that does both needs a claim path that knows which service is which. Mixing them creates denials that look like coding errors and are actually benefit errors.
What an infusion audit is actually asking
The usual questions are whether the drug was ordered for a covered use, whether it was delivered to this patient, and whether the nursing or administration the claim reports actually happened. A delivery ticket without an administration record, or the reverse, leaves half the claim unsupported.
When a payer or CMS changes how a code or a per diem is billed, the next month of claims is the sample. Update the path. Do not only appeal the old claims and keep submitting the old way.
Common questions
- Are home infusion services billed as home health?
- Not automatically. Home infusion often has its own coverage and billing path for the drug, the supplies, and the professional services. A home health plan of care may exist for the same patient and still not be the claim that should carry the drug. Which claim carries which service has to be decided before the appeal is written.
- What records support an infusion per diem or administration code?
- The order, proof the drug was available to the patient for the dates billed, and documentation that the nursing or other service the code describes was furnished. A standing order with no visit notes does not support an administration claim.
- What if only the drug was denied and the nursing was paid?
- Appeal the drug on the drug’s coverage rule. Do not resubmit the nursing notes as if they were a drug invoice. The paid line can stay in the file as context. It is not the evidence for the denied line.
800 E. Ellis Road, Ste 515, Norton Shores, MI 49441
(231) 799-4870
info@rivethealthlaw.com
rivethealthlaw.com
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Bring these
6 itemsOne course of therapy
One patient, every claim, the order, and the proof of delivery or administration. That shows which line is actually broken.
Check items off as you collect them. Your progress is saved on this device.
This sheet is a gather list for your own file. It is not legal advice.
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This page is general information about how this setting is paid and reviewed. It is not legal advice and does not create an attorney-client relationship.