Guides Medicare home infusion therapy benefit
Service-line guide
The Medicare home infusion therapy benefit
A separate Medicare Part B benefit, in force since January 1, 2021, that pays an accredited supplier for the professional services of home infusion (nursing, training and monitoring) on the days a clinician is in the home. It is not the home health benefit, and it covers a narrow list of pump-administered drugs.
Educational summary, last reviewed October 17, 2026. Not legal advice — confirm with the state licensing agency or counsel.
Last reviewed October 17, 2026. 28 findings: 25 verified, 3 provisional. 1 time-sensitive, flagged with a recheck date. How findings are sourced and labelled.
1What it is
The benefit
VerifiedSection 5012 of the 21st Century Cures Act created a Medicare home infusion therapy services benefit effective January 1, 2021. It covers professional services, including nursing, training and education, remote monitoring and monitoring, furnished by a qualified home infusion therapy supplier.
Source: CMS: HIT services benefit FAQ (June 2022)CMS MLN MM12108
A qualified supplier
VerifiedA qualified supplier is “a pharmacy, physician, or other provider of services or supplier licensed by the State” where it furnishes services (SSA §1861(iii)(3)(D)). It furnishes infusion therapy to people with acute or chronic conditions, ensures safe care 24 hours a day, 7 days a week, and is accredited by a CMS-designated organization (42 CFR 486.505).
Source: CMS: HIT services benefit FAQ (June 2022)42 CFR 486.505
A home infusion drug
VerifiedA parenteral drug or biological “administered intravenously, or subcutaneously for an administration period of 15 minutes or more,” in the home, through a pump that is durable medical equipment. Insulin pump systems and drugs on the self-administered exclusion list are excluded (42 CFR 486.505).
Source: 42 CFR 486.505
The visit day
VerifiedPayment is made per “infusion drug administration calendar day”: a day on which skilled professionals furnish the services in the patient’s home. “Payment is made only on those days in which the home infusion therapy supplier is in the beneficiary’s home.”
Source: 42 CFR 486.505CMS: HIT services benefit FAQ (June 2022)
2Who regulates it
CMS sets the supplier requirements and pays through Part B; CMS-recognized accrediting organizations accredit; the state licenses the supplier as a pharmacy, physician or other provider.
A supplier “must be currently and validly accredited as such by a CMS-recognized home infusion therapy supplier accreditation organization in order to enroll and remain enrolled.” CMS lists The Joint Commission, URAC, ACHC, CHAP, NABP and The Compliance Team.
Source: CMS Manual Transmittal r10467pi
Accreditor approval terms
VerifiedCurrent approval terms in the Federal Register: The Joint Commission to December 15, 2029; URAC to March 27, 2030; NABP to September 26, 2030; The Compliance Team to September 28, 2030.
Source: FR 2023-27469 (TJC)FR 2024-06144 (URAC)FR 2024-21409 (NABP)FR 2024-21410 (TCT)
ACHC and CHAP terms
VerifiedACHC’s home infusion therapy approval runs April 23, 2024 to April 23, 2030, and CHAP’s September 25, 2024 to September 25, 2030. Every accreditor’s terms are on the Accreditation & Surveys page.
3Federal rules
Required services
VerifiedSuppliers provide, 7 days a week and 24 hours a day under the plan of care, professional services including nursing, patient training and education not already paid under the DME benefit, and remote monitoring and monitoring, following nationally recognized standards of practice and state and federal law (42 CFR 486.525).
Source: 42 CFR 486.525
The plan of care
VerifiedThe plan prescribes the type, amount and duration of services and the medication, dose and frequency; the ordering physician signs and dates it before the claim and on any change, and reviews it periodically with the DME supplier and the HIT supplier (42 CFR 414.1515, 486.520).
Patient eligibility
VerifiedThe patient is enrolled in Part B, is under the care of a physician, nurse practitioner or physician assistant, and has a physician-established plan of care.
Which drugs qualify
VerifiedOnly drugs on the DME local coverage determination for external infusion pumps (L33794) qualify. Professional services for other home infusion drugs, such as most IV antibiotics, are not covered by this benefit; depending on the patient they may fall under Part D, the Part A home health benefit for a homebound patient, or a Medicare Advantage plan.
The supplier does not have to furnish the pump, drug or pharmacy services: those stay under the DME benefit, billed by a Medicare-enrolled DMEPOS supplier. An HIT supplier need not enroll as a DME supplier.
4Payment
Three payment categories
VerifiedCategory 1: certain IV drugs (antifungals, antivirals, inotropes, pulmonary hypertension, pain management, chelation). Category 2: subcutaneous infusions such as SCIG. Category 3: IV chemotherapy and other highly complex drugs. Subsequent visits are G0068, G0069 and G0070; initial visits G0088, G0089 and G0090.
One payment per visit day
VerifiedClaims report time in 15-minute units, but payment is a single unit per category per visit day, equal to five hours of physician-office infusion, and is “payment in full” for the services. An initial-visit amount applies to a new patient or after more than 60 days without an HIT code. Payment is 80% of the lesser of the charge or the fee schedule, wage-adjusted (42 CFR 414.1550).
Source: 42 CFR 414.1550CMS: HIT services benefit FAQ (June 2022)
Billing with the drug
VerifiedEach HIT code is billed with the drug’s J-code; the drug is billed with the visit or no more than 30 days before it.
Source: CMS MLN MM12108
CY 2026 rates
ProvisionalNational unadjusted CY 2026 amounts for subsequent visits are reported as $190.22 (G0068), $257.04 (G0069) and $319.76 (G0070), a 2.0% update, for dates of service from January 1, 2026. Initial-visit amounts were not captured.
Not yet confirmed — check with the CMS CY 2026 HIT rate file.
Source: CMS: CY 2026 national HIT services ratesCMS CR r13512cp
Medicare Advantage
VerifiedMedicare Advantage plans must cover all Part B benefits, including home infusion therapy services.
5How it relates to home health
From January 1, 2021, home infusion therapy services are excluded from the Medicare home health benefit. A home health agency that is not an HIT supplier must tell the patient the service is no longer covered under home health and offer care from a qualified supplier.
A Medicare home health agency that is also enrolled as a qualified HIT supplier bills an HIT claim for a visit made solely to administer the home infusion drug. When the same visit also includes separate home health services, it may bill both an HH PPS claim and an HIT claim for the distinct services, with the time properly separated. Home health visits unrelated to the infusion stay on the home health claim, and infusion of drugs that are not “home infusion drugs” can stay under home health for an eligible patient.
In practice: Both enrollments must be in place, and the documentation must show which minutes belong to which benefit.
6Accreditation and enrollment
State license first
VerifiedThe supplier must already be licensed by the state as a pharmacy, physician or other provider or supplier.
Accreditation before applying
ProvisionalMACs deny enrollment if the supplier is not yet accredited, so accreditation comes before the application. Suppliers enroll in each state where they have an accredited practice location.
Not yet confirmed — check with cms.gov (MLN MM11954) or your MAC.
Source: CMS MLN MM11954 (mirror)The Joint Commission: Home Infusion Therapy FAQ
Enrollment
VerifiedThe supplier files a CMS-855B with its contractor, holds current HIT accreditation and passes limited-risk screening (42 CFR 424.68, 424.518). It enrolls as a Part B supplier with specialty D6.
Source: 42 CFR 424.68CMS: HIT services benefit FAQ (June 2022)
Public list of suppliers
VerifiedCMS publishes enrolled HIT suppliers and the localities they serve on data.cms.gov.
72026–2027 changes
April 1, 2027: enacted in law
VerifiedFederal law (Consolidated Appropriations Act, 2026, §6222(a)) treats certain external infusion pumps, their home infusion drugs and supplies as “appropriate for use in the home” under the DME definition from April 1, 2027, where the drug requires administration by or under the supervision of a health professional and is administered or supervised by a qualified HIT supplier.
Source: CMS fact sheet: CY 2027 HH PPS proposed rule (CMS-1844-P)McDermott Will & Schulte: CY 2027 HH PPS proposed rule (secondary)
CMS’s implementing rule: proposed
ProvisionalCMS proposed how to implement it in the CY 2027 home health proposed rule (July 2026), including limiting the professional to an MD or DO, NP, PA, CNS or RN licensed in the state of infusion and physically present (excluding LPNs and LVNs), and reading “at least 12 times a year” as at least monthly. These details are proposals, not final.
Not yet confirmed — check with the CY 2027 final rule.
Time-sensitive. The final rule is expected around November 2026; recheck the proposed conditions then.
Source: CMS fact sheet: CY 2027 HH PPS proposed rule (CMS-1844-P)McDermott Will & Schulte: CY 2027 HH PPS proposed rule (secondary)
8Common pitfalls
Billing a suite visit
VerifiedServices are paid only “in the individual’s home”, so visits in an ambulatory infusion suite are not billable under this benefit (42 CFR 486.505).
Source: 42 CFR 486.505
Billing monitoring separately
VerifiedRemote monitoring, by telephone or electronically, is bundled into the visit-day payment and cannot be billed on its own.
Only L33794 pump drugs qualify; elastomeric and gravity infusions, and most IV antibiotics, fall outside the benefit.
Source: CMS: HIT services benefit FAQ (June 2022)CMS LCD L33794 policy article
Official sources
- CMS: HIT services benefit FAQ (June 2022)
- CMS MLN MM12108
- 42 CFR 486.505
- CMS Manual Transmittal r10467pi
- FR 2023-27469 (TJC)
- FR 2024-06144 (URAC)
- FR 2024-21409 (NABP)
- FR 2024-21410 (TCT)
- FR 2024-07884 (ACHC)
- FR 2024-21084 (CHAP)
- 42 CFR 486.525
- 42 CFR 414.1550
- CMS: CY 2026 national HIT services rates
- CMS CR r13512cp
- CMS MLN MM11954 (mirror)
- The Joint Commission: Home Infusion Therapy FAQ
- 42 CFR 424.68
- CMS fact sheet: CY 2027 HH PPS proposed rule (CMS-1844-P)
- McDermott Will & Schulte: CY 2027 HH PPS proposed rule (secondary)
- CMS LCD L33794 policy article
Revision history
| Date | Change |
|---|---|
| 2026-10-17 | First published |
About this guide. Published and maintained by Paloma Health Technologies; Findings are cited to official sources, dated and status-labelled; see the editorial policy. Educational summary, last reviewed October 17, 2026. Not legal advice — confirm with the state licensing agency or counsel.
Questions
Medicare home infusion therapy benefit: common questions
Is the Medicare HIT benefit the same as home health?
No. It is a separate Part B supplier benefit for professional infusion services tied to specific pump drugs, excluded from the home health benefit since January 1, 2021.
Can a home health agency bill both home health and HIT for the same visit?
Yes, if it is enrolled as both a Medicare home health agency and a qualified HIT supplier and the visit includes distinct services under each benefit with the time separated, under CMS’s conditions.
Does a supplier have to dispense the drug or furnish the pump?
No. The pump, drug and pharmacy services stay under the DME benefit, billed by a DMEPOS supplier.
Which accreditors are recognized for HIT suppliers?
The Joint Commission, URAC, ACHC, CHAP, NABP and The Compliance Team, per CMS.
What changes on April 1, 2027?
Federal law extends DME coverage to certain external pumps and their drugs that require professional administration by a qualified HIT supplier. CMS’s implementing rule was proposed in July 2026 and is not yet final.