Many patients, especially the elderly, sometimes require prolonged treatments, which, if provided at hospitals, only burden the health systems. Therefore, medical attention is delivered to them right in their homes. This is where home health services help both patients and healthcare providers.
Often, these services are provided by skilled registered nurses (RNs). CPT code 99602 represents one of these services. In this guide, we will discuss what this code represents and how you can effectively use it in your billing. So, let’s start.
CPT Code 99602 – Description
CPT code 99602 is defined as:
“Home infusion/specialty drug administration, per visit (up to 2 hours); each additional hour.”
99602 represents an add-on home infusion service provided by a registered nurse. It cannot stand alone and must always be reported with CPT 99601.
An essential point to note here is that the phrase “per visit (up to 2 hours)”in the definition is a bit misleading. Code 99602 is used to bill any additional hours after the completion of two hours under 99601, and not the first two hours. Also, the time calculation for CPT code 99602 is different from facility-based nursing, where only direct patient contact time counts. According to the National Home Infusion Association (NHIA), for this code, time includes all activities necessary for the visit, such as preparation, travel to the patient’s home, time spent with the patient, documentation, post-visit reporting, and follow-up activities.
Additionally, a point that many billers miss is that it is not necessary to complete 1 hour of services for 99602 to be valid. You can still bill for the additional time if you have provided services for 30 minutes or more.
Apart from the infusion/administration of drugs, the following services are also included in 99602:
- Evaluation and assessment
- Education and training for the patient or caregiver
- Inspection and consultation of the aseptic home environment
- Catheter insertion
- Patient assessment
Scenarios Where CPT Code 99602 is Applicable
To make things simple, let’s look at a couple of real-world scenarios in which CPT code 99602 can be used:
Chronic Dehydration
Suppose an elderly patient with a history of declining cognitive function is prescribed electrolyte therapy to treat chronic dehydration and electrolyte imbalance. This therapy must be administered via intravenous infusions for 3 hours to stabilize the patient’s vital signs. The duration will ensure that almost 1 to 2 litres of fluids are delivered in each session.
So, a registered nurse arrives at the patient’s home and begins by setting up the infusion equipment and administering electrolyte treatment. Throughout the three-hour infusion, the nurse checks the patient’s vital signs every 15 minutes, carefully monitoring for any signs of adverse reactions such as allergic responses. After the IV therapy, the nurse performs a thorough assessment and documents the entire process from start to finish.
In this scenario, the billing department can use CPT code 99601 to bill the first two hours, and CPT code 99602 to bill the additional third hour.
Pain Management Care
Suppose a patient just had complex spinal fusion surgery and is dealing with intense post-operative pain that regular oral medications cannot mitigate. The surgeon decides that home infusion pain management would be the best route to help the patient recover comfortably without having to stay in the hospital for an extended period.
A nurse is appointed to provide routine infusions and care to the patient at home. For the first session, the nurse spends 4 hours administering pain medication through infusion.
So, the medical billing department codes and submits the claim for reimbursement. In this case, CPT code 99601 is used to report the first 2 hours of infusion, and 2 units of CPT code 99602 explains the additional 2 hours of service.
Applicable Modifiers for CPT Code 99602
The following modifiers are frequently used with CPT code 99602:
| Modifier Name | Short Description | When To Use |
|---|---|---|
| SD | Specialized, Highly Technical Services | Home infusion services by an RN with specialized home infusion training. |
| SH | Second Concurrent Therapy | Second concurrent infusion therapy was administered on the same day. |
| SS | Infusion Suite Service | Home infusion service provided in the provider’s infusion suite, not at home. |
| SJ | Third+ Concurrent Therapy | Third or more concurrent infusion therapies on the same day. |
CPT Code 99602 – Billing & Reimbursement Guidelines
Before filing any claims with 99602, please make sure to go through the following guidelines:
Ensure Accurate Unit Calculation
Each unit of 99602 represents one hour beyond the initial two hours covered by 99601. Time increments round to the nearest hour at the midpoint. For example, a visit lasting 2 hours and 35 minutes would be billed as 99601 (one unit) plus 99602 (one unit), while a visit lasting 3 hours and 45 minutes would be billed as 99601 (one unit) plus 99602 (two units).
Provide Detailed Documentation
Documentation is vital if you want your claims to be accepted. Your documents should be detailed and to the point.
Documentation supporting medical necessity must demonstrate why additional home infusion beyond two hours was required. Your notes should detail:
- Clinical complexity requiring an additional hour of infusion.
- Patient education and caregiver training completed.
- Any complications encountered and addressed during the visit.
- Clinical assessment findings justifying extended monitoring.
Wrapping Up
Let’s wrap up everything we have discussed in this blog.
- CPT code 99602 is an add-on code for home infusion services, specifically for each additional hour.
- Attaching supporting documentation with your claims helps justify medical necessity.
- Time calculation is vital. If you are confused, take another look at the unit calculation section.
However, even with all the precautions, claim denials can occur. That’s why it is always better to get professional home health billing services. You may contact our billing consultants to book a session.
