Question 1

What is HCPCS code S9359?

Accepted Answer

HCPCS code S9359 is "Hit anti-tnf per diem". Home infusion therapy, anti-tumor necrosis factor intravenous therapy; (e.g., infliximab); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

Question 2

What category is S9359 in?

Accepted Answer

S9359 belongs to HCPCS Category S (Temporary National Codes (Non-Medicare)).

Question 3

When should I use HCPCS code S9359?

Accepted Answer

Use S9359 when billing for hit anti-tnf per diem. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is S9359 covered by Medicare?

Accepted Answer

Coverage for S9359 (Hit anti-tnf per diem) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for S9359?

Accepted Answer

Documentation for S9359 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).