How To Use HCPCS Code G0090

HCPCS code G0090 describes professional services for the administration of intravenous chemotherapy or other highly complex infusion drug or biological for each infusion drug administration calendar day in the individual’s home, during each 15-minute interval. This code is used to identify the initial visit for the administration of intravenous chemotherapy or other highly complex infusion drug or biological in a patient’s home setting.

1. What is HCPCS G0090?

HCPCS code G0090 is used to identify the professional services provided during the initial visit for the administration of intravenous chemotherapy or other highly complex infusion drug or biological in a patient’s home. This code is specific to the first visit and is used to report the time spent by the healthcare provider in administering the infusion drug or biological.

2. Official Description

The official description of HCPCS code G0090 is “Professional services, initial visit, for the administration of intravenous chemotherapy or other highly complex infusion drug or biological for each infusion drug administration calendar day in the individual’s home, each 15 minutes.” The short description for this code is “Adm iv chemo 1st home visit.”

3. Procedure

1. The healthcare provider begins by assessing the patient’s medical condition and determining the appropriate intravenous chemotherapy or infusion drug.
2. The provider prepares the necessary equipment and medication for the administration.
3. The provider ensures the patient’s safety and comfort during the procedure.
4. The provider administers the intravenous chemotherapy or infusion drug according to the prescribed dosage and schedule.
5. The provider monitors the patient’s vital signs and response to the medication throughout the procedure.
6. After the administration, the provider documents the details of the procedure and any observed side effects or complications.

4. When to use HCPCS code G0090

HCPCS code G0090 should be used when a healthcare provider performs the initial visit for the administration of intravenous chemotherapy or other highly complex infusion drug or biological in a patient’s home. This code is specific to the first visit and should not be used for subsequent visits.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0090, healthcare providers should ensure that the following documentation requirements are met:

• Documentation of the patient’s medical condition necessitating the intravenous chemotherapy or infusion drug.
• Documentation of the time spent by the healthcare provider in administering the infusion drug or biological.
• Documentation of any observed side effects or complications during the procedure.

6. Historical Information and Code Maintenance

HCPCS code G0090 was added to the Healthcare Common Procedure Coding System on January 01, 2021. As of the effective date, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

HCPCS code G0090 is eligible for coverage by Medicare. The pricing indicator code 11 indicates that the price for this service is established using national relative value units (RVUs). The multiple pricing indicator code A indicates that this code is not applicable as HCPCS priced under one methodology.

8. Examples

Here are five examples of when HCPCS code G0090 should be billed:

1. A patient with a diagnosis of cancer receives their first intravenous chemotherapy treatment at home.
2. A patient with a complex medical condition requires the administration of a highly specialized infusion drug in their home setting.
3. A healthcare provider visits a patient’s home to administer intravenous chemotherapy for the first time after a hospital stay.
4. A patient with a chronic illness receives their initial infusion therapy at home.
5. A healthcare provider administers a highly complex infusion drug to a patient in their home as part of a clinical trial.