1. (1) Codes that have "PA" indicated require prior authorization. Codes with "BR" indicated are covered by report.

2. (2) Standard Total Parenteral Nutrition (TPN):

   1. (a) Bill using Healthcare Common Procedure Coding System (HCPCS) codes S9365 through S9368;

   2. (b) Home infusion for stand TPN includes the following drugs and products in the per diem rate:

      1. (A) Non-specialty amino acids (e.g., aminosyn, freeamine, travasol)
      2. (B) Concentrated dextrose (e.g., D10, D20, D40, D50, D60, D70)
      3. (C) Sterile water;
      4. (D) Electrolytes (e.g., CaC12, KCL, KPO4, MgSo4, NaAc, NaCl, NaPO4);
      5. (E) Standard multi-trace elements (e.g., MTE4, MTE5, MTE7);
      6. (F) Standard multi-vitamin solutions (e.g., MVI-13).

   3. (c) The following items are not included in the per diem and should be billed separately:

      1. (A) Specialty amino acids for renal failure, hepatic failure or for high stress conditions (e.g., aminess, aminosyn-RF, nephramine, RenAmin, HepatAmine, Aminosyn-HBC, BranchAmin, FreeAmine HBC, Trophamine);
      2. (B) Specialty amino acids with concentrations of 15% and above when medically necessary for fluid restricted patients (e.g., Aminosyn 15%, Novamine 15%, Clinisol 15%);
      3. (C) Lipids
      4. (D) Added trace elements, vitamins not from standard multitrace element or multivitamin solution;
      5. (E) Products serving non-nutritional purposes (e.g., heparin, insulin, iron dextran).

3. (2) Parenteral Nutrition Solutions:

   1. (a) Bill using HCPCS codes B4164 through B5200. See HCPCS book for description.
   2. (b) Note: Reimbursement for compounding, admixture and administrative fees is included in the unit price.
4. (3) Parenteral Supply Kits/Supplies — Procedure Codes
5. (4) Parenteral Nutrition Equipment — Procedure Codes — Table 0280-1.

6. (5) Not Otherwise Classified (NOC) — B9999, NOC For Parenteral Supplies — PA/BR.

   [ED. NOTE: Tables referenced are available from the agency.]

Statutory/Other Authority

ORS 413.042

Statutes/Other Implemented

ORS 414.065

History

OMAP 15-2004, f. 3-11-04, cert. ef. 4-1-04
OMAP 22-2003, f. 3-26-03, cert. ef. 4-1-03
OMAP 46-2001, f. 9-24-01, cert. ef. 10-1-01, Renumbered from 410-121-0860
OMAP 29-2000, f. 9-29-00, cert. ef. 10-1-00
OMAP 7-1998, f. 2-27-98, cert. ef. 3-1-98
HR 3-1995, f. & cert. ef. 2-1-95
HR 26-1993, f. & cert. ef. 10-1-93
HR 26-1990, f. 8-31-90, cert. ef. 9-1-90