Billing and Coding: Prolonged Drug and Biological Infusions Started Incident To a Physician’s Service Using an External Pump

Medicare covers drugs and biologicals furnished “incident to” a physician’s service (1861(s)(2)(A)/(B)), including medically necessary prolonged infusions that are started in the physician’s office or hospital outpatient using an external pump and continued at home, but the external pump is not separately billable as durable medical equipment and the physician/hospital must incur the drug/biologic cost. For paper claims, enter “PUMP” in the UB‑04 remarks or CMS‑1500 block 19 to indicate use of an external pump (not required on electronic equivalents).

"“The word ‘PUMP’ should be entered in the REMARKS section of the CMS-1450 (UB-04) claim form or the electronic equivalent to indicate the claim is for use of an external pump for the administration..."

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