Notice to home infusion providers

This notice is to inform providers who bill home infusion services for Anthem members that you must register as both Provider Type 90 (DME) and Provider Type 54 (Pharmacy). Specialty pharmacies that bill Anthem for home infusion nursing, administration, and supply services must also register with Medicaid as Provider Type 90 (DME).

Home infusion nursing, administration, and supply services must be billed to the member’s medical benefit using the provider’s NPI and taxonomy associated with Provider Type 90 (DME).

Home infusion drugs must be billed to the member’s pharmacy benefit manager, MedImpact, using the provider’s NPI and taxonomy associated with Provider Type 54 (Pharmacy).

Provider Type 54 (Pharmacy) is not a billable provider type for medical services unless billing procedure code 99401 for vaccine counseling. Home infusion claims billed to the member’s medical benefit with the pharmacy NPI and taxonomy will be denied.

For additional information, please reference the Kentucky Injectable Drug List and the DME Fee Schedule.

If you have questions, please contact your provider relationship management representative.