CommercialCoverageHigh impact
New Infusion Site-of-Service Policy
EmblemHealth·Oncology, Hematology, Rheumatology +3 more·Provider News
Effective date
Aug 1, 2024
We identified it
Jun 20, 2026
Summary
Starting August 1, 2024, EmblemHealth and ConnectiCare will only cover routine maintenance infusion services for adults 21+ in specific outpatient settings: home, office, or ambulatory infusion suites. Hospital outpatient infusions will no longer be covered except for initial doses or members with justifiable medical need.
Action Required
By August 1, 2024: Billing team must verify infusion services are performed in covered settings (POS 11, 12, 24, 49, or POS 12 with Modifier SS). Update place of service codes on claims for maintenance infusions. Contact HomeInfusionteam@emblemhealth.com or 800-367-8103 to locate appropriate infusion settings for patients. Claims for hospital outpatient infusions will be denied without proper justification.