Medicare AdvantageBilling CodesHigh impact
Geisinger Gold aligns with Medicare regulations for home infusion therapy billing
Geisinger Health Plan·Claims
Effective date
Jan 1, 2026
We identified it
Jul 29, 2026
Summary
Effective January 1, 2026, Geisinger Gold (Medicare Advantage) will no longer pay for S and 99 codes billed for home infusion therapy administration. Providers must align with Medicare standards by billing professional services under the Medicare home infusion therapy benefit (requiring External Infusion Pump LCD L33794 compliance) instead. Claims submitted with S or 99 codes on or after this date will deny as provider liability.
Action Required
By December 31, 2025: Billing team must audit current home infusion therapy billing practices to identify all claims using S codes and 99 codes. Update billing system logic to reject or reroute S and 99 codes for home infusion therapy claims with dates of service on or after January 1, 2026, preventing submission. Providers and billing staff must review Medicare guidelines (Medicare Benefit Policy Manual Chapter 15, Sections 50 and 320, and External Infusion Pump LCD L33794) and retrain on correct billing requirements: professional services must be billed under the Medicare home infusion therapy benefit (not S/99 codes), drugs must be billed with external infusion pump and supplies under DME benefit, and only drugs listed in LCD L33794 are payable. Update encounter forms and clinical documentation templates to ensure providers understand drugs must be billed with pump/supplies to be payable. Communicate changes to all providers and home infusion therapy suppliers. Beginning January 1, 2026, all claims using S or 99 codes for home infusion therapy will be denied as provider liability—no payment will be issued.