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Geisinger Health PlanMedicare Advantage · Billing Codes · ClaimsHigh impact

Geisinger Gold aligns with Medicare regulations for home infusion therapy billing

Act
by Dec 31, 2025
Effective date
Jan 1, 2026
Identified
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.

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What to do

by Dec 31, 2025 · 6 steps
01Billing team must audit current home infusion therapy billing practices to identify all claims using S codes and 99 codes.
02Update 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.
03Providers 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.
04Update encounter forms and clinical documentation templates to ensure providers understand drugs must be billed with pump/supplies to be payable.
05Communicate changes to all providers and home infusion therapy suppliers.
06Beginning 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.

Codes mentioned

L33794

Original notice

Geisinger Gold aligns with Medicare regulations for home infusion therapy billing
geisinger.org · Always check the source before changing claims.
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Related policy hubs

Geisinger Health Plan policiesCode L33794

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