I’m hoping someone has an idea what we can do to override a problem we are having between Anthem BCBS and Tricare for Life. We are an infectious disease clinic and many of our patients opt to infuse themselves at home rather than come to the clinic daily. We are not involving a home health agency and provide the patient with all supplies and medications. Anthem requires we bill S9494 with POS 12, however CMS does not allow coverage for this code, therefore Tricare rejects it. Is there any way around this problem, or are we going to have to write off a large sum?

We have since learned from the patient’s account that anytime a federal payer is involved the patient has no choice but to have their infusions in the office due to Anthem’s billing requirements. We are just hoping we may get our original patient paid.

Any help is appreciated, thank you!
Meg W.
Billing Specialist
Infectious Disease Specialists, PC