Reimbursement of Hospital Compound Solutions

Policy No: 109
Originally Created: 07/01/2016
Section: Facility
Last Reviewed: 01/01/2025
Last Revised: 01/01/2025
Approved: 01/09/2025
Effective: 05/01/2025
Policy Applies To: Group and Individual & Medicare Advantage

The policy applies to inpatient hospital facilities.

Epidural Medications – Medications administered into the epidural space.

Injection – Administration of medications into the body.

Intra-arterial Medications – Medications injected into an artery.

Intra-ocular Medications – Medications injected into the eye.

Intradialytic Parenteral Nutrition (IDPN) – Refers to the infusion of TPN through an existing dialysis access catheter or site to patients with protein calorie malnutrition during hemodialysis.

Intraperitoneal Medication – Medications administered into the peritoneum.

Intraperitoneal Parenteral Nutrition (IPPN) or Intraperitoneal Amino Acid (IPAA) Supplementation - TPN is provided using a peritoneal dialysate solution with amino acids, instead of or in addition to glucose.

TPN Product categories - There are two (2) basic TPN product categories:

• Commercially premixed multi-chamber TPN bags
• Hospital-compounded, individualized TPN admixtures.

Intramuscular Medications – Medications administered into a muscle.

Intrathecal Medications – Medications administered into the subarachnoid space.

Intravenous (IV) Solutions and IV Medications – IV solutions and medications are solutions administered directly into the venous circulation via a syringe or intravenous catheter (tube).

The Medication Administration Record (MAR or eMAR for electronic version) – The report that serves as a legal record of the drugs administered to a patient at a facility by a health care professional.

Premixed Solutions – A premixed solution contains amino acids, dextrose, electrolytes, and trace elements in a ready-to-be-infused form. Formulations of standing TPN orders for CVC or PICC line administration are very similar to those of commercially premixed TPN. Premixed TPN solutions may require manual addition of electrolytes, trace elements, vitamins and/or drugs before administration to the patient.

Premixed solutions and TPN nutrients or additives include, but are not limited to, the items shown in the table below.

Solutions – A type of mixture in which two or more substances are combined to form a single solution.

Subcutaneous Medications – Medications administered just under the skin.

Total Parenteral Nutrition (TPN) – The provision of nutritional requirement intravenously via a central venous catheter (CVC) or peripherally-inserted central catheter (PICC) line to correct/prevent specific nutrient deficiencies and to prevent adverse effects of malnutrition when the patient’s gastrointestinal tract either cannot absorb or cannot tolerate adequate food orally or via the tube-feeding route.

For premature or sick neonates, an IV line is often placed in a vein in the infant’s foot, scalp, hand or umbilical vein. Sometimes a PICC line is used for long-term IV nutrition.

Note: This policy is not effective until 5/1/2025. To view the current policy, click here.

In the inpatient hospital setting, solutions and medications administered, for all routes of administration are eligible for reimbursement when supported by a treating physician’s signed written or standing order.

• All administered solutions must be recorded in the patient's MAR, eMAR, or anesthesia record to be eligible for reimbursement.
• When an additive and/or nutrient which is not a component of a premixed solution is separately billed, there must be a physician’s signed written order documented in the patient’s medical records to be eligible for separate reimbursement.
• If the physician orders separate administration of one of the components of TPN or solutions, it will be separately reimbursed when documented in the patient’s MAR, eMAR, or anesthesia records.
• Non-compounded TPN components that may be eligible for separate reimbursement include, but are not limited to, the following:
  • Specialty amino acids for renal failure (e.g., Aminess®, Aminosyn-RF®, NephrAmine®, RenAmin®) for IDPN or IPAA.
  • Specialty amino acids for hepatic failure (e.g., HepatAmine®).
  • Specialty amino acids for high stress conditions (e.g., Aminosyn-HBC®, BranchAmin®, FreAmine HBC®).
  • Specialty amino acids with concentrations of 15% and above when medically necessary for fluid restricted members (e.g., Aminosyn® 15%, Novamine® 15%, Clinisol® 15%).
  • Specialty amino acids for premature or sick neonates (including low birth weight) and young children (TrophAmine®).
  • Standard premix amino acids (e.g., Clinimix®, FreAmine® III).
  • Lipids (e.g., Intralipid®, Liposyn®).
  • Added trace elements not from a standard multi-trace element solution (e.g., chromium, copper, iodine, manganese, selenium, zinc).
  • Added vitamins not from a standard multivitamin solution (e.g., folic acid, vitamin C, vitamin K).
  • Products serving non-nutritional purposes (e.g., heparin, insulin, iron dextran, Pepcid®, Sandostatin®, Zofran®).
• Multiple charges for the same product when supported by documentation.
  • Documentation of a drip rate check, change, or new unit scanned/administered is not sufficient to justify reimbursement for a new unit if it conflicts with the documented drip rate.

The following charges are not separately reimbursable including, but not limited to:

• Unbundling additives and/or nutrients (e.g., carbohydrates, amino acids, electrolytes, trace elements, heparin, vitamins, diluents and medications) in premixed solutions are not eligible for separate reimbursement.
• Diluents which are required to prepare a drug for administration will not be separately reimbursed.
• Hospital-compounded solutions must be billed as a single item when administered in a single bag or syringe for all routes of administration. Individual components are not eligible for separate or individual reimbursement.Parenteral nutrition infusion pump (portable or stationary), parenteral nutrition tubing, IV pole, IV tubing, Viaflex® bags, and administration kits are not separately reimbursable. They are included in the room and board charge.

Gargasz, Anne, PharmD, BCPS. Neonatal and Pediatric Parenteral Nutrition. AACN Advanced Critical Care Volume 23, Number 4, pp.451-464

Centers for Medicare & Medicaid Services (CMS), Claims Processing Manual, Chapter 3 – Inpatient Hospital Billing

Centers for Medicare & Medicaid Services (CMS), National Correct Coding Initiative (NCCI) Policy Manual. Chapter 11, Section B. Therapeutic or Diagnostic Infusions/Injections and Immunizations. (Note: In the absence of inpatient guidelines, outpatient guidance is followed)

Centers for Medicare & Medicaid Services (CMS), National Coverage Policy. Coverage Guidance-Coverage Indications, Limitations, and/or Medical Necessity. CMS Pub. 100-3 (National Coverage Determinations Manual), Chapter 1, Section 180.2

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