Doxycycline

Home infusion per diem (S-codes)

When a home infusion pharmacy dispenses this drug, the drug is billed with the code above and each day of pharmacy services, supplies, and equipment with a per diem S-code. CMS publishes no drug-to-per-diem crosswalk, so CodeRx picks the therapy category from the FDA pharmacologic class and route. S-codes are not payable by Medicare; confirm the code against the payer contract.

• Antibiotic, antiviral, or antifungal

  Derived calculationVerification needed

  Matched on: Tetracycline-class Drug

  • S9500Once every 24 hoursCMS: Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 24 hours
  • S9501Once every 12 hoursCMS: Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 12 hours
  • S9502Once every 8 hoursCMS: Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 8 hours
  • S9503Once every 6 hoursCMS: Home infusion therapy, antibiotic, antiviral, or antifungal; once every 6 hours
  • S9504Once every 4 hoursCMS: Home infusion therapy, antibiotic, antiviral, or antifungal; once every 4 hours
  • S9497Once every 3 hoursCMS: Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 3 hours
  • S9494General per diem — only when the payer does not use the dosing-frequency codes aboveCMS: Home infusion therapy, antibiotic, antiviral, or antifungal therapy

  Pick the code that matches the prescribed dosing interval.

Home infusion per diem (S-codes)

Medicare

Not payable by Medicare — CMS coverage code I (all 7 codes)

Part B pricing indicator

00 — Not separately priced by Part B (all 7 codes)

National payment amount

None. No per diem code here is in the CMS Part B payment limit file for Q4 2026; CMS sets no national per diem rate.

Washington Apple Health (Medicaid)

Not on HCA’s Home Infusion Therapy/Parenteral Nutrition Program fee schedule (effective Jul 1, 2026), so these per diems are not separately paid. Home infusion is paid with the supply, pump, and nutrition codes in that schedule instead (below).

Billing unit

1 unit = 1 day on service (the CMS descriptor ends “per diem”)

Who sets the rate

Each commercial plan’s contract or state Medicaid fee schedule. Some payers reduce a second per diem billed for the same day.

Billed separately

The drug, with its own HCPCS code and units, and nursing visits — the CMS descriptor says “drugs and nursing visits coded separately”.

Verification neededCodeRx links to coverage documents instead of copying them: CMS distributes their code lists under AMA, ADA, and AHA license terms that limit reuse. Medicare Advantage, Medicaid, and commercial plans set their own coverage and prior-authorization rules.

Every import with its checksum is listed on the data sources page.