Does Medicare cover home infusion therapy?

What does Medicare cover for home infusion therapy?

Infusion therapy delivers medicine or other treatment intravenously (through your veins) or subcutaneously (under your skin), and home infusion therapy lets you get it at home instead of in a hospital or clinic. Medicare Part B covers:

• Home infusion equipment and supplies as durable medical equipment (DME), including pumps, IV poles, tubing and catheters, used to give certain infusion drugs at home
• Infusion therapy services needed to safely give certain intravenous or subcutaneous drugs at home, like nursing visits, caregiver training and patient monitoring

Which drugs qualify for home infusion therapy services?

CMS says the Part B home infusion therapy services benefit covers certain drugs and biologicals given intravenously, or subcutaneously over 15 minutes or more, through a pump that's an item of DME. The infusion pump, supplies and the home infusion drug itself are covered under the DME benefit. CMS groups the qualifying drugs into three payment categories:

• Certain intravenous drugs, such as antifungals and antivirals, inotropic and pulmonary hypertension drugs, pain management drugs and chelation drugs
• Subcutaneous infusions, such as certain subcutaneous immunotherapy infusions
• Intravenous infusions of certain chemotherapy drugs and other highly complex drugs and biologicals

Who qualifies for Medicare home infusion therapy?

CMS says you must have Medicare Part B and meet both of these requirements:

• You're under the care of a physician, nurse practitioner or physician assistant
• You're under a plan of care set up by a physician that lists the type, amount and length of the services (including monitoring), the medication, the dose and how often you get it

What do I pay for home infusion therapy?

In most cases, you pay 20% of the Medicare-approved amount for home infusion therapy services and for the equipment and supplies you use at home. The Part B deductible ($283 in 2026) applies to the equipment and supplies.

For the equipment, ask the supplier whether it participates in Medicare or will accept assignment before you get it. A supplier that doesn't participate or won't accept assignment may charge you more, and for rented equipment, a supplier that won't accept assignment for all rental months can ask you to pay the full cost upfront, with Medicare paying you back its share after your claims are processed.

Who provides home infusion services?

A qualified home infusion therapy supplier provides the services. It can be a pharmacy, physician or other provider licensed by the state, and it must be accredited by a Medicare-approved accrediting organization and enrolled in Medicare. CMS says the supplier must make sure home infusion therapy services are provided safely 7 days a week, 24 hours a day, and CMS publishes a searchable directory of home infusion therapy suppliers.

Nurses typically train you or your caregiver to give the drug, explain side effects and the goals of therapy, and visit to check the infusion site and change dressings. See Does Medicare cover caregiver training?.

Does Medicare Advantage cover home infusion therapy?

For the equipment and supplies, yes: Medicare's equipment booklet says Medicare Advantage plans must cover the same medically necessary categories of durable medical equipment as Original Medicare, though the suppliers you use and your costs depend on the plan. Medicare Advantage plans provide almost all medically necessary services Original Medicare covers, and in many cases you'll need to use providers in the plan's network, so check with your plan before you get home infusion therapy. See What is the difference between Original Medicare and Medicare Advantage?.