Georgia Medicare Home Infusion Therapy 2026 Guide

Medicare's Home Infusion Therapy (HIT) benefit pays for the professional services that let a Georgia beneficiary receive IV or subcutaneous drug therapy at home. It covers the skilled nursing, pharmacy coordination, patient training, and monitoring around the infusion, so a course that once meant a hospital or infusion-center stay can finish at home. The benefit is set by Section 1834(u) of the Social Security Act and became a permanent Medicare benefit on January 1, 2021. It pays only for the services around the infusion; the drug and the external infusion pump are covered separately, through Medicare Part B durable medical equipment (DME) or, for some self-administered drugs, Part D. This guide explains what HIT covers, how it is paid, who can supply it, and how a Georgia family arranges home infusion after a hospital stay.

In This Guide

• The Federal Framework
• What HIT Covers and Excludes
• How HIT Is Paid
• What You Pay in 2026
• HIT Suppliers and Accreditation
• Drug Coverage: Part B DME vs. Part D
• Common Home Infusion Therapies
• Home Infusion in Georgia
• How It Works: Two Examples
• Frequently Asked Questions
• Learn More

The Federal Statutory Framework

Section 1834(u) of the Social Security Act sets Medicare's coverage and payment rules for home infusion therapy services: the payment categories and amounts, the quality reporting requirement, and the definition of a qualified HIT supplier. Section 1861(iii) of the Act defines "home infusion therapy" as the items and services for administering a home infusion drug, generally a parenteral drug or biological given intravenously or subcutaneously through a pump that is an item of durable medical equipment.

Two laws built the benefit in stages. Section 5012 of the 21st Century Cures Act of 2016 created the home infusion therapy benefit and directed CMS to establish payment categories, supplier qualifications, and quality reporting. Because the permanent benefit did not start until 2021, Section 50401 of the Bipartisan Budget Act of 2018 authorized a transitional payment for calendar years 2019 and 2020 so beneficiaries were not left without coverage in the interim. CMS then implemented the permanent benefit effective January 1, 2021 through the CY 2021 Home Health Prospective Payment System final rule; see the CMS Home Infusion Therapy Services page for the current rules. CMS carries the implementing regulations at 42 CFR Part 414.

What HIT Covers and What It Does Not

The Section 1834(u) benefit covers the professional services a supplier provides in connection with home infusion:

• Pharmacy services: compounding and preparing the drug, delivering it to the home, quality assurance, drug-interaction review, and coordination with the prescriber.
• Nursing services: the initial home assessment, drug administration when a nurse gives it, IV-access management, and ongoing patient assessment.
• Patient and caregiver training: administration technique, pump and IV-access use, sterile technique, and recognizing adverse reactions.
• Monitoring and coordination: periodic assessment, adverse-event reporting, and plan-of-care updates with the physician.

The benefit does not pay for:

• The drug itself (covered separately under Part B DME or Part D).
• The external infusion pump, which is covered under Part B DME after the annual deductible and 20 percent coinsurance.1
• General home health nursing unrelated to the infusion (covered under the home health benefit if the patient qualifies).
• Services for a patient who has elected the Medicare hospice benefit, or infusion furnished in a hospital or facility (different benefits apply).

How HIT Is Paid: The Three Payment Categories

Section 1834(u) pays HIT on a per-visit, per-day basis rather than as a lump sum. CMS assigns each home infusion drug, by its billing code, to one of three payment categories based on complexity. The initial visit is paid at a higher rate to reflect the assessment, IV-access setup, and training done on day one; each later day on which the drug is administered is paid as a single infusion-drug administration day. The specific dollar amounts are updated each year in the Home Health Prospective Payment System rule and are published on the CMS Home Infusion Therapy Services page.

A single day can hold more than one drug administration and still counts as one infusion-drug administration day. Payment rates are updated annually, so a course that spans a year boundary may be paid at two different rates.

What You Pay in 2026

HIT services are billed under Medicare Part B, so standard Part B cost-sharing applies. In 2026, you first meet the annual Part B deductible of $283, then pay 20 percent coinsurance of the Medicare-approved amount.2 There is no separate facility fee, because the services are furnished in your home.

You pay that 20 percent twice over: once on the HIT professional services, and again on the DME drug and pump, which carry their own 20 percent Part B coinsurance after the same $283 deductible.1 To see how the arithmetic works with a hypothetical monthly total (not an actual Medicare rate): if the approved amount for a month of services plus the drug and pump came to $1,500, you would first meet the $283 deductible, then pay 20 percent of the remaining $1,217, or about $243.2 Your real amount depends on the drug, its payment category, and how long therapy lasts.

Over a multi-week or lifelong course, that coinsurance adds up. A Medigap policy or a Medicare Advantage plan can reduce or cap what you pay out of pocket; check your specific plan documents.

HIT Suppliers and Accreditation

Section 1834(u)(5) defines a "qualified home infusion therapy supplier" as a pharmacy, physician, or other provider that is licensed in the state where it furnishes the services, furnishes infusion therapy to patients with acute or chronic conditions, ensures safe administration, provides care coordination, and is accredited by a CMS-approved organization. A supplier that loses its accreditation cannot bill Medicare for HIT services.

Three CMS-approved organizations accredit most HIT suppliers:

• Accreditation Commission for Health Care (ACHC): standards for pharmacy and nursing services, patient care, and quality management.
• Community Health Accreditation Partner (CHAP): standards for community-based health care including home infusion.
• The Joint Commission: home infusion standards within its broader health-care accreditation framework.

Accreditation involves an application, a standards review, an on-site survey, correction of any deficiencies, and ongoing re-accreditation. Before relying on a supplier, confirm it is enrolled in Medicare and currently accredited.

Qualified HIT suppliers must also report quality data to CMS under the HIT Quality Reporting Program authorized by Section 1834(u)(3). A supplier that fails to report faces a reduction in its annual payment update. Check the CMS Home Infusion Therapy Services page for the current measures and reporting rules.

Drug Coverage: Part B DME Versus Part D

The single most common point of confusion is that HIT services and the drug are two different Medicare benefits with two separate claims. Both must be in place for a complete home infusion episode.

Part B DME pathway. Most home infusion drugs given through an external pump are covered as durable medical equipment under the External Infusion Pumps Local Coverage Determination (LCD L33794). This pathway covers the pump, the drug, and disposable supplies such as tubing and dressings, all under the standard Part B DME cost-sharing of 20 percent after the annual deductible.1 The LCD lists the specific covered drugs and indications, including certain IV antibiotics, antifungals and antivirals, continuous-infusion chemotherapy drugs (for example, fluorouracil), inotropic therapy (dobutamine, milrinone), and pain management. Home total parenteral nutrition (TPN) is covered instead under the separate Medicare Parenteral and Enteral Nutrition benefit, not the External Infusion Pumps LCD.

Part D pathway. Some self-administered infusion drugs that do not qualify for Part B DME are covered under Part D, subject to the plan's formulary, prior authorization, and cost-sharing rules.

When the HIT supplier is also enrolled as a DME supplier (most major suppliers are), both claims flow through the same company, but they still follow separate coverage rules and generate separate cost-sharing. The beneficiary sees one home infusion service and two lines of Part B coinsurance.

Common Home Infusion Therapies

Home infusion serves a wide range of conditions that once required an inpatient or clinic stay:

• IV antibiotics for serious infections that need weeks of therapy, such as osteomyelitis, endocarditis, septic arthritis, and complicated diabetic foot infections. Common agents include ceftriaxone, vancomycin, daptomycin, and ertapenem.
• Immune globulin for primary and secondary immunodeficiency and certain autoimmune neurologic conditions. Subcutaneous immune globulin (SCIG) products such as Hizentra and Hyqvia are increasingly given at home; IVIG remains appropriate for some indications.
• Chemotherapy given by continuous infusion through a portable pump, most often 5-fluorouracil for gastrointestinal cancers.
• Total parenteral nutrition (TPN) for intestinal failure, short bowel syndrome, and severe malabsorption, frequently lifelong.
• Inotropic therapy (continuous dobutamine or milrinone) for advanced heart failure, and other therapies including antifungals, antivirals, and iron infusion.

The prescribing physician sets the drug, dose, route, and duration and establishes the plan of care that the HIT supplier follows.

Home Infusion in Georgia

National HIT suppliers operate across Georgia, including Coram CVS Specialty Infusion, Optum Infusion Pharmacy, and Option Care Health, alongside regional providers such as Soleo Health and Amerita. Several Georgia health systems run their own home infusion programs, including Emory at Home (Emory Healthcare), Wellstar HomeCare (Wellstar Health System), Piedmont Home Infusion (Piedmont Healthcare), and Northside HomeCare (Northside Hospital). To find a Medicare-enrolled supplier serving a specific ZIP code, use the supplier directory at Medicare.gov.

HIT pharmacies operating in Georgia must be licensed by the Georgia Board of Pharmacy, and home infusion nursing intersects with home care licensing administered by the Georgia Department of Community Health. In rural Georgia, suppliers cover longer distances from regional hubs; most drug days are self-administered after training, with a nurse returning weekly for line assessment and lab draws, and some suppliers add telehealth check-ins between visits. Rural location does not change Medicare's HIT coverage rules.

How It Works: Two Examples

Home IV antibiotics after a hospital stay. A Medicare beneficiary in Marietta is hospitalized for osteomyelitis following a diabetic foot infection. After surgical debridement, the infectious-disease physician orders several weeks of IV ceftriaxone to finish at home. The hospital case manager arranges discharge with a HIT supplier, which sends a nurse for the initial visit to assess the home, confirm the PICC line, and train the patient and a family caregiver on sterile technique, drug administration, and warning signs. Medicare pays the Category 1 initial-visit rate, then a per-day rate for each administration day; the ceftriaxone and pump are billed separately under Part B DME. Most days the patient self-administers, with a weekly nursing visit for a PICC-site check and labs.

Weekly SCIG for immunodeficiency. A beneficiary in Atlanta with common variable immunodeficiency transitions from monthly IVIG clinic infusions to weekly subcutaneous immune globulin at home. The immunologist orders Hizentra dosed to her weight and prior IVIG dose. The HIT supplier provides the drug, pump, and supplies, and a nurse conducts an extended initial training visit on site selection, infusion technique, and pump operation. Medicare pays the Category 2 rate, higher on the initial visit and standard thereafter; the drug is covered separately. After training she self-administers weekly, with ongoing nursing support as needed, and avoids monthly trips to the infusion center.

Where to Get Help

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The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.