Infusion service in clinic viable?

[Neurologo]

1 hour of IV infusion has charge code 96365 which only gets about $75 from Medicare. IV push is 96374 getting only $42. In comparison, IM or SQ injections are much higher while taking only 5-15 minutes to complete. With this level of poor reimbursement rate, it does not even cover for the equipment, rental space and RN salary. How are infusion centers surviving? Am I missing some other codes to charges for non-facility infusion?

[8arclay]

Cash payment

[G]

1 hour of IV infusion has charge code 96365 which only gets about $75 from Medicare. IV push is 96374 getting only $42. In comparison, IM or SQ injections are much higher while taking only 5-15 minutes to complete. With this level of poor reimbursement rate, it does not even cover for the equipment, rental space and RN salary. How are infusion centers surviving? Am I missing some other codes to charges for non-facility infusion?

Interesting. Can't speak to your question, but this shows that private insurance--once again--greases the wheels of healthcare! Would hate to see the Medicaid rates--oh, right, they just get sent to the ER.

[childay]

1 hour of IV infusion has charge code 96365 which only gets about $75 from Medicare. IV push is 96374 getting only $42. In comparison, IM or SQ injections are much higher while taking only 5-15 minutes to complete. With this level of poor reimbursement rate, it does not even cover for the equipment, rental space and RN salary. How are infusion centers surviving? Am I missing some other codes to charges for non-facility infusion?

Are you sure there's no facility fee charge?

[Notsobad]

One nurse can do 8-10 patients a day, more if the treatment is simple. But it will not make a profit unless you are able to have a margin on the infused product.

[Neurologo]

Are you sure there's no facility fee charge?

This is what I am wondering.

[Lordosis]

What are you infusing?

[Neurologo]

Usual neuro meds that can prevent unnecessary ED visits or admission. For infusion such as methylprednisolone, MS meds, few seizure meds loading. For IV push for headaches like Benadryl, Compazine, Dexamethadone. No ketamine or other magic fluids.

[BlueCollarMD]

If Infusion makes money it is because of the margin on drugs. Thats it. Payments for administration are small in comparison. Biologics, but you need to be diligent about the price and reimbursement and make sure denials are very close to zero (compulsive preauth and collection of copays for drugs).

[funkmstr47]

Usual neuro meds that can prevent unnecessary ED visits or admission. For infusion such as methylprednisolone, MS meds, few seizure meds loading. For IV push for headaches like Benadryl, Compazine, Dexamethadone. No ketamine or other magic fluids.

This is the way our org makes money on our infusion center - but only because we have capitated payments for these individuals. Doubt it would be a moneymaker for those still under FFS.