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Home Infusion Therapy

DMA Clinical Policy and Programs
919-855-4380
Fax 919-715-9025

The Home Infusion Therapy (HIT) program covers self-administered infusion therapy and enteral supplies provided to a Medicaid recipient residing in a private residence or an adult care home.  Covered services include:

• Total parenteral nutrition (TPN)
• Enteral nutrition (EN)
• Intravenous chemotherapy
• Intravenous antibiotic therapy
• Pain management therapy, including subcutaneous, epidural, intrathecal, and intravenous pain management therapy

For service requirements, coverage criteria and limitations, refer to Clinical Coverage Policy #3H1, Home Infusion Therapy.

Medicaid Bulletins

For changes and updates to coverage criteria, billing information, and other program requirements refer to the N.C. Medicaid general and special bulletins.

• Index of Articles for HIT Providers
• Index of All Bulletins
• All Bulletins by Date

Home Infustion Therapy Forms

To see forms that apply to all providers, please visit our Provider Forms page.

• Prior Approval (General)
  • Non-Covered State Medicaid Plan Services Request Form for Recipients under 21 Years of Age (PDF, 28KB)
  • General Request for Prior Approval Form - (372-118) (PDF, 61KB)

Home Infusion Therapy Fee Schedules

• Adobe Acrobat Format - effective date 07/01/12
• Microsoft Excel Format - effective date 07/01/12
• Adobe Acrobat Format - effective date 11/01/11
• Microsoft Excel Format - effective date 11/01/11
• Adobe Acrobat Format - updated 09/30/09
• Microsoft Excel Format - updated 09/30/09
• Adobe Acrobat Format - updated 09/01/08
• Microsoft Excel Format - updated 09/01/08
• Adobe Acrobat Format - updated 01/02/08
• Microsoft Excel Format - updated 01/02/08