Some medications no longer available to Geisinger Gold members through home infusion starting May 1

For dates of service on and after Wednesday, May 1, Geisinger Gold will only pay for home infusion drugs that are explicitly listed as payable under the home infusion therapy services in the Medicare Claims Processing Manual, chapter 32, section 411 (pg. 295). Home infusion medications not covered under the Medicare home infusion therapy services benefit that are billed for Geisinger Gold members on or after May 1 will be denied.

We’re notifying Geisinger Gold members who will be impacted by this change. Geisinger Gold members cannot be held liable for denials associated with these home infusion drugs.

Drugs no longer available through home infusion may be coverable at an alternative infusion location. Call 800-498-9731, Monday – Friday, 8 a.m. – 8 p.m., to find a participating provider.

Prescribers should only prescribe home infusion medications to Geisinger Gold members who are covered under the Medicare home infusion therapy services benefit.

Home health agencies and other home infusion providers should not bill Geisinger Gold or Geisinger Gold members for home infusion drugs or services that are not payable under Medicare guidelines.

Some of the infusion drugs affected by this change may have received prior authorization. Prior authorization verifies medical necessity criteria have been met and is not a guarantee of payment. Drugs administered to Geisinger Gold members through home infusion and not covered under the Medicare home infusion therapy services benefit are not payable regardless of prior authorization status.