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See a sample rate comparisonHCPCS S5521 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Home infusion therapy, all supplies (including catheter) necessary for a midline catheter insertion
| Key Fact | Detail |
|---|---|
| Service Type | Temporary National Codes (Non-Medicare) Home Infusion Therapy |
| Common Place of Service | None 99 - Other POS 11 - Office |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for S5521 |
National average reimbursement for HCPCS S5521 by major payers:
$115.03
$70.00
$10.00
$204.15
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HCPCS S5521
5 of 25 sample ratesHigher to lower in this preview
Florida Hospital Home Infusion, LLP, Florida Hospital Home Infusion LLP Tampa Division
Florida Hospital Home Infusion, LLP
$129.00Published rateCoram Alternate Site Services Inc, Coram Cvs/Specialty Infusion Services
$70.00Published rateOptum Infusion Services 202, Inc.
$60.00Published rateZenith 24, LLC
$50.00Published rateApricusrx LLC, Vital Care Of Sarasota
Apricusrx LLC
$50.00Published rate
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See a sample payer proposalHCPCS S5521 vs. Other Home Infusion Therapy Codes
The HCPCS S5521 code is part of the Temporary National Codes (Non-Medicare) services used for Home Infusion Therapy. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS S5521 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| S5520-HCPCS | Low | Home infusion therapy, all supplies (including catheter) necessary for a peripherally inserted central venous catheter (PICC) line insertion |
| S5521-HCPCS | Low | Home infusion therapy, all supplies (including catheter) necessary for a midline catheter insertion |
| S5522-HCPCS | Low | Home infusion therapy, insertion of peripherally inserted central venous catheter (PICC), nursing services only (no supplies or catheter included) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS S5521. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the S5521 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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