Medicare coverage out patient IV antibiotic

Nurses General Nursing

Published

I an on Medicare and have a question. I went to the ER tonight. Rather then admit me, I was discharged, given a script and told to return for outpatient IV therapy. I have Part D. Dies anyone know if Part D or my regular Medicare coverage will cover my treatment and which one.

Grannynurse:balloons:

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Specializes in Hospice, Med/Surg, ICU, ER.

From www.medicare.gov

Medicare Part B covers medically necessary services you get as an outpatient from a Medicare-participating hospital for diagnosis or treatment of an illness or injury.

Covered outpatient hospital services include:

  • Services in an emergency room or outpatient clinic, including same-day surgery;
  • Laboratory tests billed by the hospital;
  • Mental health care in a partial hospitalization program, if a physician certifies that inpatient treatment would be required without it;
  • X-rays and other radiology services billed by the hospital;
  • Medical supplies such as splints and casts; and
  • Drugs and biologicals that you cannot give yourself.

They asked "What State" before providing this answer, so I'm not sure if it applies to your state.

Hope this helps.

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Specializes in Med/Surg, Ortho.

You need to check with the admission office/UR nurse to see if they have verified that it will pay before you take your first treatment. I would think if they are doing their job they will have done all the checking to see what is or what isnt covered.

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You need to check with the admission office/UR nurse to see if they have verified that it will pay before you take your first treatment. I would think if they are doing their job they will have done all the checking to see what is or what isnt covered.

I am leaving in a few minutes. Unfortunately there is no admissions office, just pre-registration in the ER, with a pink lady. My money is tight and even with Part D coverage my cost could run from $30-$90 a dose. Thans everyone for your reply.

Grannynurse:balloons:

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Specializes in Hemodialysis, Home Health.
I am leaving in a few minutes. Unfortunately there is no admissions office, just pre-registration in the ER, with a pink lady. My money is tight and even with Part D coverage my cost could run from $30-$90 a dose. Thans everyone for your reply.

Grannynurse:balloons:

Grannynurse... let us know what you find out.

Is it really coming to this? Another way to cheat you out of your medicare you paid into for so long ...and most certainly deserve to get something in return for? :madface:

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I will never understand medicare. We had a pt. who needed 10 days of IV antibiotics after an outpatient procedure. He had a PICC put in and prepared for discharge. Medicare wouldn't pay for home health to adm the AB so they had to admit him for 10 days. :uhoh3: CRAZY, the HH would cost SO much less.

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Specializes in Hemodialysis, Home Health.
I will never understand medicare. We had a pt. who needed 10 days of IV antibiotics after an outpatient procedure. He had a PICC put in and prepared for discharge. Medicare wouldn't pay for home health to adm the AB so they had to admit him for 10 days. :uhoh3: CRAZY, the HH would cost SO much less.

I certainly agree. And we DO give a lot of home abx txs.. via IV Ball, and other methods. But these are patients already established and previously receiving HH.

I guess if it's a new pt. not already on HH, and the patient just needs abx and nothing more.. and is able to drive etc., then they don't consider him meeting HH criteria. But it doesn't make sense... why pay hospital fees for something which could be offered for far less in a HH environment? :stone

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Specializes in 5 years peds, 35 years med-surg.
But it doesn't make sense... why pay hospital fees for something which could be offered for far less in a HH environment? :stone

When has medical care in the states ever made sense? My husband is Canadian and can't believe how things are done here. No, the Canadian system isn't perfect, but at least EVERYONE has some kind of care. It's the same in Sweden. Yes, they have higher taxes also. Which is worse....higher taxes and medical coverage....or lower taxes and paying hundreds of dollars a month for insurance.......only for people that can afford it? My daughter pays $800 a month for herself and the kids....the law firm where her hubby works pays his part of $300. Can a person making minimum wage afford insurance? Besides costing more....benefits are being reduced. It's a sad state of affairs.

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