S9504 Hit antibiotic q4h diemHome infusion therapy, antibiotic, antiviral, or antifungal; once every 4 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
Status I: not valid for Medicare (Medicare uses another code).
1 of 1 payer prior-auth lists that name S9504 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Cross and Blue Shield of Texas | Texas PA exemption (gold card), outpatient, fully insured | TX | prior auth required | Gold-card exemption available | Jan 1, 2026 | BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range) |
S9504 appears in 14 coverage policies from Aetna, Anthem, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Home Health Aides (0218) | listed, no stance (range S9490-S9810) | Sep 10, 2026 | payer document |
| Aetna | Infusion Pumps (0161) | covered if criteria are met | Mar 31, 2026 | payer document |
| Aetna | Lyme Disease and other Tick-Borne Diseases (0215) | covered if criteria are met (range S9494-S9504) | Jul 21, 2026 | payer document |
| Aetna | Skilled Home Private Duty Nursing Care (0136) | listed, no stance (range S9490-S9810) | Apr 7, 2026 | payer document |
| Anthem | Home Health (CG-MED-23) | covered if criteria are met (range S9494-S9504) | Nov 6, 2025 | payer document |
| Anthem | Parenteral Antibiotics for the Treatment of Lyme Disease (CG-MED-98) | covered if criteria are met | Nov 6, 2025 | payer document |
| UnitedHealthcare | Home Health Care Services (for Kentucky Only) (CS137KY.12) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Home Health, Skilled, and Custodial Care Services (CS137.X) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Home Health, Skilled, and Custodial Care Services (MP.022.28) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Home Health, Skilled, and Custodial Care Services (for Kansas Only) (CS137KS.04) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Home Health, Skilled, and Custodial Care Services (for Nebraska Only) (CS137NE.V) | listed, no stance | Jan 1, 2026 | payer document |
| UnitedHealthcare | Home Health, Skilled, and Custodial Care Services (for New Mexico Only) (CS137NM.D) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Home Health, Skilled, and Custodial Care Services (for Ohio Only) (CS137OH.E) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Home Health, Skilled, and Custodial Care Services (for Tennessee Only) (CS137TN1.J) | listed, no stance | Jan 1, 2026 | payer document |
Prior authorization required or conditional in IN.
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.