Infusion Therapy

Infusion therapy is when medication is administered through a needle or catheter and is often prescribed when someone’s condition is so severe that oral medication cannot effectively treat the condition, such as cancers, blood disorders, autoimmune diseases, and infections. Compare the median payments statewide across all insurers for infusion therapy services administered from July 1, 2023 – June 30, 2024.

The cost for infusion therapy varies across settings:

  • Clinics – Clinic infusions may take place in a dedicated center or a physician’s office.
  • Homes – Patients may choose to have their infusion therapy administered in their home by registered nurses and pharmacists, directed by a physician. This service may be referred to as an Ambulatory Infusion Suite (AIS) of the home infusion therapy provider.
  • Hospitals – Infusion services can be delivered in an inpatient or outpatient setting, including cancer centers and ambulatory infusion clinics.
  • Ambulatory Surgery Centers (ASC) – Healthcare settings that provide same-day surgery care, including diagnostic and preventive procedures, can also administer infusion therapy services.
  • Mixed Mode – Combination of settings.

Regardless of your health insurance, talk with your provider to see if receiving infusion therapy in a less expensive setting is an option.

The Steps MHDO Takes to Calculate Payments for Infusion Therapy Services on CompareMaine

Step 1: Filter the Data

To create the analytic set, we filter the data by removing claims with missing information, claims from public payors (Medicare and Medicaid), and commercial claims from Medicare Advantage or for anyone 65 years old or older, as these claims are often paid for in-part by a public payor like Medicare and including them would distort the average. We also remove claims from providers with a business practice location outside of Maine.

Step 2: Find Claims Linked to a Service or Procedure

We calculate the median payments for one unit of a drug and its administration via needle in an IV, for four high cost, high utilization infusion therapy services:

Code Drugs Brand Names Use
J1569 Gammagard Liquid Injection (500 mg) Gammagard Liquid® Protects against infection in immune system disorders
J1745 Infliximab Injection Remicade® Minimizes inflammation
J3010 Fentanyl Citrate Injection Treats severe pain
J7120 Ringers Lactate Infusion (up to 1000 cc) Restores fluids and electrolytes

Step 3: Calculate the Average Payment

We use the median to calculate the average payment for each of the infusion therapy drugs listed above by healthcare setting. We also tally and display the number of providers in each healthcare setting and the number of times a specific infusion therapy drug appeared in the claims data by all payors and calendar year. We do not calculate a payment estimate if the healthcare setting has fewer than five claims for that procedure in the analytic set.