Intramuscular and intravenous injections of medications constitute skilled nursing
services. However, if the drug injected is not considered an effective treatment for
the condition given, or a medical reason does not exist for providing it by injection
rather than by mouth, the injection is not considered reasonable and necessary to
the treatment of the individual's illness. Also, if the patient or a member of his
family has been taught to administer an intramuscular injection it would not be deemed
reasonable and necessary to have a nurse administer the injection. Intravenous injections
may only be given by a professional medical person.
The drugs and biologicals injected are specifically excluded from coverage under the
home health benefit.
a. Vitamin B-12 injections
Vitamin B-12 injections are considered specific therapy only for the following conditions:
Pernicious anemia: megaloblastic anemias, macrocytic anemias; fish tapeworm anemia;
CERTAIN GASTROINTESTINAL DISORDERS
Gastrectomy; malabsorption syndromes such as sprue and idiopathic steatorrhea; surgical
and mechanical disorders such as resection of the small intestine, strictures, anastomoses
and blind loop syndromes;
Posterolaterial sclerosis; other neuropathies associated with pernicious anemia; during
the acute phase or acute exacerbation of a neuropathy due to malnutrition and alcoholism.
Insulin injections are specific therapy for diabetes. However, if the individual or
a family member has been taught to give the injection it is not considered reasonable
and necessary to the treatment of the individual's illness to have a nurse administer
such injections. If the patient is mentally and physically able to be taught to give
himself the injection but refuses to learn to do so, visits by a nurse to administer
the injections are not considered reasonable and necessary and would not be reimbursable under the program.
If a patient has a psychological block to giving himself an insulin injection, he
would be considered mentally unable to be taught to render the self-injection.