Starting Aug. 1: New Commercial Plan Site of Service Coverage Rules for Maintenance Infusions


Starting Aug. 1, in support of our commitment to keeping members’ costs down, we are changing how we cover ongoing maintenance infusion services for adults (21+) in our commercial plans for both EmblemHealth and ConnectiCare. Routine maintenance will be covered in the following outpatient settings:

  • Home (POS 12)
  • Office (POS 11)
  • Ambulatory infusion suites (POS 24, POS 49, or POS 12 with Modifier SS)

Exceptions for initial doses and members with justifiable needs to continue care in a hospital outpatient setting will be allowed. Your patients’ current authorizations from Express Scripts’ company Care Continuum will be valid through the date noted in their approval letter. 


For full details, please see our new Site of Service Medical Policy – Infusions and Injectables.


For assistance in locating an optimal infusion setting for your patient, email us at