Article Detail - JD DME

When an insulin infusion pump is covered, the drug and necessary supplies are also covered. When an insulin pump is beneficiary owned, the drugs and supplies are covered if the coverage criteria for the pump are met. Continued coverage for insulin infusion pumps and supplies requires that the beneficiary be seen and evaluated by the treating practitioner at least every three months.

Suppliers must not dispense a quantity of supplies exceeding a beneficiary's expected utilization. Reordering of supplies and accessories is based on actual usage. Suppliers should stay attuned to atypical utilization patterns on behalf of their beneficiaries and verify with the ordering practitioner that the atypical utilization is warranted. Regardless of utilization, a supplier must not dispense more than a three (3) - month quantity at a time.

A beneficiary or their caregiver must specifically request supply refills before they are dispensed. The supplier must not automatically dispense supplies on a predetermined basis, even if the beneficiary has "authorized" this in advance. As referenced in the Program Integrity Manual (CMS IOM, Publication 100-08, Medicare Program Integrity Manual, Chapter 5, Section 5.2.6), "Contact with the beneficiary or designee regarding refills must take place no sooner than 14 calendar days prior to the delivery/shipping date. For delivery of refills, the supplier must deliver the DMEPOS product no sooner than 10 calendar days prior to the end of usage for the current product.” Refer to the Noridian Medicare Home Page and related EIP Policy page for more information.