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External Infusion Pumps

Coverage

Documentation

Reviews/Audits

  • Medical Review - View notifications/findings of pre/post claim reviews completed by Noridian Medical Review

Tips

Topic Details
Documentation
  • For continued coverage of an external insulin pump and supplies, the treating physician must see the patient at least every 3 months. Documentation must be available upon request or in the event of a review.
Drugs Used With External Infusion Pumps
  • Coverage of drugs used with external infusion pumps may have differing denials. It is important for suppliers of these drugs to understand issues related to coverage and denials
Billing Drugs or Supplies When the External Infusion Pump (EIP) is Beneficiary-Owned
  • Suppliers must ensure that beneficiary-owned equipment information is on file with Medicare Fee-for-Service (FFS) to avoid denials. Additional documentation to support medical necessity is required for supplies and accessories when the base equipment, such as a pump, has been provided and was not initially paid for by Medicare FFS.
    • Claims submitted for drugs and supplies used with beneficiary-owned equipment require three elements as listed below.
      • Healthcare Common Procedure Coding System (HCPCS) code of base equipment (pump); and
      • A notation that the pump is beneficiary-owned; and
      • Approximate date the beneficiary obtained the pump
      • Example narrative for EIP supplies for a beneficiary owned pump:
      • BENEFICIARY OWNED K0455 PURCHASED MARCH 2016

 

Last Updated Fri, 15 Jul 2022 18:46:27 +0000

The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime.

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