RETIRED - Correct Coding - Insulin Used with Continuous External Insulin Infusion Pumps

IMPORTANT: THIS DOCUMENT CONTAINS OUTDATED INFORMATION.

Content Provided on this page contains outdated information and instruction and should not be considered current. Noridian is providing this archived information for research purposes only. This archived article contains previously issued instructions that have since been updated or are no longer applicable for Medicare billing purposes.

DME MAC Joint Publication

Posted on October 19, 2017

Recently the DME MACs have become aware of pharmacy billing to Medicare Part D for insulin used in a Durable Medical Equipment (DME) external insulin infusion pump (E0784 [EXTERNAL AMBULATORY INFUSION PUMP, INSULIN]). The DME MACs have jurisdiction for claims for DME and related supplies used with the DME items.  Payment under Part D is prohibited when there is coverage under a Part B benefit. In the case of insulin, when it is administered via a Part B-covered DME pump, payment from Part D is excluded. All claims for DME and supplies used with DME items must be billed to the DME MACs.

The correct HCPCS code to use for billing insulin used with an E0784 pump is:

  • J1817 - INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS  

Use of HCPCS codes J1815 [INJECTION, INSULIN, PER 5 UNITS] or J7799 [NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH DME] are incorrect coding and will be denied.

Refer to the External Infusion Pump LCD, related Policy Article, Standard Documentation Requirements article and DME MAC Supplier Manual for additional information on coverage, coding, documentation, and billing.

Correct coding is an essential element for correct claim payment. The Pricing, Data Analysis and Coding (PDAC) contractor maintains a variety of resources to assist suppliers in determining the appropriate code for Medicare billing. For questions about correct coding, contact the PDAC Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail questions to the PDAC by completing the DME PDAC Contact Form.

Publication History

Date of Change Description
10/19/2017 Original publication
09/30/21 Retired. See revised article published on 09/30/21

 

Last Updated Dec 10 , 2023