Article - External Infusion Pumps - Policy Article (A52507)

Pump HCPCS CodeAssociated CodesNon-Associated CodesE0779A4221, A4222, K0552*A4224, A4225E0780A4221, A4222A4224, A4225, K0552E0781A4221, A4222A4224, A4225, K0552E0784A4224, A4225, A4238**, A4239**A4221, A4222, K0552E0791A4221, A4222A4224, A4225, K0552K0455A4221, A4222, K0552*A4224, A4225*For E0779 and K0455 pumps, either A4222 or K0552 may be billed, but not both.**For E0784 pumps, either A4238 or A4239 may be billed if used in conjunction with an integrated adjunctive or non-adjunctive CGM, respectively.Prior to January 1, 2023, insulin infusion pumps with integrated continuous glucose sensing capabilities must be coded using HCPCS codes E0784 (EXTERNAL AMBULATORY INFUSION PUMP, INSULIN) and K0554 (RECEIVER (MONITOR), DEDICATED, FOR USE WITH THERAPEUTIC GLUCOSE CONTINUOUS MONITOR SYSTEM). On or after January 1, 2023, insulin infusion pumps with integrated continuous glucose sensing capabilities must be coded using HCPCS codes E0784 (EXTERNAL AMBULATORY INFUSION PUMP, INSULIN) and E2103 (NON-ADJUNCTIVE, NON-IMPLANTED CONTINUOUS GLUCOSE MONITOR OR RECEIVER).Prior to January 1, 2023, the related accessories/supplies for these integrated units must be coded using HCPCS codes A4224 (SUPPLIES FOR MAINTENANCE OF INSULIN INFUSION CATHETER, PER WEEK), A4225 (SUPPLIES FOR EXTERNAL INSULIN INFUSION PUMP, SYRINGE TYPE CARTRIDGE, STERILE, EACH), and K0553 (SUPPLY ALLOWANCE FOR THERAPEUTIC CONTINUOUS GLUCOSE MONITOR (CGM), INCLUDES ALL SUPPLIES AND ACCESSORIES, 1 MONTH SUPPLY = 1 UNIT OF SERVICE). On or after January 1, 2023, the related accessories/supplies for these integrated units must be coded using HCPCS codes A4224 (SUPPLIES FOR MAINTENANCE OF INSULIN INFUSION CATHETER, PER WEEK), A4225 (SUPPLIES FOR EXTERNAL INSULIN INFUSION PUMP, SYRINGE TYPE CARTRIDGE, STERILE, EACH), and A4239 (SUPPLY ALLOWANCE FOR NON-ADJUNCTIVE, NON-IMPLANTED CONTINUOUS GLUCOSE MONITOR (CGM), INCLUDES ALL SUPPLIES AND ACCESSORIES, 1 MONTH SUPPLY = 1 UNIT OF SERVICE).For claims with dates of service on or before March 31, 2022, insulin infusion pumps with integrated adjunctive continuous glucose monitor receiver functionality must be coded using HCPCS codes E0784 (EXTERNAL AMBULATORY INFUSION PUMP, INSULIN) and E1399 (DURABLE MEDICAL EQUIPMENT, MISCELLANEOUS) for an adjunctive continuous glucose monitor or receiver. Suppliers must bill as a rental (RR) both E0784 and E1399 to describe the rental of an insulin pump with integrated adjunctive CGM receiver functionality. When submitting a claim for E1399, suppliers must enter adjunctive in loop 2300 (claim note) and/or 2400 (line note), segment NTE02 (NTE01=ADD) of the ANSI X12N, version 5010A1 professional electronic claim format or in Item 19 of the paper claim form, so that the items can be identified as adjunctive CGM devices when processing the claim. The related accessories/supplies for these integrated units must be coded using HCPCS codes A4224 (SUPPLIES FOR MAINTENANCE OF INSULIN INFUSION CATHETER, PER WEEK), A4225 (SUPPLIES FOR EXTERNAL INSULIN INFUSION PUMP, SYRINGE TYPE CARTRIDGE, STERILE, EACH), and A9999 (MISCELLANEOUS DME SUPPLY OR ACCESSORY, NOT OTHERWISE SPECIFIED) for supplies and accessories used in conjunction with an insulin pump, which also performs the functions of an adjunctive continuous glucose monitor or receiver. Suppliers may bill 1 UOS per thirty (30) days. Code A9999 is all-inclusive; when used to bill for adjunctive CGM supplies and accessories it includes, but is not limited to, the CGM sensor, CGM transmitter and insertion devices. When submitting a claim for A9999, suppliers must enter adjunctive in loop 2300 (claim note) and/or 2400 (line note), segment NTE02 (NTE01=ADD) of the ANSI X12N, version 5010A1 professional electronic claim format or in Item 19 of the paper claim form, so that the items can be identified as adjunctive CGM supplies and accessories when processing the claim.For claims with dates of service on or after April 1, 2022, insulin infusion pumps with integrated adjunctive continuous glucose monitor receiver functionality must be coded using HCPCS codes E0784 (EXTERNAL AMBULATORY INFUSION PUMP, INSULIN) and E2102 (ADJUNCTIVE, NON-IMPLANTED CONTINUOUS GLUCOSE MONITOR OR RECEIVER). The related accessories/supplies for these integrated units must be coded using HCPCS codes A4224 (SUPPLIES FOR MAINTENANCE OF INSULIN INFUSION CATHETER, PER WEEK), A4225 (SUPPLIES FOR EXTERNAL INSULIN INFUSION PUMP, SYRINGE TYPE CARTRIDGE, STERILE, EACH), and A4238 (SUPPLY ALLOWANCE FOR ADJUNCTIVE, NON-IMPLANTED CONTINUOUS GLUCOSE MONITOR (CGM), INCLUDES ALL SUPPLIES AND ACCESSORIES, 1 MONTH SUPPLY = 1 UNIT OF SERVICE).Please refer to the Glucose Monitors LCD-related Policy Article (A52464) for more information regarding coding guidelines for continuous glucose monitors.Codes A4230 (INFUSION SET FOR EXTERNAL INSULIN PUMP, NON-NEEDLE CANNULAS TYPE) and A4231 (INFUSION SET FOR EXTERNAL INSULIN PUMP, NEEDLE TYPE) are not valid for claim submission to the DME MAC because they are included in code A4224.Use A4223 for infusion supplies not used with a covered external infusion pump.Drugs used in a durable external infusion pump must be coded using the appropriate HCPCS codes. If the drug does not have a distinct code, then use the unclassified drug code J7799. Do not use code J9999 - this code is not valid for claims billed to the DME MAC.An infusion drug not administered using a durable infusion pump must be billed using the appropriate HCPCS code plus the GY modifier. If the drug does not have a unique code, use the unclassified drug code, J3490.Use code J2274 only for morphine sulfate that is labeled "preservative free. Morphine sulfate that is not labeled "preservative free" must be coded J2270.Use code J1811, J1813 or J1817 for insulin administered through an external insulin pump (E0784).Codes A4602, K0604 and K0605 describe lithium batteries commonly used in external infusion pumps. Note that each code has an associated voltage. Claims for lithium batteries for external insulin infusion pumps (E0784) that do not use a voltage described by either code A4602, K0604 and K0605 must be billed using code A9999.Levodopa-Carbidopa enteral suspension is supplied as a single-use cassette. One unit of service contains 2000 mg levodopa and 500 mg carbidopa in 100 mL of enteral suspension.Claims for levodopa-carbidopa for dates of service on or after January 09, 2015 through December 31, 2015, must be submitted using the DME miscellaneous code J7799 (NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH DME).Claims for levodopa-carbidopa for dates of service on or after January 01, 2016 must be submitted using the HCPCS code J7340 (CARBIDOPA 5 MG/LEVODOPA 20 MG ENTERAL SUSPENSION, 100 ML).One unit of service (UOS) of blinatumomab (J9039) equals one (1) microgram (mcg), and thus, 1 vial equals 35 UOS. Reconstituted blinatumomab must be prepared using the combination of vials that result in the least amount of wastage for the dosage amount being administered. There are two alternative infusion protocols that can be used. For each protocol, the following apply:For beneficiaries using a 2-day infusion protocol, five (5) vials (175 UOS) should be used to reconstitute three bags, each containing 56 mcg (56 UOS) of blinatumomab, which can be refrigerated (2C to 8C), and used within six-days.For beneficiaries utilizing a 7-day infusion protocol, six (6) vials (210 UOS) should be used to reconstitute one bag (containing 210 mcg of blinatumomab), which is infused over 7 days.Claims for blinatumomab for dates of service on or after December 03, 2014 through December 31, 2015, must be submitted using the DME miscellaneous code J7799 (NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH DME).Claims for blinatumomab for dates of service on or after January 01, 2016, must be submitted using the HCPCS code J9039 (INJECTION, BLINATUMOMAB, 1 MICROGRAM).HYQVIA is administered subcutaneously through an E0781 pump that is pre-programmed, and the E0781 pump must be delivered to the Medicare beneficiary in a locked mode (i.e., the patient is unable to self-adjust the infusion rate).Claims for HYQVIA for dates of service on or after September 12, 2015 through December 31, 2015, must be submitted using the DME miscellaneous code J7799 (NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH DME).Claims for HYQVIA for dates of service on or after January 01, 2016 must be submitted using the HCPCS code J1575 (INJECTION, IMMUNE GLOBULIN/HYALURONIDASE, (HYQVIA), 100 MG IMMUNEGLOBULIN).Code J7999 (COMPOUNDED DRUG, NOT OTHERWISE CLASSIFIED) must be used for any compounded drugs administered using an external infusion pump for dates of service on or after January 01, 2016.When Q9977 or J7999 is billed for a compounded drug, the claim must be accompanied by the standard written order information, and a clear statement of the amount dispensed.Claims for CUVITRU for dates of service on or before December 31, 2017 must be submitted using the HCPCS code J7799 (NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH DME). One UOS equals one hundred (100) milligrams (mg).Claims for CUVITRU for dates of service on or after January 01, 2018 must be submitted using HCPCS code J1555 (INJECTION, IMMUNE GLOBULIN (CUVITRU), 100 MG). One UOS equals one hundred (100) mg.Claims for Xembify for dates of service on or after July 3, 2019 through June 30, 2020 must be submitted using the HCPCS code J7799 (NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH DME). One UOS equals one hundred (100) mg. Claims for Xembify for dates of service on or after July 1, 2020 must be submitted using the HCPCS code J1558 (INJECTION, IMMUNE GLOBULIN (XEMBIFY), 100 MG).Claims for Cutaquig for dates of service on or after December 12, 2018 through June 30, 2022 must be submitted using the HCPCS code J7799 (NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH DME). One UOS equals one hundred (100) mg. Claims for Cutaquig for dates of service on or after July 1, 2022 must be submitted using HCPCS code J1551(INJECTION, IMMUNE GLOBULIN (CUTAQUIG), 100 MG).Claims for Hizentra for beneficiaries with CIDP for dates of service on or after July 18, 2021 must be submitted using the HCPCS code J1559 (INJECTION, IMMUNE GLOBULIN (HIZENTRA), 100 MG). One UOS equals one hundred (100) mg.Specific infusion pump HCPCS codes are used with specific SCIg preparations according to the table below.Infusion PumpSCIg PreparationE0779J1555, J1559, J1561, J1562, J1569E0781J1575