Q&A: Billing and reporting requirements for an insulin infusion pump

February 14, 2020
Medicare Web

Q: What are the billing and reporting requirements for HCPCS Level II code E0784 (external ambulatory insulin infusion pump)?

A: Continued coverage of an external insulin pump and supplies requires that the beneficiary be seen and evaluated by the treating physician at least every three months. In addition, the external insulin infusion pump must be ordered, and follow-up care rendered by a physician who manages multiple beneficiaries on continuous subcutaneous insulin infusion therapy. The treating physician also must works closely with a team of nurses, diabetic educators, and dieticians who are knowledgeable in the use of continuous subcutaneous insulin infusion therapy.

HCPCS code E0787 went into effect January 1, 2020, and describes an external ambulatory insulin infusion pump, with dose-rate adjustment using therapeutic continuous glucose sensing. Coverage for this HCPCS code is only met if the beneficiary meets all the coverage criteria for insulin pumps and all criteria for a therapeutic continuous glucose monitor as outlined in Local Coverage Determination (LCD) L33822 for glucose monitors.

All devices billed to Medicare using HCPCS code E0787 must be reviewed for correct coding by the pricing, data analysis, and coding contractor. Products that have not been reviewed and listed on the product classification list for HCPCS code E0787 will be denied for incorrect coding. Refer to the coding guidelines in the LCD-related policy article for additional information.

Editor’s note: The answer to this question was provided by Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, coding regulatory specialist for HCPro in Middleton, Massachusetts.

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

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