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Calcitonin and Forteo

Nursing visits for the administration of calcitonin or forteo (i.e., Calcimar or Miacalcin) may be payable when used for the treatment of Paget's Disease, osteoporosis, or hypercalcemia. However, it is CMS's position that calcitonin and Forteo are typically self-administered, and coverage would generally be limited to visits required to teach the beneficiary self-administration of the drug.

If the beneficiary or caregiver is not capable of being taught to inject, skilled nursing visits for administration of calcitonin or Forteo would be covered if the intermittent requirement is met. Forteo administration is generally daily for a period of two years or more. This does not meet the intermittent criteria for home health skilled nursing.

If the frequency of calcitonin injection is less than once weekly, physician consultation may be obtained to determine the medical necessity of injections at this frequency.

Requirements for Calcitonin or Forteo Drug Coverage Under Home Health

Medicare Claims Processing Manual (CMS Pub. 100-04, Ch. 10 §90.1)External PDF

Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 ยง50.4.3)External PDF

Medicare covers calcitonin and Forteo when administered to a female beneficiary who meets all of the following criteria:

  • The individual has Medicare Part B and qualifies for covered home health skilled nursing services;
  • Has a diagnosis of postmenopausal osteoporosis;
  • Sustained a bone fracture that a physician certifies was related to postmenopausal osteoporosis; and
  • The physician certifies that the individual is unable to learn the skills needed to self-administer the drug, or is otherwise physically or mentally incapable of administering the drug, and that her family or caregivers are unable or unwilling to administer the drug.

You must submit a separate home health bill for skilled nursing visits to administer the calcitonin or Forteo before Medicare will pay for the drug. For billing information, refer to the Billing Osteoporosis Drugs for Home Health Beneficiaries web page.

Updated: 11.13.20

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