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License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

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CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CGS or the CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

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POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

These materials contain Current Dental Terminology, Fourth Edition (CDT), copyright © 2002, 2004 American Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.

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  1. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT-4. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.
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September 30, 2021

Insulin Used with Continuous External Insulin Infusion Pumps – Correct Coding – Revised

DME MAC Joint Publication

Recently the Durable Medical Equipment (DME) Medicare Administrative Contractors (MACs) have become aware of an issue with pharmacies billing to Medicare Part D for insulin used in a DME external insulin infusion pump (E0784 EXTERNAL AMBULATORY INFUSION PUMP, INSULIN). The DME MACs have jurisdiction for DME and related supplies used with the DME items. Payment under Part D is prohibited when there is coverage available under a Medicare Part B benefit. In the case of insulin, when it is administered via a Part B-covered DME pump, the insulin is considered a supply used with the DME pump. Therefore, payment from Part D is excluded. All claims for DME and supplies used with DME (such as insulin) 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) to bill for insulin that is used with a covered-durable medical pump, represents incorrect coding and will be denied.

Refer to the External Infusion Pump LCDExternal Website, related Policy ArticleExternal Website, Standard Documentation Requirements articleExternal Website 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 HCPCS Helpline at (877) 735-1326 during the hours of 9:30 am to 5:00 pm ET, Monday through Friday.  You may also visit the PDAC websiteExternal website to chat with a representative, or select the Contact UsExternal website  button at the top of the PDAC website for email, FAX, or postal mail information.

Publication History

September 30, 2021 Revised to clarify insulin as a supply and updated the PDAC contact information
October 19, 2017 Originally Published

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