G9147, Outpatient intravenous insulin treatment (oivit) either pulsatile or
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- No specific documentation requirements are stated in this Clinical Policy Bulletin.
- The policy explicitly states that diagnostic measurements often used in the context of intermittent IV insulin therapy (respiratory quotient, urine urea nitrogen, arterial/venous/capillary glucose, potassium concentration) are of unproven clinical value in this context and thus are not supported by the policy; documentation of such testing does not make the therapy medically necessary per this policy.
- Review the member's benefit contract or Summary Plan Description (SPD) to determine defined coverage, exclusions, and limitations.
- Rely on the written Medical Policy coverage position for benefit coverage determinations rather than on the presence or absence of procedure codes.
Key Coverage Criteria
- No covered indications — intermittent intravenous insulin therapy is considered experimental, investigational and/or unproven for all indications.
- Intermittent intravenous (variable-dose) insulin therapy for diabetic patients to improve long-term glycemic control.
- Insulin therapy is required for patients with type 1 diabetes.
- Insulin therapy for type 1 diabetes typically consists of multiple daily subcutaneous injections of both basal and mealtime insulin or continuous subcutaneous insulin infusion (insulin pump).
- Use of an insulin infusion pump for chronic intermittent intravenous insulin therapy.
- Use of insulin infusion pumps that have been FDA-cleared (510(k)) for delivery of intravenous medications.
7 Active Policies
ANTHEM-MED.00152, MED.00152 Outpatient Intravenous Insulin Therapy
AETNA-CPB-0742, Intermittent Intravenous Insulin Therapy
MED201.028, Intermittent Intravenous Insulin Therapy
BCBSIL-MED201.028, Intermittent Intravenous Insulin Therapy
BCBSMT-MED201.028, Intermittent Intravenous Insulin Therapy
Related Codes
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