S5571 — Insulin delivery device, disposable pen (including insulin); 3 ml size
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high 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.
1 Active Policy
AETNA-CPB-0742 — Intermittent Intravenous Insulin Therapy
Related Codes
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