S9145 — Insulin pump initiation, instruction in initial use of pump (pump not included)
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
- Record that home visits take place during the same period the infusion therapy is ordered/being administered.
- Documentation of failed conservative treatments (oral and/or rectal medications and/or non‑pharmacological therapies).
- For reauthorization requests, documentation by the ordering provider showing reassessment of the member and rationale/clinical need for continued infusion therapy.
- Documented blood pressure readings showing ≥140/90 mm Hg on two occasions at least four hours apart with dates/times and gestational age >20 weeks (or postpartum status and date of delivery).
Key Coverage Criteria
- Obstetrical Nurse Assessment
- Metoclopramide or Ondansetron Infusion Therapy
- Hydration Therapy – one to four liters
- Diabetes in Pregnancy Clinical Management Programs
- Hypertensive Disorders of Pregnancy Program
- Dietary Analysis
1 Active Policy
AMBETTER-CP.MP.91 — Obstetrical Home Care Programs
Related Codes
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