External Infusion Pumps - Policy Article

External infusion pumps are covered under the DME benefit when Medicare DME rules and the LCD reasonable-and-necessary requirements are met; drugs are covered only as supplies to a covered pump. Specific non-coverage includes disposable elastomeric pumps (A4305/A4306/A9274) and devices not meeting DME definition, one pump payment for epoprostenol/treprostinil (K0455) only, and jurisdictional billing rules requiring A/B MAC billing for drugs initiated in practitioner offices; documentation requirements include WOPD/face-to-face for Final Rule 1713 items and device-specific clinical documentation (e.g., >=4 glucose tests/day or CGM for insulin pumps).

"External infusion pumps are covered as Durable Medical Equipment (DME) when the device meets Medicare DME benefit rules and the reasonable and necessary (R&N) requirements in the related Local Cove..."

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