Billing and Coding: Implantable Infusion Pumps for Chronic Pain

Medicare covers implantable infusion pumps for severe chronic intractable pain (malignant or nonmalignant) when intrathecal or epidural administration of opioids or appropriate drugs is required, the patient has a life expectancy of at least 3 months, and pain has failed less invasive therapies. Coverage requires specialist validation, a documented preliminary trial with a temporary catheter, comprehensive and legible medical records (including trial and refill documentation), and adherence to billing and reimbursement rules for compounded drugs and pump management.

"Implantable infusion pumps are covered when used to administer opioid drugs, alone or in combination with other opioid or non-opioid drugs, via the intrathecal or epidural route."

Sign up to see full coverage criteria, indications, and limitations.