Billing and Coding: Implantable Infusion Pumps for Chronic Pain

Medicare covers implantable intrathecal or epidural infusion pumps for severe chronic intractable pain (malignant or nonmalignant) to deliver opioids or other appropriate drugs only when the patient has a life expectancy of ≥3 months and pain is unresponsive to less invasive therapy — pumps are not covered if these criteria are not met. Coverage requires documentation that oral/subcutaneous therapies failed or caused unacceptable side effects, specialist evaluation confirming other treatments have failed, a successful temporary intrathecal/epidural trial demonstrating pain relief, tolerable side effects and patient acceptance, and use of appropriate drugs in the pump.