External Insulin Infusion Pumps - DME.GC.101.A

External ambulatory insulin infusion pumps (HCPCS E0784) and associated supplies (A4224, A4225, A4238, A4239) are covered for patients with type 1 or type 2 diabetes who use insulin (MDI or continuous), perform SMBG ≥4 times/day or use a CGM, and have documentation of at least one qualifying clinical criterion (e.g., HbA1c >7%, fasting morning glucose >200 mg/dL, frequent hypoglycemia, difficult-to-control glucose, or participation in a diabetes management program). Exclusions include implanted pumps (E0782/E0785/E0786), disposable pumps (A9274) and certain obsolete codes; coverage requires documentation linking supplies to E0784 (A4224 dispensed weekly), verification of device-specific FDA age approvals, and compliance with prior authorization and payer billing rules.

"HCPCS codes A4230 and A4231 are not valid for claim submission after 3/31/2000."

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