Outpatient IV Insulin Therapy Non-Covered

The Centers for Medicare & Medicaid Services (CMS) has rendered outpatient intravenous insulin therapy (OIVIT) nationally non-covered by Medicare, effective Dec. 23, 2009.

CMS says it will create a new HCPCS Level II code for use of this non-covered service that will be effective Dec. 23, 2009 and implemented with the April 2010 Integrated Outpatient Code Editor (IOCE) and Medicare Physician Fee Schedule Database (MPFSDB).

“Effective April 5, 2010,” CMS announces in a recent transmittal to contractors, “HCPCS code 99199, unlisted special service, procedure, or report, is no longer an appropriate code to be used for OIVIT. Effective April 5, 2010, HCPCS code 94681, exhaled air analysis CO2, should not be used in conjunction with OIVIT or diabetes-related conditions (250.00-250.93). Claims billed with these CPT codes will be returned to provider/returned as unprocessable to be billed with new code G9147, Outpatient Intravenous Insulin Treatment (OIVIT) either pulsatile or continuous, by any means, guided by the results of measurements for: respiratory quotient; and/or, urine urea nitrogen (UUN); and/or, arterial, venous or capillary glucose; and/or potassium concentration.”

Source: CMS Transmittal 112, Change Request (CR) 7554 and Transmittal 1913, CR 6775, issued Feb. 5.

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3 Responses to “Outpatient IV Insulin Therapy Non-Covered”

  1. Asad says:

    This means that te new HCPCS code G9147 is to be used for dates of service on and after April 05, 2010. This new HCPCS G9147 should not be used on medicare claims for service dates of December 23, 2009. December 23, 2009 only refers to the date when this code was created to go out in effect for April 5, 2010 and later dates of service. Is our understanding correct? Thank you.

  2. karen says:

    what about situations where the patient is not in hosp solely for insulin but was brought in for infusion of other meds (pain, antibx..) and happens to be diabetic so the insulin was added to the pump? would the insulin be reported with the g9147 or C8957?

  3. Nerice says:

    Wow, that’s a rellay clever way of thinking about it!

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