Appendix E - National Coverage Determinations Manual / INFUSION_PUMPS

Why This Topic Matters

Infusion pump coverage policy affects whether claims may be payable under Medicare and how device-related services are documented and reviewed. Understanding the scope of covered indications, noncovered uses, and related CMS policy references helps support compliant reimbursement and reduce denial risk.

Article Sections

1. A. General

   Introduces infusion pumps and describes their general medical purpose and function.

2. B. Nationally Covered Indications

   Outlines the covered uses of infusion pumps under Medicare, separated by external and implantable device categories.

3. 1. External Infusion Pumps

   Summarizes the covered external pump indications and related policy considerations for selected conditions.

4. e. Continuous Subcutaneous Insulin Infusion (CSII) Pumps

   Covers Medicare policy related to diabetes pump therapy, general eligibility framework, and ongoing coverage requirements.

5. Other Uses of CSII

   Addresses how other CSII uses are handled within Medicare coverage policy and clinical trial references.

6. 2. Implantable Infusion Pumps

   Summarizes covered implantable pump uses and the general categories of therapy addressed by the policy.

7. d. Coverage of Other Uses of Implanted Infusion Pumps

   Describes the general coverage framework for other implanted pump uses when certain administrative and labeling conditions are met.

8. e. Implantation of Infusion Pump Is Contraindicated

   Lists patient-related situations that affect suitability for pump implantation.

9. C. Nationally Noncovered Indications

   Identifies infusion pump uses that Medicare does not cover and the broad reasons for noncoverage.

10. 1. External Infusion Pumps

    Summarizes the noncovered external pump use addressed by the policy.

11. 2. Implantable Infusion Pump

    Summarizes the noncovered implantable pump uses addressed by the policy.