billing the dmercs and others for infusion pumps - ION Solutions

COVERAGE CONDITIONS FOR EXTERNALPUMPS (E0779, E0780, E0781, AND E0791)Coverage for the administration of other drugs, based on the criteria set in(1) or (2), using an external infusion pump is limited to the followingsituations:Administration of epoprostenol (J1325) or treprostinil (J3285) for patients withpulmonary hypertension if they meet specific disease criteria.Gallium nitrate (J1457) is covered for the treatment of symptomatic cancerrelatedhypercalcemia (ICD-9 275.42). In general, patients with serum calcium(corrected for albumin) less than 12 mg/dl would not be expected to besymptomatic.The recommended usage for gallium nitrate is daily for fiveconsecutive days. Use for more that 5 days will be denied as not reasonable andnecessary.More than one course of treatment for the same episode ofhypercalcemia will be denied as not reasonable and necessary.Ziconotide (J2278) is covered for the management of severe chronic pain inpatients for whom intrathecal (IT or epidural) therapy is warranted, and who areintolerant of or refractory to other treatment, such as systemic analgesics,adjunctive therapies, or IT morphine.Subcutaneous immune globulin (J1559, J1561, J1562) is covered only if BOTHOF THESE ARE MET:The subcutaneous immune globulin preparation is a pooled plasma derivative which isapproved for the treatment of primary immune deficiency disease; and The patient has a diagnosis of primary immune deficiency disease (ICD-9 codes 279.04,279.05, 279.06, 279.12, 279.2).Coverage of subcutaneous immune globulin applies only tothose products that are specifically labeled as subcutaneous administration products.Intravenous immune globulin products are not covered under this LCD.Coverage of subcutaneous products is only for drugs that are labeled subcutaneous, notfor IVIG. Only E0779 is covered under this situation.