MEDICARE WILL PAY FOR
INSULIN PUMPS
����������� As
of April 1, 2000, Medicare recipients who have type 1 diabetes can receive
coverage for purchase of insulin pumps.�
The Health Care Financing Administration (HCFA) now classes insulin
pumps as Durable Medical Equipment, and will cover them as �medically
necessary� where the patient meets the following criteria (A or B):
A.������� The patient has completed a
comprehensive diabetes education program, and has been on a program of multiple
daily injections of insulin (i.e. at least 3 injections per day) with frequent
self-adjustments of insulin dose for at least 6 months prior to initiation of
the insulin pump, and has documented frequency of glucose self-testing an
average of at least 4 times per day during the 2 months prior to initiation of
the insulin pump, and meets one or more of the following criteria while on the
multiple daily injection regimen:
����������� 1.�������� Glycosylated
hemoglobin level (HbA1c) greater than 7.0%
����������� 2.�������� History
of recurring hypoglycemia
����������� 3.�������� Wide
fluctuations in blood glucose before mealtime
����������� 4.�������� Dawn
phenomenon with fasting blood sugars frequently exceeding 200mg/dL
����������� 5.�������� History
of severe glycemic excursions
B.�������� The patient with type 1 diabetes has
been on a pump prior to enrollment in Medicare, and has documented frequency of
glucose self-testing an average of at least 4 times per day during the month
prior to Medicare enrollment.
Other Requirements:
����������� Type
1 diabetes needs to be documented by a C-peptide level less than 0.5.
����������� The
pump must be ordered by, and follow-up care of the patient must be managed by a
physician who manages multiple patients with CSII (pump therapy), who works
closely with a team including nurses, diabetes educators, and dietitians who
are knowledgeable in the use of CSII.
����������� Coverage
for subcutaneous insulin infusion pumps will continued to be denied (as �not
medically necessary�) for all type 2 diabetics.
����������� For
more information, call the Medicare �Durable Medical Equipment� telephone
line:� 1-800-633-4227.
����������� Source:� �HCFA Coverage Issues Manual,� 60-14.