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RE: [IP] Who is considering going back on shots?

Jeff, Here are the requirements for Medicare and Insulin Pumps. I am sure
that if you have a pump now, that you will be covered under Medicare. 


60-14 - 60-14 (Cont.) 	2 pp. 	2 pp.

Section 60-14, Infusion Pumps, revises the C-peptide requirement to be less
than or equal to 110 percent of the lower limit of normal of the
laboratory's measurement method. This change expands the value of the
laboratory test to be considered in determining coverage of the insulin
infusion pump for all diabetic patients. (Type II diabetics are no longer

This section of the Coverage Issues Manual is a national coverage decision
made under '1862(a)(1) of the Social Security Act (the Act). National
coverage determinations (NCDs) are binding on all Medicare carriers,
intermediaries, Peer Review Organizations, and other contractors. Under 42
CFR 422.256(b) an NCD that expands coverage is also binding on a
Medicare+Choice Organization. In addition, an administrative law judge may
not disregard, set aside, or otherwise review a national coverage decision
issued under '1862(a)(1) of the Act. (42 CFR 405.732, 405.860.)

DISCLAIMER: The revision date and transmittal number only apply to the
redlined material. All other material was previously published in the manual
and is only being reprinted.



A. External Infusion Pumps.--

sections 1 - 4 deleted, not about insulin infusion pumps

5. Continuous subcutaneous insulin infusion pumps (CSII) (Effective for
Services Performed On or After 4/1/2000).--

An external infusion pump and related drugs/supplies are covered as
medically necessary in the home setting in the following situation:
Treatment of diabetes

In order to be covered, patients must meet criterion 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 (HbAlc) > 7.0 percent
(2) History of recurring hypoglycemia
(3) Wide fluctuations in blood glucose before mealtime
(4) Dawn phenomenon with fasting blood sugars frequently exceeding 200 mg/dl
(5) History of severe glycemic excursions

(B) The patient with 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.

REVISED, see above

Diabetes needs to be documented by a fasting C-peptide level that is less
than or equal to 110 percent of the lower limit of normal of the
laboratorys measurement method. (Effective for Services Performed on or
after January 1, 2002.)

Continued coverage of the insulin pump would require that the patient has
been seen and evaluated the treating physician at least every 3 months. 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 and who works closely
with a team including nurses, diabetes educators, and dietitians who are
knowledgeable in the use of CSII.

6. Other uses of external infusion pumps are covered if the contractor's
medical staff verifies the appropriateness of the therapy and of the
prescribed pump for the individual patient.


    Payment may also be made for drugs necessary for the effective use of an
external infusion pump as long as the drug being used with the pump is
itself reasonable and necessary for the patient's treatment.

John S Wilkinson, Rome, NY
"A  veteran  is someone who, at one point in his or her life, wrote a blank
check made payable to The 'United States of America', for an amount of up to
and including their life." (Author unknown)
Be very, very careful what you put into that head, because you will never,
ever get it out. Thomas Cardinal Wolsey (1471-1530)

-----Original Message-----
From: email @ redacted
[mailto:email @ redacted] On Behalf Of Jeff Gamble
Sent: Sunday, July 17, 2011 2:36 PM
To: email @ redacted
Subject: Re: [IP] Who is considering going back on shots?

I'm going on Medicare, and as an insulin  dependent diabetic, Medicare 
will not pay for a pump or supplies.  So I to will be going back to 
shots when my supplies run out.  I haven't found a pen that does less 
than .5 unit increments, while I am used to .01 unit increments.  I will 
keep the Ping meter to help calculate boluses.  Other than that, just 
don't get old.

Jeff Gamble
Big Bay Lighthouse B&  B
3 Lighthouse Rd
Big Bay,MI 49808

On 7/17/2011 1:34 PM, Candace Hackney wrote:
 > Just curious, I may have to. I don't know if I can. I could not get my
> under control even though I was a robot and strict. Any slight variations
> would effect me.  Maybe with new strategies I can do better now. It has
> over 5 yrs. since I got the pump. .
> .
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