|
E0776 |
 |
Iv pole
| short | Iv pole |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
|
|
|
|
E0779 |
|
Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater
| short | Amb infusion pump mechanical |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
|
|
|
|
E0780 |
|
Ambulatory infusion pump, mechanical, reusable, for infusion less than 8 hours
| short | Mech amb infusion pump <8hrs |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
|
|
|
|
E0781 |
|
Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient
| short | External ambulatory infus pu |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E0782 |
|
Infusion pump, implantable, non-programmable (includes all components, e.g., pump, catheter, connectors, etc.)
| short | Non-programble infusion pump |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | OPH | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
E0783 |
|
Infusion pump system, implantable, programmable (includes all components, e.g., pump, catheter, connectors, etc.)
| short | Programmable infusion pump |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | OPH | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
E0784 |
|
External ambulatory infusion pump, insulin
| short | Ext amb infusn pump insulin |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
|
E0785 |
|
Implantable intraspinal (epidural/intrathecal) catheter used with implantable infusion pump, replacement
| short | Replacement impl pump cathet |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | OPH | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
E0786 |
|
Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter)
| short | Implantable pump replacement |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | OPH | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
E0787 |
|
External ambulatory infusion pump, insulin, dosage rate adjustment using therapeutic continuous glucose sensing
| short | Cgs dose adj insulin inf pmp |
|
|
|
E0791 |
|
Parenteral infusion pump, stationary, single or multi-channel
| short | Parenteral infusion pump sta |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|