Oncology & Hematology Coding Alert

Question: Does Medicare provide coverage for transfusion pumps? What are the indications covered for external and implantable transfusion pumps?

Alaska Subscriber

Answer: Medicare provides coverage for both external and implantable infusion pumps for specific places of service, conditions and benefits. The following indications are covered for the use of external infusion pumps for home infusions and reimbursed by the (Durable Medical Equipment (DME) Medicare Administrative Contractors: 

• For administration of deferoxamine in iron overload 
• For administration of heparin for the treatment of thromboembolic disease and/or pulmonary embolism (only in an institutional setting)
• For chemotherapy in unresectable primary hepatocellular carcinoma or colorectal cancer
• For morphine infusion in intractable pain caused by cancer (inpatient, outpatient, hospice setting).

While it is a Medicare Part B benefit, the reimbursement is only an accredited DMEPOS supplier providers. 

Implantable infusion pumps are covered for the following indications:

• For chemotherapy in unresectable primary hepatocellular carcinoma or colorectal cancer
• For intrathecal or epidural administration of morphine in intractable pain caused by cancer.

Tip: Make sure the documentation explains the need for the transfusion pumps. Your physician should also document that the patient did not respond to available less invasive measures.

You can read more about transfusion pumps on: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/ncd103c1_Part4.pdf.