Point32Health would like to issue a clarification regarding our coverage of insulin infusion pumps for Harvard Pilgrim Health Care commercial members. While prior authorization is not required for insulin pumps that work independently and do not communicate with a continuous glucose monitor (CGM), insulin pumps which are part of a “closed loop system” or which communicate with or work in conjunction with a CGM device do continue to require prior authorization.
In the August 2023 issue of Insights and Updates for Providers, we announced that prior authorization would no longer be required for the following codes related to insulin infusion pumps and home infusion administration: E0784, E0787, 99601, and 99602. This remains accurate and authorization is not required for those codes, but prior authorization must be obtained for A9274 and A9276 for insulin pumps that work in conjunction with a CGM.
For more information, please refer to our Medical Necessity Guidelines for Continuous Glucose Monitoring and Diabetes Management Devices and Home Health Care Services.
Director, Provider Relations & Communications
Senior Manager, Provider Communications
Joseph O’Riordan, Susan Panos, Ryan Francis, Stephen Wong,