As part of ongoing efforts to review prior authorization requirements and reduce administrative burden, Harvard Pilgrim Health Care is removing prior authorization requirements for insulin infusion pumps and home infusion administration for commercial members. This change also aligns our Harvard Pilgrim commercial plan with Tufts Health Plan, which does not require prior authorization for these services.
For dates of service on or after Aug. 1, the following codes will no longer require prior authorization:
- E0784 (external ambulatory infusion pump, insulin)
- E0787 (external ambulatory infusion pump, insulin, dosage rate adjustment using therapeutic continuous glucose sensing)
- 99601 (home infusion/visit, 2 hours)
- 99602 (home infusion, each additional hour)
Previously, for Harvard Pilgrim commercial members, while insulin pumps that work independently and do not communicate with a continuous glucose monitor (CGM) did not require authorization, those that do work in conjunction with a CGM did require authorization. Going forward, prior authorization will not be required for any insulin infusion pumps, regardless of whether they work independently or communicate with a CGM.
External insulin infusion pumps consist of computer-controlled pumps that deliver insulin under the skin and can work independently or in conjunction with a continuous glucose monitoring device. For more information, please refer to our updated Continuous Glucose Monitoring and Diabetes Management Devices Medical Necessity Guidelines.
Home infusion therapy involves the intravenous or subcutaneous administration of drugs or biologicals to a member at home. For more information, please refer to the updated Home Health Care Services Medical Necessity Guidelines.
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