(Archived) External Infusion Pumps
Durable Medical Equipment
|Original Policy Date
Last Review Status/Date
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Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract. Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage. Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.
An external infusion pump (EIP) is a portable device intended to provide continuous ambulatory drug infusion therapy over an extended time period. The EIP is also known as an external pump, ambulatory pump, or a mini-infuser. The EIP is usually the size of a portable cassette player and can be worn on a belt around the patient’s waist or from a shoulder harness. It is a battery driven device.
Proposed drug delivery routes using the EIP include the intravenous, intra-arterial, sub-cutaneous, intraperitoneal, epidural, intrathecal, and intraventricular routes. A heparinized saline solution may be used during an interruption of drug therapy to maintain catheter patency. The EIP is battery powered, and drug reservoir refilling is non-invasive. A catheter from the pump is attached to the desired access route for drug delivery.
Use of the EIP for the administration of the following drugs is considered medically necessary for selected patients on:
- morphine and other parenteral analgesics for treatment of severe, chronic cancer pain that is resistant to conventional therapy. Acceptable routes are subcutaneous (SC) and intravenous (IV);
- insulin for treatment of insulin-dependent diabetes mellitus in patients who cannot be controlled by intermittent dosing. Acceptable routes are SC and IV;
- heparin for treatment of severe thromboembolic disease that cannot be managed conventionally (e.g., complicated pregnancy). Acceptable routes are SC and IV;
- chemotherapeutics for treatment of cancer. Acceptable routes are stipulated in the drug labeling and might include either IV or intra-arterial (IA).
Patient selection is key to appropriate utilization of the EIP. Factors relevant to the selection of EIP candidates may include several of the following conditions:
- Patient is ambulatory and treatment can be appropriately delivered on an outpatient basis, with an expected improvement in the quality of life;
- Drug therapy is ongoing and a therapeutic advantage is expected by using continuous (or pulsatile) infusion rather than intermittent injections;
- Patient is otherwise treatable only by conventional infusion pump in an institutional setting, or compliance difficulties make intermittent injection ineffective;
- Patient education protocols are documented and emergency support is available when unexpected adverse events occur; and
- Presence of favorable technical factors, such as a convenient, safe, and reliable EIP delivery system along with correct placement of the needle and catheter exist.
BlueCard/National Account Issues
Portable external infusion pumps are adjudicated under Durable Medical Equipment. There are over 600 different models of pumps, most of which have been received clearance for marketing by the Food and Drug Administration (FDA) through a pre-notification application (510 (K)).
A search of the literature was completed through the MEDLINE database for the period of January 1992 through May 1995. The search strategy focused on references containing the following Medical Subject Headings:
– Infusion Pumps
– Portable or External or Ambulatory
Research was limited to English-language journals on humans.
TEC Evaluations 1989: p. 59
|ICD-9 Procedure||No Code|
See pain for specific body part
Insulin-dependent diabetes, uncontrolled
Arterial embolism and thrombosis of unspecified artery
See cancer codes
|HCPCS||E0781||Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient|
|Type of Service||DME|
|Place of Service||Inpatient
Infusion Pumps, External
External Infusion Pumps
Pump, Portable Infusion
|03/09/96||Add to Mental Health section||New Policy|
|04/15/02||Replace Policy||Policy reviewed without literature review; new review date only|
|04/29/03||Replace Policy||Policy no longer scheduled for routine literature review.|