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External Infusion Pumps - Policy Article
Article A52507 · 41 versions, 2015 to today · last changed 2026-10-01 (R40)
Version 88 of Article A52507: in force by CMS's dates 2022-07-01 to 2022-09-30. The policy text on this page comes from this archived version.
JA · Noridian 16013
JB · CGS 17013
JC · CGS 18003
JD · Noridian 19003
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Sections in this version: Article Text · Coding Information. Plus 1 section marked N/A in this version.
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Version history, Article A52507
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Revision history, every version
CMS's own change log, quoted, 40 entries. It does not change with the version shown. A revision (R-number) is a change CMS logged. The version (vN) is the snapshot that carries it.
R40 · 2026-10-01 · v160
Revision Effective Date: 10/01/2026 CODING GUIDELINES: Added: “An ambulatory infusion pump (E0788) is an electrical or battery-operated device, approved by the FDA to be used with a specific drug (i.e., FDA-approved as a device-drug combination). It is used to deliver solutions containing a parenteral drug under pressure at a regulated flow rate. It is designed to be worn or carried by the beneficiary.” Added: “Code A4228 includes all necessary supplies to maintain a specific device-drug combination, per week. This includes, but is not limited to, cassettes, syringe reservoirs or bags, diluting solutions, infusion sets, tubing and other administration supplies, port cap changes, compounding charges, and preparation charges.” Revised: The table that describes HCPCS supply codes that are used with different types of external infusion pumps, by adding a row that contains E0788 in the Pump HCPCS Code column, A4228 in the Associated Codes column, and A4221, A4222, A4224, A4225, and K0552 in the Non-Associated Codes column Removed: J7799 billing information for foslevodopa/foscarbidopa injection for continuous subcutaneous infusion (effective for dates of service on or after October 17, 2024 through June 30, 2025) due to being past the timely filing limit for claims Removed: E1399 and A9999 billing information for the VYAFUSER pump and related administration supplies, respectively (effective for dates of service before January 24, 2025) due to being past the timely filing limit for claims Revised: “Claims for the VYAFUSER pump, used to administer foslevodopa/foscarbidopa continuous subcutaneous infusion, for dates of service on or after January 24, 2025 must be submitted using the HCPCS code E0781” to “Claims for the VYAFUSER pump, used to administer foslevodopa/foscarbidopa continuous subcutaneous infusion, for dates of service on or after January 24, 2025 through September 30, 2026 must be submitted using the HCPCS code E0781” Added: Billing information for the VYAFUSER pump for dates of service on or after October 1, 2026 10/08/2026: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R39 · 2026-01-25 · v156
Revision Effective Date: 01/25/2026 MODIFIERS: Removed: J1562 from JB modifier section CODING GUIDELINES: Removed: Past timely filing directions regarding billing for E0784, E1399 (for an adjunctive continuous glucose monitor or receiver), A4224, A4225, and A9999 (for supplies and accessories used in conjunction with an insulin pump, which also performs the functions of an adjunctive continuous glucose monitor or receiver) Removed: Past timely filing directions regarding billing for levodopa-carbidopa Clarification : Alternative infusion protocol information pertaining to beneficiaries using a 3-day infusion protocol and pertaining to beneficiaries using a 4-day infusion protocol is effective for dates of service on or after 12/17/2024 (FDA Approval Date) Removed: Past timely filing directions regarding billing for the following: blinatumomab, HYQVIA, CUVITRU, Xembify, and Cutaquig Added: Billing direction for gallium nitrate Removed: J1562 from SCIg preparations column in the table PROFESSIONAL SERVICES: Removed: Past timely filing directions for G0068, G0069, and G0070 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Revised: “For HCPCS code J1457” to “For gallium nitrate” in Group 2 Paragraph Removed: J1562 from Group 3 Paragraph 02/05/2026: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R38 · 2026-01-25 · v151
Revision Effective Date: 01/25/2026 DME INFORMATION FORM (DIF): Removed: DME INFORMATION FORM (DIF) section due to timely filing CODING GUIDELINES: Revised: “Claims for levodopa-carbidopa” to “Claims for levodopa-carbidopa enteral suspension” Added: Billing information for foslevodopa/foscarbidopa injection for continuous subcutaneous infusion for October 17, 2024 through June 30, 2025 Added: Billing information for foslevodopa/foscarbidopa injection for continuous subcutaneous infusion for dates of service on or after July 1, 2025 Added: Billing information for Foslevodopa/foscarbidopa injection for continuous subcutaneous infusion Added: Billing information for the VYAFUSER pump Revised: “ There are two alternative infusion protocols that can be used ” to “ There are four alternative infusion protocols that can be used ” for blinatumomab Added: Alternative infusion protocol information pertaining to beneficiaries using a 3-day infusion protocol and pertaining to beneficiaries using a 4-day infusion protocol ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Added: J7356 to Group 4 Paragraph 12/11/2025: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R37 · 2025-02-19 · v146
Revision Effective Date: 02/19/2025 CODING GUIDELINES: Added: “Claims for K0552 (SUPPLIES FOR EXTERNAL NON-INSULIN DRUG INFUSION PUMP, SYRINGE TYPE CARTRIDGE, STERILE, EACH) are not separately payable if an infusion drug is pre-packaged and supplied in a syringe type cartridge.” as clarification 08/21/2025: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R36 · 2025-02-19 · v143
Revision Effective Date: 02/19/2025 MODIFIERS: Revised: “Effective January 1, 2024, the JZ modifier is also required when billing for drugs and biologicals from single-dose containers that are dispensed by the supplier but self-administered by the beneficiary or the beneficiary’s caregiver.” to “Effective for claims with dates of service on or after January 1, 2024, the JZ modifier is also required when billing for drugs and biologicals from single-dose containers dispensed by the supplier but have no unused and discarded amounts that are self-administered by the beneficiary or the beneficiary’s caregiver.” Added: “Effective for claims with dates of service on or after January 1, 2025, the JW modifier is also required if a billing supplier is not administering a drug or biological, but there are unused and discarded amounts during the preparation process before supplying the drug or biological to the patient as described in scenario 3 below.” Revised: “The JW modifier is not required for drugs dispensed by the supplier and self-administered by the beneficiary or the beneficiary’s caregiver in the beneficiary’s home, as it is not expected that the beneficiary or their caregiver provide discarded drug information to the supplier. The JZ modifier is required in this scenario (effective for claims with dates of service on or after January 1, 2024).” to “The JZ modifier is required for drugs and biologicals that are dispensed by the supplier but have no unused and discarded amounts during the preparation process and are self-administered by the beneficiary or the beneficiary’s caregiver in the beneficiary’s home.” Revised: “drug” to “drugs” in “Multi-use vials are not subject to payment for discarded amounts of drugs or biologicals.” Revised: “Below are two scenarios in regard to the JW modifier.” to “Below are three (3) scenarios in regard to the JW and JZ modifiers.” Added: “claim” to “In this scenario, the JW modifier must be billed on a separate claim line to provide payment for the amount of discarded drug or biological.,” as clarification Added: “claim” to “The 70 mg dose is billed correctly by rounding up to 1 UOS (representing the entire 100 mg vial) on a single claim line item with the JZ modifier.,” as clarification Added: “claim” to “The single claim line item of 1 UOS would be processed for payment of the combined total of 100 mg of the administered and discarded amounts.,” as clarification Added: “claim” to “The discarded 30 mg must not be billed as another 1 UOS on a separate claim line item with the JW modifier.,” as clarification Added: Scenario 3 billing information and example 05/22/2025: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R35 · 2025-02-19 · v139
Revision Effective Date: 02/19/2025 CODING GUIDELINES: Added: Single asterisks to A4222 and K0552 in the Associated Codes column of the table for HCPCS supply codes associated with external infusion pumps HCPCS codes Revised: “*For E0779, E0780, E0781, E0791 and K0455 pumps, either A4222 or K0552 may be billed, but not both” to "*For E0779, E0780, E0781, E0791 and K0455 pumps, either A4222 and/or K0552 may be billed” 03/13/2025: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R34 · 2025-01-23 · v134
Revision Effective Date: 01/23/2025 CODING GUIDELINES: Revised: Code K0552 to indicate use with HCPCS codes K0455, E0779, E0780, E0781 or E0791 when used to administer a drug utilizing a syringe-type reservoir. Revised: “The reservoir may be either glass or plastic and includes the needle for drawing up the drug.” to “The reservoir may be either glass or plastic and includes the needle or equivalent for drawing up or transferring the drug to the reservoir.” Revised: Table in the HCPCS Supply Codes Associated with External Infusion Pumps HCPCS Codes section by removing "K0552" from the Non-Associated Codes column in the rows pertaining to E0780, E0781, and E0791, and by adding "K0552" to the Associated Codes column in the rows pertaining to E0780, E0781, and E0791 Revised: Statement under table “*For E0779 and K0455 pumps, either A4222 or K0552 may be billed, but not both." to "*For E0779, E0780, E0781, E0791 and K0455 pumps, either A4222 or K0552 may be billed, but not both." 01/23/2025: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R33 · 2024-01-12 · v130
Revision Effective Date: 01/12/2024 MODIFIERS: Added: "Effective January 1, 2024, the JZ modifier is also required when billing for drugs and biologicals from single-dose containers that are dispensed by the supplier but self-administered by the beneficiary or the beneficiary’s caregiver." Revised: " The JW and JZ modifiers are not required for drugs dispensed by the supplier and self-administered by the patient or caregiver in the patient’s home." to "The JW modifier is not required for drugs dispensed by the supplier and self-administered by the beneficiary or caregiver in the beneficiary’s home, as it is not expected that the beneficiary or their caregiver provide discarded drug information to the supplier. The JZ modifier is required in this scenario (effective for claims with dates of service on or after January 1, 20 24)." Removed: The JZ modifier from the statement regarding expected rare use Added: " As of July 1, 2023, the JZ modifier is required in this situation." to Scenario 2 Added: Information to include the JZ modifier in the billing instructions for the 70 mg dose in Scenario 2 03/14/2024: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R32 · 2024-01-12 · v124
Revision Effective Date: 01/12/2024 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Added: “J1575” to Group 6 Paragraph 02/08/2024: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R31 · 2023-10-01 · v122
Revision Effective Date: 10/01/2023 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Removed: ICD-10-CM code G20 from Group 4 Codes due to ICD-10-CM code updates Added: ICD-10-CM codes G20.A1, G20.A2, G20.B1, G20.B2 to Group 4 Codes due to ICD-10-CM code updates 09/21/2023: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R30 · 2023-07-01 · v119
Revision Effective Date: 07/01/2023 CODING GUIDELINES Revised: Non-associated supply HCPCS codes for E0781 to remove duplicate HCPCS code A4224 and replace with A4225 08/03/2023: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R29 · 2023-07-01 · v117
Revision Effective Date: 07/01/2023 MODIFIERS: Added: HCPCS codes J1811 and J1813 to the JK and JL modifier instructions to comply with the Inflation Reduction Act insulin coinsurance cap CODING GUIDELINES: Added: J1811 and J1813 to instruction for billing insulin administered through an external insulin pump (E0784) ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Added: HCPCS codes J1811 and J1813 to Group 1 Paragraph 06/22/2023: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R28 · 2023-04-01 · v114
Revision Effective Date: 04/01/2023 MODIFIERS: Revised: JW and JZ modifier instructions to align with the CMS 2023 Physician Fee Schedule final rule (effective 01/01/2023) 06/15/2023: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R27 · 2023-04-01 · v110
Revision Effective Date: 04/01/2023 MODIFIERS: Added: JK and JL modifier instructions to comply with the Inflation Reduction Act insulin coinsurance cap 03/30/2023: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R26 · 2023-01-01 · v106
Revision Effective Date: 01/01/2023 MODIFIERS: Revised: GA, GZ and KX modifier instructions to include external infusion pumps, drugs and supplies submitted on or after March 1, 2023 for dates of service on or after January 1, 2023 01/19/2023: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R25 · 2023-01-01 · v103
Revision Effective Date: 01/01/2023 POLICY SPECIFIC DOCUMENTATION REQUIREMENTS: Added: Documented use of continuous glucose monitor meets glucose self-testing of at least 4 times per day within criterion IV. C. and D. of the related LCD MODIFIERS: Added: JZ modifier instructions Revised: GA, GY, GZ and KX modifier instructions to include external infusion pumps, drugs and supplies 01/12/2023: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R24 · 2023-01-01 · v99
Revision Effective Date: 01/01/2023 CODING GUIDELINES: Added: “A4238**, A4239**” to table describing associated codes with pump codes for pump code row E0784 Added: “**For E0784 pumps, either A4238 or A4239 may be billed if used in conjunction with an integrated adjunctive or non-adjunctive CGM, respectively.” after table describing associated codes Revised: Billing direction dates for HCPCS codes K0554 and K0553 Added: Billing direction for HCPCS codes E2103 and A4239 on or after January 1, 2023 Removed: Language describing “non-therapeutic” Added: “NON-IMPLANTED” to the description of CGM code E2102 and CGM supply code A4238 12/29/2022: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R23 · 2023-01-01 · v95
Revision Effective Date: 01/01/2023 POLICY SPECIFIC DOCUMENTATION REQUIREMENTS: Added: Billing information relevant to DIFs, for DOS affected by the DIF elimination 11/17/2022: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R22 · 2022-10-01 · v91
Revision Effective Date: 10/01/2022 ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY: Added: ICD-10-CM code D81.82 to Group 3 Codes due to ICD-10-CM code updates 09/22/2022: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R21 · 2022-07-01 · v88
Revision Effective Date: 07/01/2022 MODIFERS: Revised: J7799 (Cutaquig) to HCPCS code J1551 in JB modifier requirements CODING GUIDELINES: Revised: Billing direction dates for Cutaquig under HCPCS code J7799 Added: Billing direction for Cutaquig for HCPCS Code J1551, effective on or after July 1, 2022 Revised: specific SCIg preparations table to list HCPCS J1551, instead of J7799 (Cutaquig) CODING INFORMATION: Revised: Cutaquig HCPCS code to J1551 under Group 3 07/28/2022: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R20 · 2022-02-28 · v84
Revision Effective Date: 02/28/2022 REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 FED. REG VOL 217): Removed: “The link will be located here once it is available.” Added: “The required Face-to-Face Encounter and Written Order Prior to Delivery List is available here.” with a hyperlink to the list 04/14/2022: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R19 · 2022-02-28 · v80
Revision Effective Date: 02/28/2022 CODING GUIDELINES: Added: Billing directions for insulin infusion pumps with integrated adjunctive or non-therapeutic continuous glucose monitor receiver functionality, and supply codes A4224, A4225, and A9999 for dates of service on or before March 31, 2022 Added: Billing directions for HCPCS codes E0784 and E2102 for insulin infusion pumps with integrated adjunctive or non-therapeutic continuous glucose monitor receiver functionality, and supply codes A4224, A4225, and A4238 for dates of service on or after April 1, 2022 CODING INFORMATION: Removed: ICD-10-CM codes O24.415, O24.425, O24.435 from Group 1 codes 03/24/2022: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R18 · 2021-07-18 · v77
Revision Effective Date: 07/18/2021 MODIFIERS: Removed: Registered trademark symbol from first use of Cutaquig CODING GUIDELINES: Added: Supply codes associated with external infusion pumps HCPCS codes table Added: Billing instruction for Hizentra for beneficiaries with CIDP using the HCPCS code J1559 Removed: Registered trademark symbol from first use of Xembify Added: A table to identify which infusion pump is used for which specific SCIg preparations ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY: Revised: Group 3 paragraph to include “primary immune deficiency disorders” Added: Group 6 listing for HCPCS code J1559, for CIDP 06/03/2021: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R17 · 2020-09-15 · v73
Revision Effective Date: 09/15/2020 NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES: Removed: Information related to HCPCS code E0787, which is invalid for Medicare submission for DOS on or after 09/15/2020 MODIFIERS: Removed: HCPCS code E0787 CODING GUIDELINES: Removed: Guidelines for HCPCS codes E0787 and A4226 Added: Coding guidelines for insulin infusion pumps with integrated continuous glucose sensing capabilities ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY: Removed: HCPCS code E0787 from Group 1 Paragraph 09/17/2020: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R16 · 2020-09-06 · v70
Revision Effective Date: 09/06/2020 MODIFIERS: Added: J1558 and J7799 (Cutaquig) to the JB modifier requirements CODING GUIDELINES: Added: Billing instructions for Xembify based on DOS Added: UOS billing instruction for J7799 (Cutaquig) ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY: Added: J1558 and J7799 (Cutaquig) to the Group 3 paragraph 07/23/2020: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R15 · 2020-05-31 · v63
Revision Effective Date: 05/31/2020 NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES: Revised: “physician’s” to “practitioner’s” Removed: REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO 42 CFR 410.38(g) section REQUIREMENTS FOR SPECIFIC DMEPOS ITEMS PURSUANT TO FINAL RULE 1713 (84 Fed. Reg Vol 217): Added: Section and related information based on Final Rule 1713 DME INFORMATION FORM (DIF): Revised: “physician” to “practitioner” MODIFIERS: Added: J7799 ( Xembify ® ) to the JB modifier requirements CODING GUIDELINES: Revised: 'detailed order' to 'standard written order' Added: UOS billing instruction for J7799 (Xembify ® ) ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY: Added: J7799 ( Xembify ® ) to the Group 3 paragraph 04/16/2020: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R14 · 2020-01-01 · v55
Revision Effective Date: 01/01/2020 NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES Added: PDAC approval requirement for HCPCS code E0787 KX, GA, GY and GZ MODIFIERS: Added: HCPCS code E0787 CODING GUIDELINES: Added: Coding information for E0787 and A4226 Added: All-inclusive statement to A4224 ICD-10 CODES THAT SUPPORT MEDICAL NECESSITY: Revised: Section header “ICD-10 Codes that are Covered” updated to “ICD-10 Codes that Support Medical Necessity” Added: E0787 to Group 1 ICD-10 CODES THAT DO NOT SUPPORT MEDICAL NECESSITY: Revised: Section header “ICD-10 Codes that are Not Covered” updated to “ICD-10 Codes that DO NOT Support Medical Necessity” 12/19/2019: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R13 · 2019-08-13 · v51
Revision Effective Date: 08/13/2019 ICD-10 CODES THAT ARE COVERED: Added: Codes D80.2, D80.3, D80.4, D80.6, D80.7, D81.5, D82.1, D82.4, and G11.3 to Group 3 per update to Medicare Benefit Policy Manual, Chapter 15, section 50.6 07/25/2019: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R12 · 2019-01-01 · v47
Revision History Effective Date: 01/01/2019 CODING GUIDELINES: Added: Professional services description ICD-10 CODES THAT ARE COVERED: Added: All diagnosis codes formerly listed in the LCD ICD-10 CODES THAT ARE NOT COVERED: Added: Notation excluding all unlisted diagnosis codes from coverage 02/14/2019: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.
R11 · 2018-01-01 · v41
Revision Effective Date: 01/01/2018 NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES: Added: Clarified claims adjudication of pumps when an infusion is started in the physician’s office 06/07/2018: At this time 21st Century Cures Act applies to new and revised LCDs that restrict coverage, which require comment and notice. This revision is to an article that is not a local coverage determination.
R10 · 2018-01-01 · v38
Revision Effective Date: 01/01/2018 CODING GUIDELINES: Added: Treprostinil to K0455 Added: HCPCS code J9039 Updated: Levodopa-Carbidopa UOS Removed: Coding instructions for HCPCS Q9977 for DOS between July 01, 2015 through December 31, 2015 04/19/2018: At this time 21st Century Cures Act applies to new and revised LCDs that restrict coverage, which require comment and notice. This revision is to an article that is not a local coverage determination.
R9 · 2017-07-11 · v35
Revision Effective Date: 07/11/2017 CODING GUIDELINES: Revised: Clarified blinatumomab UOS, and added instructions for a 7-day infusion protocol Revised: Added HCPCS code J1555 for CUVITRU effective for claims on or after 01/01/2018 11/30/2017: At this time 21st Century Cures Act applies to new and revised LCDs that restrict coverage, which require comment and notice. This revision is to an article that is not a local coverage determination.
R8 · 2017-01-01 · v29
Revision Effective Date: 01/01/2017 CODING GUIDELINES: Revised: A4221 descriptor to include subcutaneous infusion catheter Revised: Typographical error K0522 to correct code of K0552 Added: Coding guidelines for Cuvitru (J7799) - effective 9/13/2016
R7 · 2017-01-01 · v24
Revision Effective Date: 01/01/2017 NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES: Replaced: A4221 with A4224 when using catheter insertion devices POLICY SPECIFIC DOCUMENTATION REQUIREMENTS: Added: 42 CFR 410.38(g), DIF and Modifiers requirements CODING GUIDELINES: Added: Billing instructions for A4224 and A4225 RELATED LOCAL COVERAGE DOCUMENTS: Added: The LCD-related Standard Documentation Requirements Language Article
R6 · 2016-07-01 · v16
Revision Effective Date: 07/01/2016 NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES: Revised: Language regarding payment rules for infusion drugs started in a physician’s office or hospital outpatient department. – Effective 4/25/2016
R5 · 2016-07-01 · v11
Effective July 1, 2016 oversight for DME MAC Articles is the responsibility of CGS Administrators, LLC 18003 and 17013 and Noridian Healthcare Solutions, LLC 19003 and 16013. No other changes have been made to the Articles.
R4 · 2016-01-01 · v10
Revision Effective Date: 01/01/2016 NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES: Revised: Standard Documentation Language to remove start date verbiage from Prescription Requirements (Effective 11/5/2015) CODING GUIDELINES: Updated: HCPCS Code Q9977 cross-walked to J7999 Added: J1575, J7340, J9039 (previously J7799) Updated: Billing instructions, by HCPCS code, based on dates of service.
R3 · 2015-12-01 · v7
Revision Effective Date: 12/01/2015 Draft Policy Article promoted to final CODING GUIDELINES: Added: Q9977 (Compounded drug NOC)
R2 · 2015-10-01 · v5
Revision Effective Date: 01/01/2015 (March 2015 Publication) CODING GUIDELINES: Revised: Units of service for blinatumomab Added: Instructions for least wastage of blinatumomab; inadvertently omitted from previous publication
R1 · 2015-10-01 · v4
Revision Effective Date: 10/01/2015 NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES: Removed: “When required by state law” from ACA new prescription requirements Revised: Face-to-Face Requirements for treating practitioner CODING GUIDELINES: Added: Coding requirements for lithium batteries Deleted: References to codes J2271 and J2275 Added: Levodopa-Carbidopa enteral suspension (effective for dates of service on or after 01/09/2015) Added: Blinatumomab (effective for dates of service on or after 12/03/2014)
Receipts for auditors
Version 88 of Article A52507, shown on this page: in force by CMS's dates 2022-07-01 to 2022-09-30. Archived 2026-09-26. CMS's copy · Our archived file. 3 of 3 sections are proven word-identical to the archived file.
Every archived version of Article A52507 (41 versions, CMS's dates, window by the as-of rule).
| Document | Version | In force | Archived on | Verify |
|---|---|---|---|---|
| Article A52507 | version 2 | 2015-10-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 4 | 2015-10-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 5 | 2015-10-01 to 2015-11-30 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 7 | 2015-12-01 to 2015-12-31 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 10 | 2016-01-01 to 2016-06-30 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 11 | 2016-07-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 16 | 2016-07-01 to 2016-12-31 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 24 | 2017-01-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 29 | 2017-01-01 to 2017-07-10 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 35 | 2017-07-11 to 2017-12-31 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 38 | 2018-01-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 41 | 2018-01-01 to 2018-12-31 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 47 | 2019-01-01 to 2019-08-12 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 51 | 2019-08-13 to 2019-12-31 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 55 | 2020-01-01 to 2020-05-30 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 63 | 2020-05-31 to 2020-09-05 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 70 | 2020-09-06 to 2020-09-14 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 73 | 2020-09-15 to 2021-07-17 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 77 | 2021-07-18 to 2022-02-27 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 80 | 2022-02-28, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 84 | 2022-02-28 to 2022-06-30 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 88 shown | 2022-07-01 to 2022-09-30 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 91 | 2022-10-01 to 2022-12-31 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 95 | 2023-01-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 99 | 2023-01-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 103 | 2023-01-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 106 | 2023-01-01 to 2023-03-31 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 110 | 2023-04-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 114 | 2023-04-01 to 2023-06-30 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 117 | 2023-07-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 119 | 2023-07-01 to 2023-09-30 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 122 | 2023-10-01 to 2024-01-11 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 124 | 2024-01-12, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 130 | 2024-01-12 to 2025-01-22 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 134 | 2025-01-23 to 2025-02-18 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 139 | 2025-02-19, superseded same day | 2026-10-09 | CMS's copy · Our archived file |
| Article A52507 | version 143 | 2025-02-19, superseded same day | 2026-10-09 | CMS's copy · Our archived file |
| Article A52507 | version 146 | 2025-02-19 to 2026-01-24 | 2026-10-09 | CMS's copy · Our archived file |
| Article A52507 | version 151 | 2026-01-25, superseded same day | 2026-10-09 | CMS's copy · Our archived file |
| Article A52507 | version 156 | 2026-01-25 to 2026-09-30 | 2026-09-26 | CMS's copy · Our archived file |
| Article A52507 | version 160 | 2026-10-01 to today | 2026-10-09 | CMS's copy · Our archived file |
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