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News: CMS to expand coverage for insulin infusion pumps

Patient Financial Services Weekly Advisor, October 8, 2004

In response to Medtronic MiniMed's request to remove the C-Peptide testing requirement for insulin pump coverage, CMS announced September 30 that it will expand Medicare coverage for insulin infusion pumps.

The agency will accept public comment on the draft decision memorandum for 30 days, and will make the decision final within 90 days.

Insulin infusion pumps have been covered for some Medicare beneficiaries with diabetes since 1999.

CMS is proposing modifications to the C-peptide requirement for the insulin pump coverage, including the following:

1. CMS would allow an alternative test-called beta cell autoantibody-to identify beneficiaries with type 1 diabetes who would benefit from the insulin pump.

2. By standardizing C-peptide testing and relaxing the criteria for those with kidney disease, the number of beneficiaries with type 2 diabetes who qualify for insulin pumps would increase. CMS would not change the remaining criteria for insulin pump therapy dealing with diabetic control and side effects.

If approved, this proposal may make it easier for Medicare beneficiaries with diabetes to qualify for more services, such as continuous subcutaneous insulin, according to a CMS release.

It also may promote future clinical trials to evaluate the health benefit laboratory tests to select diabetic patients for insulin pumps, the agency said.

To read the draft decision memorandum, click here.

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