CMS Pub. 100-02, ch. 15, § 320.7.1

In general, Medicare Part B covers a limited number of home infusion drugs through the

DME benefit if:

1. the drug is necessary for the effective use of an infusion pump classified as DME

and determined to be reasonable and necessary for administration of the drug; and

2. the drug being used with the pump is itself reasonable and necessary for the

treatment of an illness or injury.

Specifically, under this home infusion therapy services benefit, a home infusion drug

must require infusion through an external infusion pump that is covered under the DME

benefit. If the drug or biological can be infused through a disposable pump or by a

gravity drip, it does not meet this criterion.

Only certain types of infusion pumps are covered under the DME benefit. The Medicare

National Coverage Determinations Manual, Publication 100-03, Chapter 1, Section 280.1

describes the types of infusion pumps that are covered under the DME benefit. The DME

MACs then specify the details of which infusion drugs are covered with these pumps.

The drugs and biologicals identified in the DME Local Coverage Determination (LCD)

for External Infusion Pumps (L33794) qualify as home infusion drugs as long as they are

infused intravenously or subcutaneously over a period of 15 minutes or more, are not

classified as insulin for insulin pump use, and are not on a self-administered drug

exclusion list. These drugs continue to be paid for under the DME benefit as supply

drugs to the covered infusion pump. Any additional training and education services

needed for the patient to administer these drugs at home would be covered under this

home infusion therapy services benefit.

There are other infusion drugs covered under Part B that could potentially be added to the

DME LCD for External Infusion Pumps (L33794) and thus qualify for services under the

home infusion therapy services benefit. Allowing the DME MACs to maintain the list of

infusion drugs and biologicals ensures quarterly review of any and all medications that

meet the criteria for external infusion pumps, thus ensuring an up to date, inclusive

benefit.