US · guidance
CMS Pub. 100-04, ch. 20, § 30.7.1
Payment for Parenteral and Enteral Pumps
B3-5017; PM B-01-54
Effective April 1, 1990, claims for rental of parenteral and enteral pumps are limited to
payments for a total of 15 months during a period of medical need. Payment policies for
these pumps generally follow the rules for capped rental items.
A period of medical need ends when enteral or parenteral nutrients are not medically
necessary for 2 consecutive months.
DME MACs do not allow additional rental payments once the 15-month limit is reached
or pump is purchased unless the attending physician changes the prescription between
parenteral and enteral nutrients.
DME MACs do not begin a new 15-month rental period when a patient changes
suppliers. The new supplier is entitled to the balance remaining on the 15-month rental
period.
The supplier that collects the last month of rental (i.e., 15th month) is responsible for
ensuring that the patient has a pump for the duration of medical necessity and for
maintenance and servicing (M/S) of the pump during the duration of therapy.
A period of voluntary non-billing care and institutional care is not counted toward the 15
months. Calculation is resumed when the voluntary care ends or when the patient is
released from institutional care.
An entire month's rent may not be paid when a patient is hospitalized during the month.
The DME MAC will request documentation to verify a break in medical need of two
months or more before approving an additional 15-month rental period.
DME MACs notify the supplier of the last rental payment.
The patient has the option of purchasing or renting the pump from the supplier. DME
MACs must request written authorization from the patient before or after paying for a
pump purchase. If the patient decides to purchase the pump once rentals have been paid,
the purchase allowance will consist of the used purchase allowance less the amount
allowed to date for rentals.
DME MACs provide coverage for one pump for parenteral nutrition. DME MACs do not
allow additional benefits for portable pumps or additional pumps.
History
(Rev. 1, 10-01-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
592226f64a4983b5e0eada0661f252422756f8b42f4b1253e6866628a1d74aee
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