The Challenges of Coding for Automated Insulin Delivery Devices

Insulin pumps represent a significant technological space in diabetes management and have been improving patients’ quality of life and providing precise care for decades, continuing to see improvements in technology. The absence of direct CPT codes for insulin pump training presents a major challenge for health care providers.  Since there are no direct CPT Codes, how can providers bill for time spent on various tasks with these devices?

While specific CPT codes for insulin pump training are still yet to be established, health care providers have various alternatives.

Avenues to Ensure Appropriate Billing & Reimbursement

Diabetes Self-Management Training (DSMT) Codes

Use DSMT codes G0108 for individual diabetes outpatient self-management training services, per 30 minutes and G0109 for group sessions (2 or more) as part of diabetes self-management education, which includes insulin pump training, per 30 minutes.

Ensure that patients receive specific referrals for DSMT which are distinct from referrals for the insulin pump itself.

Medical Nutritional Therapy (MNT) Codes

Consider billing under MNT codes 97802, 97803 and 97804 when insulin pump training overlaps with nutritional management, especially in adjusting insulin based on dietary considerations.

Evaluation & Management (E&M) Codes

If a physician or an advanced practitioner conducts the insulin pump training, E&M codes can be used. This billing is time-based and suitable for personalized training sessions.

Education & Training Codes

Explore general education and training codes, such as 98960, 98961 and 98962, which can be applied when offering standardized curriculum-based education related to insulin pump usage. While Medicare may not reimburse these codes, many commercial payers will (see code explanations below). 

Maximizing Reimbursement Through Education & Training Codes

For education-specific sessions related to insulin pump management, health care providers can leverage the following codes:

• 98960: For individual face-to-face education sessions lasting 30 minutes.
• 98961: For small group training involving 2-4 patients, enhancing shared learning experiences.
• 98962: For larger group educational settings with 5-8 patients, ideal for workshop formats.

Implementing Billing Strategies in Clinical Practice

Incorporating these billing strategies requires careful planning and documentation. Ensure that each training session, whether individual or group, is documented with the appropriate code and that all referral requirements are met before submission. By using a combination of DSMT, MNT, E&M and education training codes, health care providers can secure reimbursement for the essential training services provided.

Collaboration with manufacturers is another option to ensure that people with diabetes get the training that they need despite lack of insurance coverage for the provider. Partnering with insulin pump manufacturers can also offer billing solutions and training support, assisting in covering costs associated with patient education.

Recent Insulin Pump Specific Changes in Medicare Reimbursement as of December 2023 

Training

No specific CPT codes for insulin pump training; however, DSMT (Diabetes Self-Management Training) and MNT (Medical Nutrition Therapy) codes can be used. 

Referral Requirements

Separate referrals required for insulin pump and DSMT. 

Billing Options

Consider E&M codes for training performed by physicians or advanced practitioners, and explore contracts with manufacturers for additional support. 

Find more information on automated insulin delivery options.