Insulin for administration through dme (i.e., insulin pump) per 50 units

Injection, insulin, per 5 units

Insulin delivery device, disposable pen (including insulin); 3 ml size

Insulin (fiasp), per 5 units

Insulin (lyumjev), per 5 units

Insulin cartridge for use in insulin delivery device other than pump; 150 units

Insulin cartridge for use in insulin delivery device other than pump; 300 units

Insulin delivery device, disposable pen (including insulin); 1.5 ml size

Insulin, rapid onset, 5 units

Insulin syringes (100 syringes, any size)

Insulin (fiasp) for administration through dme (i.e., insulin pump) per 50 units

Insulin (lyumjev) for administration through dme (i.e., insulin pump) per 50 units

External ambulatory infusion pump, insulin

Insulin, long acting; 5 units

Infusion set for external insulin pump, needle type

Insulin, intermediate acting (nph or lente); 5 units

Insulin delivery device, reusable pen; 3 ml size

Supplies for maintenance of insulin infusion catheter, per week

Insulin, most rapid onset (lispro or aspart); 5 units

Infusion set for external insulin pump, non needle cannula type

Syringe with needle for external insulin pump, sterile, 3 cc

Insulin delivery device, reusable pen; 1.5 ml size

Insulin pump initiation, instruction in initial use of pump (pump not included)

Supplies for external insulin infusion pump, syringe type cartridge, sterile, each

External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories

External ambulatory infusion pump, insulin, dosage rate adjustment using therapeutic continuous glucose sensing

Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately)

Home infusion therapy, continuous insulin infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

Outpatient intravenous insulin treatment (oivit) either pulsatile or continuous, by any means, guided by the results of measurements for: respiratory quotient; and/or, urine urea nitrogen (uun); and/or, arterial, venous or capillary glucose; and/or potassium concentration

Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each

Supplies for maintenance of insulin infusion pump with dosage rate adjustment using therapeutic continuous glucose sensing, per week

Artificial pancreas device system (e.g., low glucose suspend (lgs) feature) including continuous glucose monitor, blood glucose device, insulin pump and computer algorithm that communicates with all of the devices