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Disposable Insulin Delivery System Code Is Now a Medi-Cal DME Code

October 19, 2018

Effective for dates of service on or after September 1, 2018, HCPCS code A9274 (external ambulatory insulin delivery system, disposable, each, includes all supplies and accessories) is updated to a Durable Medical Equipment (DME) code when billing Medi-Cal directly. There are no changes regarding the submission of Treatment Authorization Requests (TARs) or claims.

The Centers for Medicare & Medicaid Services has defined disposable insulin delivery systems (items that meet HCPCS code A9274 description) as coverable under Medicare Part D. Medi-Cal does not reimburse for any items coverable under Medicare Part D for Medicare/Medi-Cal dual eligible and Part D-eligible recipients. Providers must submit claims for disposable insulin delivery systems to the Prescription Drug Plan or Medicare Advantage-Prescription Drug Plan in which the recipient is enrolled.

This update will be reflected in the Medical Supplies Billing Codes, Units and Quantity Limits spreadsheet in a future Medi-Cal Update.