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2012 Texas Medicaid Provider Procedures Manual

Inpatient and Outpatient Hospital Services Handbook : 5. Ambulatory Surgical Center and Hospital Ambulatory Surgical Center : 5.2 Services/Benefits, Limitations, and Prior Authorization : 5.2.9 Implantable Infusion Pumps

Procedure codes E0782, E0783, and E0786 are a benefit of Texas Medicaid if a medical necessity exists. Implantable infusion pumps may be medically necessary in the following circumstances:
An IIP is not a benefit for the following uses:
All supplies associated with an IIP are included with the reimbursement for the surgery to implant the infusion pump and are not reimbursed separately.
Procedure codes E0782, E0783, and E0786 may be reimbursed separately from the global fee. Prior authorization requests for implantable infusion pumps must be submitted to the Special Medical Prior Authorization Department.
Refer to:
Subsection, “Implantable Infusion Pumps,” in Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook (Vol. 2, Provider Handbooks).

Texas Medicaid & Healthcare Partnership
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