Summary & Overview
HCPCS Level II J1817: Insulin for Insulin Pump, per 50 Units
HCPCS Level II code J1817 represents insulin supplied for use in durable medical equipment insulin pumps, billed per 50 units. This code matters nationally because insulin pump therapy is a common management strategy for people with insulin-dependent diabetes and has implications for pharmacy benefit management, durable medical equipment billing, and reimbursement across public and commercial payers. The code captures a specific supply line for pump-delivered insulin rather than syringe or pen formulations.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find an overview of how the code is used in clinical and billing workflows, benchmark considerations for per-unit supply claims, and the typical sites of service associated with pump-delivered insulin (primarily home and outpatient DME settings). The publication also outlines what to expect in claims reporting and areas where policy updates or payer coverage rules commonly affect utilization and reimbursement for pump insulin supplies.
The report provides context on coding intent, service classification, and payer relevance to support billing, compliance, and operational decisions. Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes is noted where applicable.
Billing Code Overview
HCPCS Level II code J1817 describes insulin for administration through durable medical equipment (DME), specifically for use in insulin pumps, billed per 50 units. The service type is pharmaceutical administration for infusion pump supply, and the typical site of service is home or other outpatient settings where a patient uses an insulin pump supplied as DME.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 28-year-old adult with type 1 diabetes mellitus managed with an insulin infusion pump presenting for routine durable medical equipment (DME) supply refill. The patient receives prescription orders from their endocrinologist for insulin formulated for pump delivery, billed per 50 units under J1817. Clinical workflow: the endocrinology clinic documents ongoing pump therapy, verifies recent glucose logs and pump settings, writes a DME order specifying quantity of insulin in 50-unit increments; the DME supplier dispenses the insulin for pump use and bills the payer with J1817 for each 50 units supplied. Typical site of service: outpatient DME supplier or ambulatory clinic coordinating DME, with insulin administered by patient via their insulin pump at home. Common clinical scenarios include routine maintenance supply for continuous subcutaneous insulin infusion, interim supply after pump replacement, or supply following hospitalization when outpatient pump therapy is resumed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No specific modifier (default) | Use when no other modifier applies and service is billed routinely. |