Chronic Intermittent Intravenous Insulin Therapy
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This policy governs the coverage stance for outpatient chronic intermittent intravenous insulin therapy for patients with type 1 diabetes and clarifies that inpatient intravenous insulin use is outside its scope. It applies to Blue Cross and Blue Shield of Kansas members and their providers.
No material clinical or coverage changes in this revision.
Coverage Criteria and Policy Position
Not covered (experimental/investigational)
Coverage stance
This is the policy's explicit coverage determination from the document.
Medical Necessity and Evidence Conclusion
Coverage determination based on available evidence:
Summary of the available RCTs and uncontrolled studies.
Policy conclusion based on the evidence review.
This policy does not apply to use of intravenous insulin infusions in the inpatient setting (for example, treatment of diabetic ketoacidosis or diabetic hyperosmolar coma). Please refer to the member's contract benefits in effect at the time of service to determine coverage or non‑coverage for an individual member.
Chronic intermittent intravenous insulin therapy (CIIIT) is designated as Experimental/Investigational for all diagnoses related to this medical policy and is explicitly excluded from being considered medically necessary under this policy.
Outpatient chronic intermittent intravenous insulin therapy (CIIIT) is considered experimental/investigational and therefore not medically necessary per this policy.
The available evidence, including two randomized controlled trials and multiple uncontrolled studies, is limited to small studies reporting changes in intermediate laboratory outcomes. The clinical significance of these findings is uncertain, and the evidence is insufficient to demonstrate an improvement in net health outcome. Therefore, CIIIT is not supported as medically necessary.
Coding and Billing Information
| lZG | FDA product code for infusion pumps cleared for intravenous medication delivery (510(k)) |
| 96365 | Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour. |
| 96366 | Intravenous infusion; each additional hour (List separately in addition to code for primary procedure). |
| G9147 | Outpatient Intravenous Insulin Treatment (OIVIT) either pulsatile or continuous, by any means, guided by measurements (e.g., respiratory quotient, UUN, glucose, potassium). |
| J1817 | Insulin for administration through DME (i.e., insulin pump) per 50 units. |
| J7050 | Infusion, normal saline solution, 250 cc. |
| ICD-10 (unspecified) | Policy states Experimental / Investigational for all diagnoses related to this medical policy. |
Provider Actions and Administrative Requirements
Predetermination / Member Benefit Verification
Verify member benefits and plan exclusions prior to service. State and federal mandates and the member's contract take precedence over Medical Policy. Contact Blue Cross and Blue Shield of Kansas Customer Service or submit a predetermination request for coverage questions.
- Check member contract and benefit limitations
- Contact BCBSKS Customer Service or submit a predetermination
Predetermination Recommended
Prior authorization (predetermination) is recommended when coverage is uncertain. If there are questions about coverage of this service, contact Blue Cross and Blue Shield of Kansas customer service, your professional or institutional relations representative, or submit a predetermination request.
- Submit predetermination for outpatient chronic intermittent intravenous insulin therapy (CIIIT) coverage questions
Comparator Therapy
Standard medical management is the comparator/usual care for decisions about maintaining normoglycemia in patients with type 1 diabetes.
- Guideline-directed diabetic medical therapy including subcutaneous insulin
- Diabetes self-management with glucose monitoring, diet, and exercise
Coding and Documentation Note
Coding listed for informational purposes; inclusion or exclusion of codes does not guarantee coverage or reimbursement. Codes are medically necessary ONLY if the procedure is performed according to the Policy section of this document. Review the member's contract benefits for coverage determinations.
Denial Risk for Outpatient CIIIT
Chronic intermittent intravenous insulin therapy (CIIIT) is designated experimental/investigational for all diagnoses in this policy and outpatient CIIIT may be denied.
- CIIIT is experimental/investigational for all diagnoses
- Outpatient CIIIT considered experimental — denial risk for services billed outpatient
Background and Rationale
Chronic intermittent intravenous insulin therapy (CIIIT) delivers variable‑dose insulin intravenously, typically as pulsatile or intermittent infusions administered in outpatient clinic sessions, commonly on a weekly schedule. Infusions are delivered over several hours using a pump with computerized dosing adjustments guided by frequent glucose monitoring. The proposed mechanism is increasing portal insulin concentrations to reactivate hepatic insulin‑dependent enzymes and suppress hepatic glucose production, although this mechanism has not been demonstrated in humans.
Definitions
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