Print Epidural, Intrathecal, and Intraventricular Morphine Administration

Epidural, Intrathecal, and Intraventricular Morphine Administration

 

DESCRIPTION

Morphine may be administered by the intravenous, intramuscular, subcutaneous, epidural or intrathecal routes of administration. It is used for the management of severe pain which may occur post-surgically, after severe trauma, or during the progression of a pathological disease process (e.g., cancer).

Access of the route of drug administration may be gained by direct conventional transepidermal injection techniques in the appropriate area, injection through an external catheter port, or by injection through a previously implanted port/reservoir catheter site. Morphine may be administered by intermittent injection (discreet intervals) or by continuous infusion when diluted in compatible solutions.

 

POLICY

Epidural or intrathecal morphine administration for the management of severe, intractable pain is considered eligible for coverage.

Intraventricular administration of morphine is considered investigational.

 

POLICY EXCEPTIONS

None

 

POLICY GUIDELINES

Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.

The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.

 

POLICY HISTORY

9/1994: Approved by Medical Policy Advisory Committee (MPAC)

2/14/2002: Investigational definition added, Managed Care Requirements deleted, Prior Authorization put under the Policy Section

3/5/2002: Prior authorization deleted

4/26/2002: Type of Service and Place of Service deleted

11/12/2003: Code Reference section updated, CPT code range 62274-62279 deleted

 

SOURCE(S)

Uniform Medical Policy Manual (11/1989)

 

CODE REFERENCE

This may not be a comprehensive list of procedure codes applicable to this policy.             The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document.   

Covered Codes

Code Number

Description

CPT-4

62310Injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic  
62311   lumbar, sacral (caudal)
62318 Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic
62319 lumbar, sacral (caudal)
62350Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; without laminectomy
62351Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; with laminectomy
62355Removal of previously implanted intrathecal or epidural catheter
62360 Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir
62362Implantation or replacement of device for intrathecal or epidural drug infusion; programmable pump, including preparation of pump, with or without programming
62365Removal of subcutaneous reservoir or pump, previously implanted for intrathecal or epidural infusion
62367Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); without reprogramming
62368 Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming
95990Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular)

Note: The refill and maintenance of an intraventricular pump or reservoir is not covered.

99551Home infusion for pain management (intravenous or subcutaneous), per visit
99552 Home infusion for pain management (epidural or intrathecal), per visit

ICD-9 Procedure

03.90 Insertion of catheter into spinal canal for infusion of therapeutic or palliative substances
03.92 Injection of other agent into spinal canal
86.06 Insertion of totally implantable infusion pump

99.29

Injection or infusion of other therapeutic or prophylactic substance

ICD-9 Diagnosis

 

 

HCPCS

A4300

Implantable access catheter, (e.g., venous, arterial, epidural subarachnoid, or peritoneal, etc.) external access

A4301 Implantable access total catheter, port/reservoir (e.g., venous, arterial, epidural, subarachnoid, peritoneal, etc.)
E0779 Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater
E0780 Ambulatory infusion pump, mechanical, reusable, for infusion less than 8 hours
E0781Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient
E0785 Implantable intraspinal (epidural/intrathecal) catheter used with implantable infusion pump, replacement
E0786 Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter)
J2270 Injection, morphine sulfate, up to 10 mg
J2271 Injection, morphine sulfate, 100 mg (Deleted 12-31-2014)
J2275Injection, morphine sulfate (preservative-free sterile solution), per 10 mg (Deleted 12-31-2014)
S0093Injection, morphine sulfate, 500 mg (loading dose for infusion pump)

This may not be a comprehensive list of procedure codes applicable to this policy.

Investigational Codes

Code Number

Description

CPT-4

61026 Ventricular puncture through previous burr hole, fontanelle, suture, or implanted ventricular catheter/reservoir; with injection of medication or other substance for diagnosis or treatment
61215 Insertion of subcutaneous reservoir, pump or continuous infusion system for connection to ventricular catheter

ICD-9 Procedure

01.02 Ventriculopuncture through previously implanted catheter

ICD-9 Diagnosis

 

 

HCPCS

 

 

 

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