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

08/28/2015: Code Reference section updated for ICD-10. Removed ICD-9 procedure code 99.29 from the Code Reference section.




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

62310

Injection, 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)

62350

Implantation, 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

62351

Implantation, 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

62355

Removal of previously implanted intrathecal or epidural catheter

62360

Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir

62362

Implantation or replacement of device for intrathecal or epidural drug infusion; programmable pump, including preparation of pump, with or without programming

62365

Removal of subcutaneous reservoir or pump, previously implanted for intrathecal or epidural infusion

62367

Electronic 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

95990

Refilling 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.

99551

Home infusion for pain management (intravenous or subcutaneous), per visit

99552

Home infusion for pain management (epidural or intrathecal), per visit

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

E0781

Ambulatory 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)

J2275

Injection, morphine sulfate (preservative-free sterile solution), per 10 mg (Deleted 12-31-2014)

S0093

Injection, morphine sulfate, 500 mg (loading dose for infusion pump)

ICD-9 Procedure

ICD-10 Procedure

03.90

Insertion of catheter into spinal canal for infusion of therapeutic or palliative substances

00HU03Z, 00HU33Z, 00HU43Z

Insertion of Infusion Device into Spinal Canal, By Approach

00HV03Z, 00HV33Z, 00HV43Z

Insertion of Infusion Device into Spinal Cord, Open Approach

03.92

Injection of other agent into spinal canal

3E0R3NZ

Introduction of Analgesics, Hypnotics, Sedatives into Spinal Canal, Percutaneous Approach

3E0S3NZ

Introduction of Analgesics, Hypnotics, Sedatives into Epidural Space, Percutaneous Approach

86.06

Insertion of totally implantable infusion pump

0JHT0VZ, 0JHT3VZ, 0JH60VZ, 0JH63VZ, 0JH70VZ, 0JH73VZ, 0JH80VZ, 0JH83VZ

Insertion of Infusion Pump, by Specific Area, Subcutaneous Tissue and Fasia, By Approach

ICD-9 Diagnosis

ICD-10 Diagnosis

  

 

 

 


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

HCPCS

  

ICD-9 Procedure

ICD-10 Procedure

01.02

Ventriculopuncture through previously implanted catheter

8C01X6J

Collection of cerebrospinal fluid from indwelling device in nervous system

ICD-9 Diagnosis

ICD-10 Diagnosis

  

 

 

 

Top