Epidural, Intrathecal, and Intraventricular Morphine Administration
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.
Epidural or intrathecal morphine administration for the management of severe, intractable pain is considered eligible for coverage.
Intraventricular administration of morphine is considered investigational.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
Investigative is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized as a generally accepted standard of good medical practice for the treatment of the condition being treated and; therefore, is not considered medically necessary. For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting.
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.
06/01/2016: Policy number added. Investigative definition updated in Policy Guidelines section.
Uniform Medical Policy Manual (11/1989)
CODE REFERENCEThis 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.