Needle-Free Insulin Injection Systems

POLICY NUMBER

L.2.01.403

DESCRIPTION

An alternative to needles and syringes for insulin administration are needle-free insulin injection systems or jet injectors. These devices eject a narrow stream of insulin through a fine-holed nozzle under high pressure and at high speed so that the insulin penetrates the skin and is dispersed subcutaneously.

The goals of injecting insulin with needle-free insulin injection systems, or jet injectors, in the treatment of diabetes are to prevent long-term complications by ensuring optimal glycemic control and to encourage compliance with intensive therapy in patients with needle phobias or who experience pain upon injection.

POLICY

Needle-Free Insulin Injection Systems are considered investigational.

POLICY EXCEPTIONS

None

POLICY GUIDELINES

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.

POLICY HISTORY

5/2001: Approved by Medical Policy Advisory Committee (MPAC)

7/13/2001: Code Reference section completed, HCPCS A4210 added

2/13/2002: Investigational definition added

5/2/2002: Type of Service and Place of Service deleted

8/15/2005: Code Reference section reviewed, no changes

10/23/2006: Policy reviewed, no changes

08/04/2015: Code Reference section updated for ICD-10.

06/06/2016: Policy number L.2.01.403 added. Investigative definition updated in Policy Guidelines section.

12/29/2022: Policy reviewed; no changes.

12/07/2023: Policy reviewed; no changes.

12/16/2024: Policy reviewed; no changes.

SOURCE(S)

Hayes Medical Technology Directory

CODE REFERENCE

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

Investigational Codes

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