Knowledge Base Article

Effective December 23, 2009, CMS determined that services comprising an Outpatient Intravenous Insulin Therapy (OIVIT) regimen are nationally non-covered under Medicare when furnished pursuant to an OIVIT regimen as described below.

The term outpatient intravenous (IV) insulin therapy (OIVIT) refers to an outpatient regimen that integrates pulsatile or continuous intravenous infusion of insulin via any means, guided by the results of measurement of: 

• respiratory quotient; and/or 
• urine urea nitrogen (UUN); and/or 
• arterial, venous, or capillary glucose; and/or 
• potassium concentration; and

performed in scheduled recurring periodic intermittent episodes. The insulin administration is adjunctive to the patient’s routine diabetic management regimen (oral agent or insulin-based) or other disease management regimen, typically performed on an intermittent basis (often weekly), and frequently performed chronically without duration limits.

This regimen is also sometimes termed Cellular Activation Therapy (CAT), Chronic Intermittent Intravenous Insulin Therapy (CIIT), Hepatic Activation Therapy (HAT), Intercellular Activation Therapy (iCAT), Metabolic Activation Therapy (MAT), Pulsatile Intravenous Insulin Treatment (PIVIT), Pulse Insulin Therapy (PIT), and Pulsatile Therapy (PT).

Effective April 5, 2010 new HCPCS code

• G9147 – Outpatient Intravenous Insulin Treatment (OIVIT) either pulsatile or continuous, by any means, guided by the results of measurements for: respiratory quotient; and/or, urine urea nitrogen (UUN); and/or, arterial, venous or capillary glucose; and/or potassium concentration

should be used to bill for non-covered OIVIT and any services comprising an OIVIT regimen.  Effective April 5, 2010, HCPCS codes 99199 (unlisted special service, procedure, or report) or 94681 (exhaled air analysis CO2) are no longer appropriate codes for OIVIT and should not be used in conjunction with OIVIT or diabetes-related conditions (250.00-250.93).  Claims billed with 99199 or 94681 will be returned to providers.

Two CMS transmittals regarding the non-coverage of OIVIT were released February 5, 2010.  The effective date of the transmittals is December 23, 2009 and the implementation date is March 8, 2010.  For more information, please view the complete transmittals at the following links.

CMS Transmittal 112 NCD for OIVIT
CMS Transmittal 1913 Claims Processing OIVIT