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October 8, 2026

LCD and Policy Article Revisions Summary for October 8, 2026

Joint DME MAC Publication

Outlined below are the principal changes to the DME MAC Local Coverage Determination (LCD) and Policy Article (PA) that have been revised and posted. The policy included is External Infusion Pumps. Please review the entire LCD and PA for complete information.

External Infusion Pumps

LCD

External Infusion Pumps LCD

Revision Effective Date: 10/01/2026

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

Revised: "An infusion pump described by codes E0779, E0780, E0781, and E0791 is covered for indications I – III, V(A) – V(D), V(F), V(G), V(I) and V(J)." to "An infusion pump described by codes E0779, E0780, E0781, E0788, or E0791 is covered for indications I – III, V(A) – V(D), V(F), V(G), V(I) and/or V(J)." due to CMS HCPCS coding determinations
Revised: "Supplies for the maintenance of a parenteral drug infusion catheter (A4221) or supplies for the maintenance for an insulin infusion pump (A4224) are covered during the period of covered use of an infusion pump." to "Supplies for the maintenance of a parenteral drug infusion catheter (A4221), supplies for the maintenance for an insulin infusion pump (A4224), or supplies for the maintenance of a drug-pump combination (A4228) are covered during the period of covered use of an infusion pump." due to CMS HCPCS coding determinations

HCPCS CODES:

Added: E0788 to Group 1 Codes
Added: A4228 to Group 2 Codes
Added: J9191 and J9192 to Group 4 Codes
Removed: J9190 from Group 4 Codes

10/08/2026: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.

PA

External Infusion Pumps PA

Revision Effective Date: 10/01/2026

CODING GUIDELINES:

Added: "An ambulatory infusion pump (E0788) is an electrical or battery-operated device, approved by the FDA to be used with a specific drug (i.e., FDA-approved as a device-drug combination). It is used to deliver solutions containing a parenteral drug under pressure at a regulated flow rate. It is designed to be worn or carried by the beneficiary."
Added: "Code A4228 includes all necessary supplies to maintain a specific device-drug combination, per week. This includes, but is not limited to, cassettes, syringe reservoirs or bags, diluting solutions, infusion sets, tubing and other administration supplies, port cap changes, compounding charges, and preparation charges."
Revised: The table that describes HCPCS supply codes that are used with different types of external infusion pumps, by adding a row that contains E0788 in the Pump HCPCS Code column, A4228 in the Associated Codes column, and A4221, A4222, A4224, A4225, and K0552 in the Non-Associated Codes column
Removed: J7799 billing information for foslevodopa/foscarbidopa injection for continuous subcutaneous infusion (effective for dates of service on or after October 17, 2024 through June 30, 2025) due to being past the timely filing limit for claims
Removed: E1399 and A9999 billing information for the VYAFUSER pump and related administration supplies, respectively (effective for dates of service before January 24, 2025) due to being past the timely filing limit for claims
Revised: "Claims for the VYAFUSER pump, used to administer foslevodopa/foscarbidopa continuous subcutaneous infusion, for dates of service on or after January 24, 2025 must be submitted using the HCPCS code E0781" to "Claims for the VYAFUSER pump, used to administer foslevodopa/foscarbidopa continuous subcutaneous infusion, for dates of service on or after January 24, 2025 through September 30, 2026 must be submitted using the HCPCS code E0781"
Added: Billing information for the VYAFUSER pump for dates of service on or after October 1, 2026

10/08/2026: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Note: The information contained in this article is only a summary of revisions to the LCDs and/or PAs. For complete information on any topic, you must review the LCDs and/or PAs.