National Coverage Analysis (NCA) Tracking Sheet

Insulin Pump: C-Peptide Levels as a Criterion for Use

CAG-00092N

Issue

On August 25, 1999 HCFA issued a National Coverage Decision for the Use of the Continuous Subcutaneous Insulin Infusion Pumps. (CAG-00041 Opens in a new window).

One of the criteria for coverage was a C-peptide level <0.5 This requirement was added after consultation with various experts and specialty groups, as a way to ensure that patients were truly Type1 diabetics. Theoretically, patients with Type I diabetes should have an undetectable C-peptide level.

Within the past 12 months, we have heard from numerous beneficiaries who are Type I diabetics and who would otherwise meet the criteria except for a C-peptide level slightly above 0.5 We are interested in reviewing this requirement, and perhaps revising this cutoff point.

Benefit Category

Durable Medical Equipment

Requestor Information

Requestor Name Requestor Letter
Internal N/A
N/A

Important Dates

Formal Request Accepted and Review Initiated
02/01/2001
Expected NCA Completion Date
05/01/2001
Public Comment Period
03/05/2001 - 04/05/2001
Proposed Decision Memo Due Date
Proposed Decision Memo Released
Proposed Decision Memo Public Comment Period
Decision Memo Released
05/11/2001

Contacts

Lead Analysts
Betty Shaw
Sharon Hippler
Lead Medical Officers
Mitch Burken, MD

Medicare Benefit Category Determination Date

Actions Taken

May 11, 2001