Consumable Medical Supplies Policy
Consumable medical supplies are covered in conjunction with:
- inpatient hospital services;
- outpatient hospital facility services;
- home health services;
- diabetic services;
- breast reconstruction and breast prostheses.
Note: State or federal legislation and/or plan-specific language supercede Cigna HealthCare's administrative coverage policies.
Plan Exclusions Most plans contain exclusions for consumable medical supplies. Although plan language varies considerably, a typical exclusion defines consumable medical supplies as including, but not limited to, bandages and other disposable medical supplies, skin preparations and test strips.
- are usually disposable in nature;
- cannot withstand repeated use by more than one individual;
- are primarily and customarily used to serve a medical purpose;
- generally are not useful to a person in the absence of illness or injury;
- may be ordered and/or prescribed by a physician.
- Consumable Medical Supplies should be billed using the applicable HCPCS code(s).
- Casting & Splint Supplies (Q4001-Q4051) are payable in addition to other services billed on the claim.
- Durable Medical Equipment: Consumable medical supplies provided in conjunction with DME are covered if the supplies are necessary for the function of the equipment and the equipment is covered under the plan.
- Diabetic Supplies
- Claims for insulin needles and syringes (A4206, A4207, A4208, A4209, A4215) will be paid under the member's benefit plan, either medical or pharmacy.
- Claims for lancets (A4258 and A4259) will be denied as consumable supplies, unless covered under state mandate or pharmacy rider.
- Claims for glucose test strips (A4772, A4253) will be denied as consumable supplies, unless covered under state mandate or pharmacy rider.
- Claims for glucometer devices (E0607, E0609) will be paid under the DME benefit.
- Surgical Trays:
Surgical trays are considered reimbursable for select procedures.
- Oxygen and Oxygen Delivery Systems/Supplies: Oxygen and Oxygen Delivery Systems/Supplies are not considered consumable supplies or DME. They are considered under a member's medical benefit.
- Breast Reconstruction and Prostheses: Breast prostheses are covered under the EPA benefit. Mastectomy bras are covered following a mastectomy under a member's medical benefit.
- Consumable medical supplies can be allowed under the lead referral/precertification for the associated services.
- Ostomy supplies are covered.
- If consumable medical supplies are not provided in conjunction with authorized or referred services, and are not covered under the plan for benefits, they will not be reimbursed by Cigna HealthCare.
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