Local Coverage Determination · DME MAC
L33794
External Infusion Pumps
Version 176. CMS effective date 10/01/2026. CMS updated 09/29/2026. Read from the CMS Coverage API on 2026-10-13. Contractors on the report: CGS Administrators (DME MAC) and Noridian Healthcare Solutions (DME MAC).
CMS coverage policy citation. CMS Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Sections 280.1 and 280.14
Coverage indication
In addition to the “reasonable and necessary” criteria contained in this LCD there are other payment rules, which are discussed in the following documents, that must also be met prior to Medicare reimbursement: The LCD-related Standard Documentation Requirements Article, located at the bottom of this policy under the Related Local Coverage Documents section. The LCD-related Policy Article, located at the bottom of this policy under the Related Local Coverage Documents section. Refer to the Supplier Manual for additional information on documentation requirements. Refer to the DME MAC web sites for additional bulletin articles and other publications related to this LCD. For the items addressed in this LCD, the "reasonable and necessary" criteria, based on Social Security Act § 1862(a)(1)(A) provisions, are defined by the following coverage indications, limitations and/or medical necessity. Payment may be made for supplies that are necessary for the effective use of durable medical equipment. Such supplies include those drugs and biologicals which must be put directly into the equipment in order to achieve the therapeutic benefit of the durable medical equipment or to assure the proper functioning of the equipment. However, the coverage of such drugs or biologicals does not preclude the need for a determination that the drug or biological itself is reasonable and necessary for treatment of the illness or injury or to improve the functioning of a malformed body member.
Excerpt from the LCD indication. Full text on CMS.
Documentation requirements
Items covered in this LCD have additional policy-specific requirements that must be met to justify Medicare reimbursement. Refer to the LCD-related Policy article, located at the bottom of this policy under the Related Local Coverage Documents section for additional information.
Related articles
- A52507 · External Infusion Pumps - Policy Article
- A60373 · Response to Comments: External Infusion Pumps – DL33794
- A55426 · Standard Documentation Requirements for All Claims Submitted to DME MACs
Related NCDs
- NCD 280.1 · Durable Medical Equipment Reference List (version 4)
- NCD 280.14 · Infusion Pumps (version 2)
HCPCS codes on this LCD
64 other Level II codes are on the LCD and are not given a page in this set: E0779, E0780, E0781, E0784, E0788, E0791, E1399, A4222, A4224, A4225, A4228, A4305, A4306, A4602, A9274, K0601, K0602, K0603, K0604, K0605, J1551, J1555, J1558, J1559, J1561, J1569, J1575, J7799, J0133, J0285, J0287, J0289, J0895, J1171, J1250, J1265, J1325, J1455, J1570, J1574….
Questions
What does LCD L33794 cover?
L33794 is External Infusion Pumps. It is a current final DME MAC local coverage determination, version 176.
Where is the CMS source for L33794?
The Medicare Coverage Database page for LCD L33794 version 176.
Get the signed answer via API
The signed answer is the receipt for this code on a date of service: the rule that was in force, with a hash you can replay. The call needs an API key. The source archive and as-of resolution are public.
curl -H "X-API-Key: $VERZI_API_KEY" \
"https://api.verzi.health/v1/rules/warrant?hcpcs=E0776&as_of=2024-01-15&npi=1234567890&state=UT"