Intermittent Intravenous Insulin Therapy (CPB 0742, reviewed 2025-11-26)

By 2025-11-26: Billing team must update claim denial rules to reject all claims for intermittent/pulsatile intravenous insulin therapy (PIVIT, hepatic activation therapy, metabolic activation therapy, Trina Health artificial pancreas) and associated diagnostic testing. Specifically: (1) Flag and deny claims for HCPCS code G9147 (Outpatient Intravenous Insulin Treatment) with denial reason 'Non-covered experimental service per Aetna CPB 0742'; (2) Deny claims for CPT codes 82947, 82948, 82950, 84132, 84133, 84540 when billed in the context of intermittent IV insulin therapy with explanation that diagnostic testing in this context is experimental; (3) Deny claims for insulin J-codes (J1811-J1815, J1817) when associated with pulsatile/intermittent IV administration; (4) Deny all S5550-S5571 insulin supply codes when linked to PIVIT. Providers must be notified that these services are non-covered; claims will be denied automatically. Exceptions: Continue processing standard insulin infusions (CPT 96372, 90835 or applicable infusion codes) for diabetic ketoacidosis (DKA) and hyperosmolar coma - these remain covered. Update billing system to identify these procedure codes on encounter forms and flag for verification before claim submission.