Appropriate Billing for CeQur SimplicityTM Patch and Insulin

PAAS Tips:

• Bill one 10-count box of CeQur Simplicity ^TM patches as “10 EA”; the proper days’ supply will be determined by the patient’s insulin utilization and should never be more than a 30-day supply per 10 patches
  • Example: CeQur Simplicity^TM, #10 + 11 refills; use with Novolog U-100 insulin up to 18 units TID; change patch every 3 days; bill # 10 as a 30-day
• CeQur Simplicity^TM patches are disposable and NOT durable, therefore, the patches and the insulin to be used within the patch are not covered under a patient’s Medicare Part B/DMEPOS benefit
• Be sure the patient receives one CeQur Simplicity ^TM Inserter when they begin using the CeQur Simplicity^TM patch; the patient should call the manufacturer if a replacement inserter is needed
• Include the 20 priming units of insulin in the days’ supply calculation of the rapid-acting insulin; below is a sample calculation
  • Prescription: Novolog® U-100, 30 mL + 11 refills; administer up to 18 units TID using CeQur Simplicity^TM patch
  • Amount of insulin needed per patch: (18 units TID) x (3 days/patch) + 20 priming units = 182 units
  • Amount of insulin needed for the corresponding #10 CeQur patches: 10 patches x 182 units/patch = 1,820 units total (18.2 mL)
  • Suggested billing: 20 mL = 32 days’ supply -OR- 10 mL = 16 days’ supply