Billing Code

Product Name

Description

Size

Min Benefit

Max Benefit

Condition

AN011

Animas Vibe/One Touch Vibe Plus Insulin Pump

Ambulatory insulin infusion pump with real-time continuous glucose monitoring (CGM) capability

8.26 x 5.08 x 2.18cm

8502

AN014

t:slim X2 Insulin Pump

Ambulatory insulin infusion pump with real-time continuous glucose monitoring (CGM) capability

One size only.

8502

DF002

DANAR Insulin Pump

The DANAR Insulin Pump is a small device about the size of a pager. It holds up to 300 units of insulin, which is delivered continuously through a small tube to the patient. The DANAR Insulin Pump also has an integrated blood glucose meter and remote control via bluetooth communication.

75 x 45 x 19mm, 60grams

8502

DF003

DANA RS Diabecare insulin pump

DANA RS insulin pump is a BLE (bluetooth low energy) insulin pump which can be connected to and controlled from a BLE Smart Phone.  Smart Phone connection is via a secure (alpha-numeric) pairing code, creating a large easy to read display for set-up and control of the DANA RS insulin pump.

75mm x 45mm x 19mm (63grams)

8502

MS066

Cellnovo Insulin Infusion System

Continuous Subcutaneous Insulin Infusion Pump

The Cellnovo Insulin Infusion System is only available in one size.

8502

RB001

Accu-Chek Combo System

Insulin delivery device capable of remotely receiving and acting on information about blood glucose levels, performing bolus calculation and bolus advice on additional parameters than what is normally provided.

The Accu-Chek Combo System is only available in one size.

8502

RB002

ACCU-CHEK Insight System

Insulin delivery device capable of remotely receiving and acting on information about blood glucose levels, performing bolus calculation and bolus advice on additional parameters than what is normally provided.

No variable sizes offered. Only one system provided.

8502

YA001

mylife™ YpsoPump Insulin Pump System

Battery-operated, programmable ambulatory insulin infusion pump system

One size only

7362

MC839

Medtronic MiniMed Insulin Infusion Pump

Paradigm Veo Model MMT-554. 'Smart' Insulin Pump with REAL-Time continuous glucose monitoring capability, incorporating a low glucose suspend and with remote control.

5.1 x 7.6 x 2.0cm

9025

MC840

Medtronic MiniMed Insulin Infusion Pump

Paradigm Veo Model MMT-754. 'Smart' Insulin Pump with REAL-Time continuous glucose monitoring capability, incorporating a low glucose suspend and with remote control.

5.1 x 9.4 x 2.0cm

9025

MI150

MiniMed 640G Insulin Pump

MiniMed 640G Insulin Pump with SmartGuard Technology and continuous glucose monitoring capability, designed to automatically suspend insulin delivery before dangerous lows occur, and automatically resume after levels recover.

1.8ml and 3.0ml

9025

MI290

Medtronic MiniMed 670G Insulin Pump

MiniMed 670G Insulin Pump with SmartGuard Hybrid Closed Loop (HCL) technology and continuous glucose monitoring (CGM) capability which can be programmed to automatically adjust delivery of basal insulin based on CGM, and can suspend delivery of insulin when the sensor glucose value falls below or is predicted to fall below predefined threshold values.

One size only

9025

AN015

Autosoft, Varisoft, TruSteel Infusion Set

For use with insulin infusion pump

6 - 17mm

7

Billing Code

Product Name

Description

Size

Min Benefit

Max Benefit

Note

MC763

Reveal XT

Reveal XT Insertable Cardiac Monitor

61 x 19 x 8 mm with a volume of 9cc

3120

SJ152

SJM Confirm Model DM2102

Implantable cardiac monitor with atrial fibrillation monitoring.

6.5cc, 12g

3120

SJ390

Confirm RX

Insertable Cardiac Monitor

5cm X 0.95cm X 0.33cm

3120

BT186

BioMonitor 2-AF  Implantable Cardiac Monitor

Implantable cardiac monitor for continuous remote monitoring of patients with Atrial Fibrillation (AF) or unexplained syncope

88.4 mm x 15.2 mm x 6.2 mm , 10.1g , 5cm3

3120

MI141

Reveal LINQ

Insertable Cardiac Monitor

45 x 7 x 3.5mm, 1.18cc

3120

BS294

Latitude Communicator

Remote patient management system for implanted cardiac devices

One size only

1568

BT179

Cardio Messenger II-S 3G

Bedside/Remote transmitter w/ ICD device life network access to Biotronik standard home monitoring data management service.

Bedside Device - 203 x 136mm x 80mm, 450 grams

1568

BT187

CardioMessenger Smart 3G

Bedside/Remote transmitter w/ pacemaker/ICD device life network access to Biotronik standard home monitoring data management service.

Length - 130mm, Width - 65mm,  Height - 13mm        Weight - 75g

1568

MI180

MyCareLink Patient Monitor

Electronic cellular patient monitor which gathers and transmits cardiac information from an implanted cardiac device (CIED) to your health care professional for assessment.

One size

1568

MI196

MyCareLink Smart Patient Reader

Electronic cellular patient reader which gathers and transmits cardiac information from an implanted cardiac device (CIED) to your health care professional for assessment.

One size only

1568

SA173

Smartview Remote Monitoring Solution

The Smartview PSTN monitor and Smartview Monitor GPRS - Pacemaker programmer is designed to allow physicians and nurses following patients with a Sorin PARADYMTM RF or INTENSIA family of ICD and CRT-D devices to access valuable cardiac data and alert messages from the device while the patient is at home.

Single Device Product

1568

SJ369

Merlin@Home wireless

Home cardiac monitor (RF) with landline, cellular and broadband connectivity

one size

1568

SJ370

Merlin@Home Inductive

Home cardiac monitor (inductive) with landline, cellular and broadband connectivity

one size

1568