Endocrine Insider
January 7, 2010

(See Full Issue)

 In late December, the Centers for Medicare and Medicaid Services (CMS) issued a national non-coverage decision memo on outpatient intravenous insulin therapy (OIVIT). OIVIT consists of an outpatient regimen of pulsatile or continuous intravenous infusion of insulin, guided by the results of any of the following: measurement of respiratory quotient; measurement of urine urea nitrogen; measurement of arterial, venous or capillary glucose; and/or measurement of potassium concentration.

CMS contacted The Endocrine Society in November asking for its comments on the proposed non-coverage determination.  In its written response, the Society supported CMS’ proposal but requested that the agency alter language to clarify that non-coverage is based on a lack of conclusive evidence of therapeutic benefits of OIVIT. As a result of the Society’s comments, CMS’ final non-coverage determination stated that OIVIT (also known by many other terms, including Cellular Activation Therapy (CAT), Chronic Intermittent Intravenous Insulin Therapy (CIIIT), Hepatic Activation Therapy (HAT)) has not been clearly shown to improve health outcomes in Medicare beneficiaries and therefore is not reasonable or necessary for any indication.