A. Injections Intravenous, intramuscular, or subcutaneous injections and infusions, and hypodermoclysis or intravenous feedings require the skills of a licensed nurse to be performed (or taught) safely and effectively. Where these services are reasonable and necessary to treat the illness or injury, they may be covered. For these services to be reasonable and necessary, the medication being administered must be accepted as safe and effective treatment of the patient’s/client’s illness or injury, and there must be a medical reason that the medication cannot be taken orally. Moreover, the frequency and duration of the administration of the medication must be within accepted standards of medical practice, or there must be a valid explanation regarding the extenuating circumstances to justify the need for the additional injections.” – Medicare Benefit Policy Manual 40.1.2.4 i. Vitamin B-12 Injections are covered for specified anemias, specified gastrointestinal disorders, and specified neuropathies, for example: 1. Pernicious anemia 2. Macrocytic anemia 3. Megaloblastic anemia 4. Fish tapeworm anemia 5. Gastrectomy 6. Malabsorption syndromes 7. Surgical and mechanical disorders 8. Posterolateral sclerosis The above diagnosis must be documented on POC or verbal order. B-12 deficiency is not sufficient to support the need for B12 injections. It is treated with diet. The frequency of administration must be appropriate; maintenance is usually monthly. ii. Insulin Injections 1. Patient/client physically, mentally, or medically unable to self-inject. 2. No willing or able caregiver. 3. Documentation supports need for insulin. 4. No “end point” to care required, however if other skilled nursing services are being performed daily, an “end-point” must be documented for these services. Prefilling insulin syringes is not considered a skilled nursing service.
