E0786 — Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter)
HCPCS Level II E-code · short descriptor: “Implantable pump replacement”
- Code system
- HCPCS Level II
- Family
- E — Durable medical equipment
- Medicare coverage status
- Special coverage instructions apply
- DMEPOS payment category
- Inexpensive or routinely purchased
- Prior authorization
- Not on Medicare required-PA list
- Status
- Active (April 2026 HCPCS)
Prior authorization
Not on the Medicare required-PA list as of the January 13, 2026 update (74 items). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.
E0786 Medicare fee schedule (April 2026)
NU + KF — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $10969.75 to $11380.88 depending on state and rural status.
Former-CBA payment limits: ceiling $11380.88 · floor $9673.75
| State | Non-rural | Rural |
|---|---|---|
| AL | $11380.88 | — |
| AR | $10970.16 | — |
| AZ | $11380.88 | — |
| CA | $10970.16 | — |
| CO | $11299.27 | — |
| CT | $11380.88 | — |
| DC | $10970.16 | — |
| DE | $10970.16 | — |
| FL | $11380.88 | — |
| GA | $11380.88 | — |
| IA | $11380.88 | — |
| ID | $11380.88 | — |
| IL | $11380.88 | — |
| IN | $11380.88 | — |
| KS | $11380.88 | — |
| KY | $11380.88 | — |
| LA | $10970.16 | — |
| MA | $10970.16 | — |
| MD | $10970.16 | — |
| ME | $10970.16 | — |
| MI | $11380.88 | — |
| MN | $10969.75 | — |
| MO | $11086.31 | — |
| MS | $11380.88 | — |
| MT | $11011.27 | — |
| NC | $11380.88 | — |
| ND | $11380.88 | — |
| NE | $11380.88 | — |
| NH | $10970.16 | — |
| NJ | $10970.16 | — |
| NM | $10970.16 | — |
| NV | $11380.88 | — |
| NY | $10970.16 | — |
| OH | $11380.88 | — |
| OK | $10970.16 | — |
| OR | $10970.16 | — |
| PA | $10970.16 | — |
| RI | $10970.16 | — |
| SC | $11380.88 | — |
| SD | $11380.88 | — |
| TN | $11380.88 | — |
| TX | $10970.16 | — |
| UT | $10970.16 | — |
| VA | $10970.16 | — |
| VT | $10970.16 | — |
| WA | $11380.88 | — |
| WI | $11380.88 | — |
| WV | $11380.88 | — |
| WY | $11380.88 | — |
RR + KF — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $1097.01 to $1138.08 depending on state and rural status.
Former-CBA payment limits: ceiling $1138.08 · floor $967.37
| State | Non-rural | Rural |
|---|---|---|
| AL | $1138.08 | — |
| AR | $1097.03 | — |
| AZ | $1138.08 | — |
| CA | $1097.03 | — |
| CO | $1129.92 | — |
| CT | $1138.08 | — |
| DC | $1097.03 | — |
| DE | $1097.03 | — |
| FL | $1138.08 | — |
| GA | $1138.08 | — |
| IA | $1138.08 | — |
| ID | $1138.08 | — |
| IL | $1138.08 | — |
| IN | $1138.08 | — |
| KS | $1138.08 | — |
| KY | $1138.08 | — |
| LA | $1097.03 | — |
| MA | $1097.03 | — |
| MD | $1097.03 | — |
| ME | $1097.03 | — |
| MI | $1138.08 | — |
| MN | $1097.01 | — |
| MO | $1108.63 | — |
| MS | $1138.08 | — |
| MT | $1101.12 | — |
| NC | $1138.08 | — |
| ND | $1138.08 | — |
| NE | $1138.08 | — |
| NH | $1097.03 | — |
| NJ | $1097.03 | — |
| NM | $1097.03 | — |
| NV | $1138.08 | — |
| NY | $1097.03 | — |
| OH | $1138.08 | — |
| OK | $1097.03 | — |
| OR | $1097.03 | — |
| PA | $1097.03 | — |
| RI | $1097.03 | — |
| SC | $1138.08 | — |
| SD | $1138.08 | — |
| TN | $1138.08 | — |
| TX | $1097.03 | — |
| UT | $1097.03 | — |
| VA | $1097.03 | — |
| VT | $1097.03 | — |
| WA | $1138.08 | — |
| WI | $1138.08 | — |
| WV | $1138.08 | — |
| WY | $1138.08 | — |
UE + KF — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $8227.29 to $8535.67 depending on state and rural status.
Former-CBA payment limits: ceiling $8535.67 · floor $7255.32
| State | Non-rural | Rural |
|---|---|---|
| AL | $8535.67 | — |
| AR | $8227.64 | — |
| AZ | $8535.67 | — |
| CA | $8227.64 | — |
| CO | $8474.47 | — |
| CT | $8535.67 | — |
| DC | $8227.64 | — |
| DE | $8227.64 | — |
| FL | $8535.67 | — |
| GA | $8535.67 | — |
| IA | $8535.67 | — |
| ID | $8535.67 | — |
| IL | $8535.67 | — |
| IN | $8535.67 | — |
| KS | $8535.67 | — |
| KY | $8535.67 | — |
| LA | $8227.64 | — |
| MA | $8227.64 | — |
| MD | $8227.64 | — |
| ME | $8227.64 | — |
| MI | $8535.67 | — |
| MN | $8227.29 | — |
| MO | $8314.76 | — |
| MS | $8535.67 | — |
| MT | $8258.44 | — |
| NC | $8535.67 | — |
| ND | $8535.67 | — |
| NE | $8535.67 | — |
| NH | $8227.64 | — |
| NJ | $8227.64 | — |
| NM | $8227.64 | — |
| NV | $8535.67 | — |
| NY | $8227.64 | — |
| OH | $8535.67 | — |
| OK | $8227.64 | — |
| OR | $8227.64 | — |
| PA | $8227.64 | — |
| RI | $8227.64 | — |
| SC | $8535.67 | — |
| SD | $8535.67 | — |
| TN | $8535.67 | — |
| TX | $8227.64 | — |
| UT | $8227.64 | — |
| VA | $8227.64 | — |
| VT | $8227.64 | — |
| WA | $8535.67 | — |
| WI | $8535.67 | — |
| WV | $8535.67 | — |
| WY | $8535.67 | — |
Common denial codes to watch
Related E-codes
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