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
- Face-to-face & WOPD
- Not on the required list
- MUE unit limit
- 1
- Status
- Active (HCPCS Level II October 2026)
Prior authorization
Not on the Medicare required-PA list (CMS Required Prior Authorization List — 74 items in force on 2026-10-26; 8 more from 2026-10-28; sources: CMS list updated 2026-01-13, CMS-6109-N (91 FR 47972)). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.
Order readiness — what the written order must contain
Every Medicare DMEPOS claim needs a Standard Written Order with all six elements (42 CFR 410.38(d)):
- Beneficiary name or Medicare Beneficiary Identifier (MBI) (42 CFR 410.38(d)(1)(i)(A))
- General description of the item (42 CFR 410.38(d)(1)(i)(B))
- Quantity to be dispensed, if applicable (42 CFR 410.38(d)(1)(i)(C))
- Order date (42 CFR 410.38(d)(1)(i)(D))
- Treating practitioner name or NPI (42 CFR 410.38(d)(1)(i)(E))
- Treating practitioner signature (42 CFR 410.38(d)(1)(i)(F))
Not on the F2F/WOPD list (CMS Required F2F & WOPD List — 83 items in force on 2026-10-26; 22 more from 2026-10-28; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). The standard written order must reach the supplier before claim submission.
Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.
E0786 Medicare fee schedule (October 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 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps E0786 at 1 unit per date of service (clinical). Units above the MUE deny — typically as CO-151. Rationale: CMS Policy.
Common denial codes to watch
Related E-codes
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