MyMedi-AI

K0552 — Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each

HCPCS Level II K-code · short descriptor: “Sup/ext non-ins inf pump syr”

Code system
HCPCS Level II
Family
K — DME MAC temporary codes
Medicare coverage status
Special coverage instructions apply
DMEPOS payment category
Supplies
Prior authorization
Not on Medicare required-PA list
Face-to-face & WOPD
Not on the required 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.

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 (April 13, 2026 update — 83 items). The standard written order must reach the supplier before claim submission.

Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.

K0552 Medicare fee schedule (April 2026)

Base (no modifier) Supplies

Medicare allowable ranges from $3.47 to $3.96 depending on state and rural status.

StateNon-ruralRural
AK$3.60—
AL$3.47$3.62
AR$3.47$3.62
AZ$3.47$3.60
CA$3.47$3.60
CO$3.47$3.62
CT$3.47$3.62
DC$3.47$3.60
DE$3.47$3.62
FL$3.47$3.60
GA$3.47$3.62
HI$3.60—
IA$3.47$3.60
ID$3.47$3.60
IL$3.47$3.60
IN$3.47$3.62
KS$3.47$3.60
KY$3.47$3.62
LA$3.47$3.62
MA$3.47$3.62
MD$3.47$3.60
ME$3.47$3.62
MI$3.47$3.62
MN$3.47$3.62
MO$3.47$3.62
MS$3.47$3.62
MT$3.47$3.60
NC$3.47$3.60
ND$3.47$3.60
NE$3.47$3.60
NH$3.47$3.62
NJ$3.47$3.62
NM$3.47$3.62
NV$3.47$3.60
NY$3.47$3.62
OH$3.47$3.60
OK$3.47$3.62
OR$3.47$3.60
PA$3.47$3.62
PR$3.96—
RI$3.47$3.62
SC$3.47$3.62
SD$3.47$3.60
TN$3.47$3.62
TX$3.47$3.60
UT$3.47$3.62
VA$3.47$3.60
VI$3.62—
VT$3.47$3.62
WA$3.47$3.60
WI$3.47$3.62
WV$3.47$3.60
WY$3.47$3.60
Amounts are the Medicare DMEPOS fee-schedule allowables effective April 2026. Medicare typically pays 80% of the allowable after the Part B deductible; the patient owes 20%. A 2% sequestration reduction applies to the Medicare share. Former competitive-bidding-area adjustments and non-continental rates can differ — verify with your DME MAC.

Common denial codes to watch

CO-50 medical necessity

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