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HCPCS E0786 · Level II · DME code

E0786: Implantable programmable infusion pump, HCPCS Level II DME code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); DMEPOS fee schedule: DME26-D (October 2026) (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and DMEPOS fee schedule and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for E0786

Medicare payment
$10,969.75 to $11,380.88
DMEPOS non-rural state fees (NU-KF)
Coverage code
D
special coverage instructions apply
DME supplier MUE
1
MAI 3
OPPS status
SI N
Items and Services packaged into APC rates
NCCI PTP pairs
0
practitioner file
LCDs and articles
1 / 1

TL;DR

E0786 is a Level II code from the E section (durable medical equipment), in use since 2001: "Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter)". The October 2026 DMEPOS fee schedule (category IN, inexpensive and other routinely purchased items) sets E0786 at NU-KF (purchased, new) $10,969.75 in MN to $11,380.88 in AL, AZ, CT and 22 more (floor $9,673.75, ceiling $11,380.88); RR-KF (rental) $1,097.01 in MN to $1,138.08 in AL, AZ, CT and 22 more (floor $967.37, ceiling $1,138.08); UE-KF (purchased, used) $8,227.29 in MN to $8,535.67 in AL, AZ, CT and 22 more (floor $7,255.32, ceiling $8,535.67). CMS caps E0786 at practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction); DME supplier 1 (MAI 3, CMS Policy) units per day in the 2026 Q4 MUE tables. 1 active LCD and 1 billing and coding article list E0786 across 7 states: L33461 (Implantable Infusion Pump), A56695. OPPS status indicator N: Items and Services packaged into APC rates. HCPCS record: BETOS D1E (other DME); pricing indicator 32; type of service 9 (other medical items or services). Nearby codes: E0784, E0781, E0776, E0760.

E0786 descriptor and code status

The October 2026 HCPCS Level II file describes E0786 as “Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter)”. It sits in the E section (durable medical equipment), listed with the other E codes.

HCPCS file attributes of E0786
FieldValue
Short descriptorImplantable pump replacement
Added to HCPCS2001-01-01
Last actionN (no maintenance), effective 2001-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator32: DMEPOS inexpensive and routinely purchased DME (floors and ceilings)
BETOS categoryD1E: other DME
Type of service9: other medical items or services

Medicare payment for E0786

The October 2026 DMEPOS fee schedule (category IN, inexpensive and other routinely purchased items) sets E0786 at NU-KF (purchased, new) $10,969.75 in MN to $11,380.88 in AL, AZ, CT and 22 more (floor $9,673.75, ceiling $11,380.88); RR-KF (rental) $1,097.01 in MN to $1,138.08 in AL, AZ, CT and 22 more (floor $967.37, ceiling $1,138.08); UE-KF (purchased, used) $8,227.29 in MN to $8,535.67 in AL, AZ, CT and 22 more (floor $7,255.32, ceiling $8,535.67). The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

DMEPOS fee schedule (DME26-D)

Jurisdiction L (local Part B MAC), payment category IN (inexpensive and other routinely purchased items). Fees are set per state; AK, HI, PR and VI are not subject to the national ceiling and floor and are listed separately. A rural fee applies only in ZIP codes on the CMS rural ZIP list.

DMEPOS fees for E0786 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
NU (purchased, new), KF (FDA class III device)$9,673.75 / $11,380.88$10,969.75 (MN) to $11,380.88 (AL, AZ, CT…)——
RR (rental), KF (FDA class III device)$967.37 / $1,138.08$1,097.01 (MN) to $1,138.08 (AL, AZ, CT…)——
UE (purchased, used), KF (FDA class III device)$7,255.32 / $8,535.67$8,227.29 (MN) to $8,535.67 (AL, AZ, CT…)——

Hospital outpatient (OPPS Addendum B)

Status indicator N (Items and Services packaged into APC rates), with no separate OPPS payment rate.

Medically Unlikely Edits for E0786

CMS caps E0786 at practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction); DME supplier 1 (MAI 3, CMS Policy) units per day in the 2026 Q4 MUE tables. The DME supplier MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for E0786 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction
Facility outpatient hospital12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction
DME supplier13 Date of Service Edit: ClinicalCMS Policy

The MUE lookup for E0786 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists E0786 in v323r0.

E0786 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check E0786 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for E0786

1 active Local Coverage Determination and 1 billing and coding article list E0786. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Billing and Coding Articles listing E0786
ArticleTitleContractor(s)Related LCD
A56695Billing and Coding: Implantable Infusion PumpPalmetto GBAL33461

Denials to expect on E0786

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists E0786

CARC 151 · N362

units of E0786 exceed the DME supplier MUE of 1 per date of service

CARC 4

the NU, KF, RR payment modifier is missing or does not match the item

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

For teams evaluating QuickIntell software

Where QuickIntell fits for E0786 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for E0786 depend on, with human review of each case, and QuickRCM carries claim readiness and the CARC 50, 151 and modifier denials these items draw.

See QuickAuth for requirement checksSee QuickRCM for denial follow-up
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Optional software evaluation, not payer support or help with an individual claim. For coverage or payment decisions, use the official sources on this page. Do not include patient information in a demo booking or inquiry.

Frequently asked questions: HCPCS E0786

What does HCPCS code E0786 describe?

"Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter)" (short descriptor "Implantable pump replacement"), in the E section (durable medical equipment). Added 2001-01-01.

Is E0786 a CPT code?

It is not. E0786 belongs to the E section (durable medical equipment) of HCPCS Level II, the CMS code set, not to AMA CPT.

What does Medicare pay for E0786?

The October 2026 DMEPOS fee schedule (category IN, inexpensive and other routinely purchased items) sets E0786 at NU-KF (purchased, new) $10,969.75 in MN to $11,380.88 in AL, AZ, CT and 22 more (floor $9,673.75, ceiling $11,380.88); RR-KF (rental) $1,097.01 in MN to $1,138.08 in AL, AZ, CT and 22 more (floor $967.37, ceiling $1,138.08); UE-KF (purchased, used) $8,227.29 in MN to $8,535.67 in AL, AZ, CT and 22 more (floor $7,255.32, ceiling $8,535.67).

How many units of E0786 can be billed per day?

CMS caps E0786 at practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction); DME supplier 1 (MAI 3, CMS Policy) units per day in the 2026 Q4 MUE tables. For the DME supplier MUE (MAI 3), units above 1 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover E0786?

Coverage code D (special coverage instructions apply). 1 active LCD and 1 billing and coding article list E0786 across 7 states: L33461 (Implantable Infusion Pump), A56695.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.