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HCPCS E0788 · Level II · DME code

E0788: Ambulatory infusion pump, specific device-drug combination, single or multiple channels, 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 E0788

Medicare payment
$309.33
DMEPOS non-rural state fees (RR)
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
MUE
none published
no MUE in the 2026 Q4 tables
OPPS status
SI Y
Non-implantable DME
NCCI PTP pairs
0
practitioner file
LCDs and articles
1 / 0

TL;DR

CMS describes HCPCS E0788, added in 2026, as "Ambulatory infusion pump, specific device-drug combination, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient". E0788 is paid from the DMEPOS fee schedule as capped rental items (CR): RR (rental) $309.33 in every contiguous state, rural $315.09 to $343.40 (floor $262.93, ceiling $309.33), October 2026. 1 active LCD lists E0788: L33794 (External Infusion Pumps). OPPS status indicator Y: Non-implantable DME. HCPCS record: BETOS D1E (other DME); pricing indicator 36; type of service R (rental of DME). 3 other active codes open with "Ambulatory infusion pump"; related codes: E0781, E0780, E0779, E0784.

E0788 descriptor and code status

The October 2026 HCPCS Level II file describes E0788 as “Ambulatory infusion pump, specific device-drug combination, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient”. It sits in the E section (durable medical equipment), listed with the other E codes.

HCPCS file attributes of E0788
FieldValue
Short descriptorDev-drug combo infusion pump
Added to HCPCS2026-10-01
Last actionA (code added), effective 2026-10-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator36: DMEPOS capped rental DME (floors and ceilings)
BETOS categoryD1E: other DME
Type of serviceR: rental of DME

Medicare payment for E0788

E0788 is paid from the DMEPOS fee schedule as capped rental items (CR): RR (rental) $309.33 in every contiguous state, rural $315.09 to $343.40 (floor $262.93, ceiling $309.33), October 2026. 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 D (DME MAC), payment category CR (capped rental 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 E0788 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
RR (rental)$262.93 / $309.33$309.33 (49 states)$315.09 (DE, MA, ME…) to $343.40 (AR, CA, CO…)AK $380.71, HI $396.36, PR $376.01, VI $343.40

Hospital outpatient (OPPS Addendum B)

Status indicator Y (Non-implantable DME), with no separate OPPS payment rate.

Medically Unlikely Edits for E0788

CMS publishes no MUE for E0788 in the 2026 Q4 practitioner, facility or DME supplier tables. Some MUE values are confidential and applied without publication, so unit limits can still deny; document the quantity furnished on every claim.

The MUE lookup for E0788 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists E0788 in v323r0.

E0788 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 E0788 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for E0788

1 active Local Coverage Determination and 0 billing and coding articles list E0788. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Denials to expect on E0788

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists E0788

CARC 151 · N362

units exceed what the payer considers medically likely for one date of service

CARC 4

the 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

Where QuickIntell fits for E0788 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for E0788 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-upBook a meeting

Frequently asked questions: HCPCS E0788

What does HCPCS code E0788 describe?

"Ambulatory infusion pump, specific device-drug combination, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient" (short descriptor "Dev-drug combo infusion pump"), in the E section (durable medical equipment). Added 2026-10-01.

Is E0788 a CPT code?

No: CMS maintains E0788 in HCPCS Level II, while the AMA maintains CPT. It goes in the same procedure-code field.

What does Medicare pay for E0788?

E0788 is paid from the DMEPOS fee schedule as capped rental items (CR): RR (rental) $309.33 in every contiguous state, rural $315.09 to $343.40 (floor $262.93, ceiling $309.33), October 2026.

Does Medicare cover E0788?

Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 1 active LCD lists E0788: L33794 (External Infusion Pumps).

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.