E0786 — Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter)
E0786 is a HCPCS Level II code for implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter). It belongs to the Durable Medical Equipment section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Special coverage instructions apply
There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Medically Unlikely Edits — units per day
The most units of E0786 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 1 unit MAI 2 — Date of Service Edit: Policy · Code Descriptor / CPT Instruction
- outpatient
- 1 unit MAI 2 — Date of Service Edit: Policy · Code Descriptor / CPT Instruction
- DME supplier
- 1 unit MAI 3 — Date of Service Edit: Clinical · CMS Policy
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for E0786
- Long descriptor
- Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter)
- Short descriptor
- Implantable pump replacement
- Added
- January 1, 2001
- BETOS
- D1E
- Pricing indicator
- 32 — DMEPOS
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Inexpensive and routinely purchased DME. Price subject to floors and ceilings.
Codes adjacent to E0786
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If E0786 is not quite right, the correct code is very often within a few positions of it.
- E0776Iv pole
- E0779Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater
- E0780Ambulatory infusion pump, mechanical, reusable, for infusion less than 8 hours
- E0781Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient
- E0782Infusion pump, implantable, non-programmable (includes all components, e.g., pump, catheter, connectors, etc.)
- E0783Infusion pump system, implantable, programmable (includes all components, e.g., pump, catheter, connectors, etc.)
- E0784External ambulatory infusion pump, insulin
- E0785Implantable intraspinal (epidural/intrathecal) catheter used with implantable infusion pump, replacement
- E0787External ambulatory infusion pump, insulin, dosage rate adjustment using therapeutic continuous glucose sensing
- E0791Parenteral infusion pump, stationary, single or multi-channel
- E0830Ambulatory traction device, all types, each
- E0840Traction frame, attached to headboard, cervical traction
- E0849Traction equipment, cervical, free-standing stand/frame, pneumatic, applying traction force to other than mandible
- E0850Traction stand, free standing, cervical traction
- E0855Cervical traction equipment not requiring additional stand or frame
- E0856Cervical traction device, with inflatable air bladder(s)
Questions about E0786
What is HCPCS code E0786?
E0786 is a HCPCS Level II code for implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter). It sits in the Durable Medical Equipment section.
Does Medicare cover E0786?
The CMS HCPCS file marks E0786 as "Special coverage instructions apply". There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.