E0786 HCPCS code: Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter)

E0786 is the HCPCS Level II code for implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter). The 2026 Medicare DMEPOS fee schedule pays $10,969.75 to $11,380.88 (NU, new equipment, purchased) depending on the state. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 1 per day on DME suppliers. Its average fee ranks 11 of 12 E07 codes billed NU (family range $14.83–$11,318.55).

Code details

2026 Medicare DMEPOS fee schedule for E0786

How the E0786 fee compares

NCCI unit limits (MUE)

Medicare policy articles for this code

• A56695: Billing and Coding: Implantable Infusion Pump (Palmetto GBA (MAC - Part B))

Covered diagnoses (2,017 ICD-10-CM codes)

The diagnoses most often listed as covered in the policy articles above:

Showing 10 of 2,017. The full list, non-covered diagnoses and CSV export are in Caduvo.

What changed for E0786

• 2026-01-01: Average state fee (NU) rose 2.0%: $10,970.23 to $11,189.63
• 2026-01-01: Average state fee (RR) rose 2.0%: $1,097.02 to $1,118.96
• 2026-01-01: Average state fee (UE) rose 2.0%: $8,227.68 to $8,392.23
• 2001-01-01: E0786 added to HCPCS Level II
• Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01

Frequently asked questions

What is HCPCS code E0786?

E0786 is the HCPCS Level II code for implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter). Short descriptor: "Implantable pump replacement".

How much does Medicare pay for E0786?

Under the 2026 DMEPOS fee schedule, non-rural state fees are NU (new equipment, purchased): $10,969.75–$11,380.88; RR (rental (monthly)): $1,097.01–$1,138.08; UE (used equipment, purchased): $8,227.29–$8,535.67. Rural fees can be higher.

Does Medicare cover E0786?

Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.

Which diagnoses support coverage for E0786?

Medicare policy articles that cite E0786 list 2,017 covered ICD-10-CM diagnosis codes across 1 article. The most cited include A18.01 (Tuberculosis of spine), B02.23 (Postherpetic polyneuropathy), C00.0 (Malignant neoplasm of external upper lip). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.

Did the Medicare fee for E0786 change in 2026?

The average non-rural state fee for NU moved from $10,970.23 in 2025 to $11,189.63 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.

How many units of E0786 can be billed per day?

1 on DME suppliers; 1 on outpatient hospital claims; 1 on practitioner claims (NCCI medically unlikely edits).

Related E07 codes

• E0700 — Safety equipment, device or accessory, any type
• E0705 — Transfer device, any type, each ($5.34–$134.77)
• E0710 — Restraints, any type (body, chest, wrist or ankle)
• E0711 — Upper extremity medical tubing/lines enclosure or covering device, restricts elbow range of motion
• E0715 — Intravaginal device intended to strengthen pelvic floor muscles during kegel exercises
• E0716 — Supplies and accessories for intravaginal device intended to strengthen pelvic floor muscles during kegel exercises
• E0720 — Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized stimulation ($66.89–$393.27)
• E0721 — Transcutaneous electrical nerve stimulator for nerves in the auricular region
• E0730 — Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for multiple nerve stimulation ($68.53–$425.83)
• E0731 — Form fitting conductive garment for delivery of tens or nmes (with conductive fibers separated from the patient's skin by layers of fabric) ($87.58–$480.99)
• E0732 — Cranial electrotherapy stimulation (ces) system, any type ($31.06–$69.51)
• E0733 — Transcutaneous electrical nerve stimulator for electrical stimulation of the trigeminal nerve ($31.06–$69.51)

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Next steps

• Run a reimbursement report for a device billed under E0786
• Watch E0786 for fee, coverage and descriptor changes
• Build a full Medicare revenue model for E0786

Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule 2026; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.

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