External Infusion Pumps
HCPCS Code Definition
E0779 Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater
E0780 Ambulatory infusion pump, mechanical, reusable, for infusion less than 8 hours
Note: Code E0779 will require prior authorization if the billed amount exceeds $100.
Prior authorization is required for the implanted infusion pump or reservoir, billed with the following HCPCS codes. The hospital must have an exclusion to its Medi-Cal contract to permit separate billing using the outpatient claim format for the programmable, implanted pump.
E0781 Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient
E0783 Infusion pump system, implantable, programmable (includes components, for example, pump catheter, connectors, etc.)
The intraspinal replacement catheter used with the implantable pumps is billed with code E0785 (implantable intraspinal [epidural/intrathecal] catheter used with implantable infusion pump, replacement).
Daily inpatient hospital management of epidural or subarachnoid continuous drug administration should be billed with CPT-4 code 01996. Outpatient refilling and maintenance of the programmable, implanted pump is billed with CPT-4 codes 95990 and 95991. Electronic analysis of the programmable implanted pump for intrathecal or epidural drug infusion without reprogramming is billed with CPT-4 code 62367. If the pump is also reprogrammed, providers should use CPT-4 code 62368.
Outpatient refilling and maintenance of the external infusion pump is billed with CPT-4 code 96521 (refilling and maintenance of portable pump). Refilling and maintenance of older nonprogrammable implanted pumps may be billed with CPT-4 code 96522 (refilling and maintenance of implantable pump or reservoir).
Authorization is not required for these codes. The refilling and maintenance will occur monthly to quarterly, depending on individual patient needs.