Does E0783 require prior authorization?

Yes, E0783 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

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`E0783`, Infusion pump system, implantable, programmable (includes all components, e.g.,

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Documentation Required

When billing J7999-KD, enter the name and total dose (mg or mcg) of each drug in Box 19 of the CMS-1500 or the appropriate electronic comment loop; if Box 19 cannot accommodate all information, attach the details to the paper claim.
If a portion of a single-dose vial is not used, submit the HCPCS code for the drug on a separate claim line and append modifier JW to indicate discarded/unused portion.
Separate payment may be made for pump refilling and/or adjustments; submit these services using the appropriate drug refill or maintenance CPT/HCPCS code that accurately describes the service rendered.

Use the listed CPT/HCPCS codes when billing for opioid drugs or procedures related to implantable pumps for chronic intractable pain: J7999-KD, E0782, E0783, E0785, E0786, J2274 (example), J2278-KD, 62327, 62350, 62351, 62355, 62361, 62362, 62365, 62367, 62368, 62369, 62370, 95990, 95991.

Key Coverage Criteria

Compounded medications for use in implantable infusion pumps may be covered by Medicare when their use meets all other criteria for services provided incident to a physician's service.
True off-the-shelf (non‑compounded) drugs used without compounding and administered via DME may be billed using the drug-specific HCPCS code and are reimbursed under CMS ASP methodology.
If Prialt® is implanted as a single agent in the pump, bill using HCPCS code J2278-KD.
Compounded single-agent or combination drug formulations used in implanted infusion pumps must be billed using HCPCS code J7999-KD for reimbursement.
Postoperative analgesia after open abdominal surgery (including colorectal and aortic surgery) using continuous wound instillation/infusion
CPT range 43842 - 43848 — Gastric restrictive procedure (listed as 'Other CPT codes related to the CPB')

9 Active Policies

EVICORE-HPLAN-CIGNA-AFCE721BA4F3, Cigna Comprehensive Code List - Effective 03/07/2026

EVICORE-HPLAN-CIGNA-844835841DE9, Cigna Commercial Interventional Pain Management Code List - Effective 03/07/2026

EVICORE-HPLAN-CIGNA_MEDICARE-268F28B96146, Cigna Medicare Advantage Durable Medical Equipment Code List - Effective 01/01/2025

EVICORE-HPLAN-CIGNA_MEDICARE-47F76AA38AE6, Cigna Medicare Advantage Interventional Pain Management Code List - Effective 01/01/2025

A56695, Billing and Coding: Implantable Infusion Pump

AETNA-CPB-0607, Anesthetic and Antiemetic Infusion Pumps

AETNA-CPB-0184, Pulmonary Hypertension Treatments and Selected Indications of Prostanoids

AMBETTER-CP.MP.107, Durable Medical Equipment and Orthotics and Prosthetics Guidelines

AMBETTER-CP.MP.173, Implantable Intrathecal or Epidural Pain Pump

`E0783`, Infusion pump system, implantable, programmable (includes all components, e.g.,

Prior Authorization

Documentation Required

Key Coverage Criteria

9 Active Policies

Related Codes

Have a follow-up question?

E0783, Infusion pump system, implantable, programmable (includes all components, e.g.,

Prior Authorization

Documentation Required

Key Coverage Criteria

9 Active Policies

Related Codes

Have a follow-up question?

`E0783`, Infusion pump system, implantable, programmable (includes all components, e.g.,