{"id":180106,"date":"2026-08-14T10:36:11","date_gmt":"2026-08-14T10:36:11","guid":{"rendered":"https:\/\/pabau.com\/?p=180106"},"modified":"2026-08-14T10:53:26","modified_gmt":"2026-08-14T10:53:26","slug":"hcpcs-code-k0455","status":"publish","type":"post","link":"https:\/\/pabau.com\/nl\/procedure-codes\/hcpcs-code-k0455\/","title":{"rendered":"HCPCS code K0455: Infusion pump for parenteral medication"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"HCPCS code K0455: Infusion pump for parenteral medication\",\"description\":\"HCPCS code K0455 billing guide: coverage under LCD L33794, fee schedule basis, covered ICD-10-CM codes, modifiers, and documentation requirements.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-k0455\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-08-08\",\"dateModified\":\"2026-08-14\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>HCPCS code K0455 covers infusion pumps that deliver medication without interruption, most often epoprostenol or treprostinil for pulmonary arterial hypertension.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Suppliers bill K0455 under Medicare Part B as durable medical equipment, through the DME MAC that covers the patient&#8217;s region.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Coverage sits under LCD L33794, which requires a signed physician order and records showing why the parenteral route is necessary.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>A missing KX modifier is the most common reason a K0455 claim denies on first submission.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Practice management software like Pabau tracks prior authorization status, stores documentation, and flags missing modifiers before a claim goes out.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">HCPCS code K0455 is the billable code for an infusion pump used for uninterrupted parenteral administration of medication, such as epoprostenol or treprostinil. Suppliers bill it to Medicare Part B as durable medical equipment. Most claims cover pulmonary arterial hypertension patients on continuous prostacyclin therapy.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">K codes are temporary HCPCS Level II codes maintained by <a href=\"https:\/\/www.cms.gov\/medicare\/coding-billing\/healthcare-common-procedure-system\" target=\"_blank\" rel=\"nofollow noopener\">CMS<\/a> specifically for DME items not yet covered by a permanent code. K0455 sits in the K0455-K0605 range, which covers infusion pump hardware and the supply items DME suppliers bill alongside it.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Field<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Detail<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">HCPCS code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">K0455<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Full descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Infusion pump used for uninterrupted parenteral administration of medication (e.g., epoprostenol or treprostinil)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code type<\/td>\n<td style=\"padding:12px 16px;color:#374151\">HCPCS Level II K code, temporary DME code<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">DME category<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Infusion pumps and supplies (K0455-K0605)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Medicare benefit<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Part B, durable medical equipment<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Administering contractor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">DME Medicare Administrative Contractor (DME MAC)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Governing LCD<\/td>\n<td style=\"padding:12px 16px;color:#374151\">L33794, external infusion pumps<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code status<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Active<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h2 id=\"h-clinical-indications-when-k0455-applies\" class=\"wp-block-heading\">Clinical indications: When K0455 applies<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">K0455 covers a narrow class of pumps: those built for continuous, uninterrupted parenteral delivery. In practice that means stopping the pump would carry clinically significant consequences. Pulmonary arterial hypertension (PAH) is the primary covered indication, though LCD L33794 recognizes several others.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Sorting K0455 from the other infusion codes is the first decision on any claim. Practices that bill infusion services often build that decision into their <a href=\"https:\/\/pabau.com\/blog\/best-emr-for-iv-therapy\/\">IV therapy EMR<\/a>, so the code is set at the point of care.<\/p>\n\n\n\n<h3 id=\"h-covered-indications-under-lcd-l33794\" class=\"wp-block-heading\">Covered indications under LCD L33794<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Pulmonary arterial hypertension (PAH)<\/strong> treated with continuous IV epoprostenol (Flolan) or subcutaneous or IV treprostinil (Remodulin). This is the primary and most common indication.<\/li>\n\n\n\n<li>Chemotherapy requiring continuous infusion where an ambulatory pump is medically necessary<\/li>\n\n\n\n<li>Intractable pain unresponsive to oral or other routes of analgesia<\/li>\n\n\n\n<li>Continuous morphine infusion for intractable cancer pain<\/li>\n\n\n\n<li>Other medically necessary conditions where the treating physician documents that the parenteral route is required and the medication cannot be interrupted<\/li>\n<\/ul>\n\n\n\n<h3 id=\"h-non-covered-indications\" class=\"wp-block-heading\">Non-covered indications<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Infusion pumps used for medications that can be safely interrupted or given by alternate routes<\/li>\n\n\n\n<li>Pumps provided primarily for patient convenience rather than clinical necessity<\/li>\n\n\n\n<li>Infusion of medications not approved under the applicable LCD covered drug list<\/li>\n\n\n\n<li>Pumps used in an inpatient setting where the facility is responsible for DME<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">The distinction between covered and non-covered indications must appear explicitly in the treating physician&#8217;s notes before billing. Vague language like &#8220;patient requires IV medication&#8221; is insufficient.<\/p>\n\n\n\n<h2 id=\"h-k0455-medicare-coverage-lcd-l33794-explained\" class=\"wp-block-heading\">K0455 Medicare coverage: LCD L33794 explained<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare Part B covers K0455 as DME under the External Infusion Pumps Local Coverage Determination, LCD L33794. These claims are administered by Noridian (Jurisdictions A and D) and CGS (Jurisdictions B and C). Coverage is conditional rather than automatic, so every claim has to demonstrate medical necessity against the LCD criteria.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practices running a <a href=\"https:\/\/pabau.com\/blog\/mobile-iv-therapy-business\/\">mobile IV therapy business<\/a> or a fixed infusion center should review LCD L33794 every year. CMS may revise covered indications, add non-covered diagnoses, or adjust documentation standards between fiscal years.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Coverage requirement<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">What Medicare requires<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Medical necessity<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Treating physician must document why the parenteral route is required and why alternatives are insufficient<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Diagnosis confirmation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">ICD-10-CM code must appear on the LCD&#8217;s covered diagnosis list and match clinical records<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Physician order<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Written order from the treating physician specifying the medication, route, and pump specifications<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Documentation on file<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Signed physician order plus medical records supporting necessity, kept in the supplier file. No CMN or Form 484 is required<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Supplier enrollment<\/td>\n<td style=\"padding:12px 16px;color:#374151\">DME supplier must be enrolled with the relevant DME MAC and meet DMEPOS supplier standards<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h2 id=\"h-k0455-fee-schedule-and-reimbursement-rates\" class=\"wp-block-heading\">K0455 fee schedule and reimbursement rates<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare reimbursement for K0455 follows the DME fee schedule, which CMS updates annually. Rates vary by jurisdiction and by the modifier applied. The modifier says whether the pump is rented, purchased new, or purchased used, and each carries a different allowed amount.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Verify current-year rates against the <a href=\"https:\/\/www.cms.gov\/medicare\/payment\/fee-schedules\/dmepos\" target=\"_blank\" rel=\"nofollow noopener\">DMEPOS fee schedule files<\/a> that CMS publishes. The table below shows the billing framework. Dollar amounts change each fiscal year and vary by geographic region.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Meaning<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Rate basis<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">RR<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Rental<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Monthly rental rate (most common for K0455 PAH pumps)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">NU<\/td>\n<td style=\"padding:12px 16px;color:#374151\">New purchase<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Full purchase price (lump sum or capped rental)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">UE<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Used\/refurbished purchase<\/td>\n<td style=\"padding:12px 16px;color:#374151\">75% of the purchase price allowed amount<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">KX<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Documentation on file confirming LCD criteria met<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Required for claim to process; without it, claim will deny<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Regional variation is standard across DME fee schedules. Suppliers billing in high-cost metropolitan areas may see higher allowed amounts than those billing in rural jurisdictions. Check the figure for your own jurisdiction before you quote a rate to a referring practice.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Run a fee schedule check every October when CMS releases the updated DME fee schedule. Compare your existing contracted rates against the new CMS allowed amounts. If rates have changed significantly, update your billing system before January 1 to avoid underbilling or unexpected claim adjustments.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-icd-10-codes-that-support-medical-necessity-for-k0455\" class=\"wp-block-heading\">ICD-10 codes that support medical necessity for K0455<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Every K0455 claim must carry an ICD-10-CM diagnosis code that appears on the LCD L33794 covered diagnosis list. A code that is off the list denies automatically, however well the medical necessity is documented. The table below covers the most common ones. Confirm the full current list against the live LCD or the <a href=\"https:\/\/www.aapc.com\/codes\/hcpcs-codes-range\/\" target=\"_blank\" rel=\"nofollow noopener\">AAPC HCPCS lookup<\/a>.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">ICD-10-CM code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Clinical context for K0455<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">I27.0<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Primary pulmonary hypertension<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Most common PAH indication for epoprostenol\/treprostinil pump<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">I27.21<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Secondary pulmonary arterial hypertension<\/td>\n<td style=\"padding:12px 16px;color:#374151\">PAH secondary to connective tissue or other conditions<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">I27.29<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Other secondary pulmonary hypertension<\/td>\n<td style=\"padding:12px 16px;color:#374151\">PAH not classifiable elsewhere; requires specific documentation<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">G89.29<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Other chronic pain<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Continuous pain management indication (non-cancer)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">G89.3<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Neoplasm-related pain (acute or chronic)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Intractable cancer pain requiring continuous morphine infusion<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Using a non-specific symptom code from the R00-R99 range to support K0455 is a common error that triggers denial. The ICD-10-CM code has to reflect a confirmed, documented diagnosis rather than a symptom or a rule-out condition. Capturing that diagnosis on your <a href=\"https:\/\/pabau.com\/templates\/iv-therapy-patient-intake\/\">IV therapy intake forms<\/a> and coding it at the point of care saves rework downstream.<\/p>\n\n\n\n<h2 id=\"h-k0455-documentation-requirements\" class=\"wp-block-heading\">K0455 documentation requirements<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Documentation deficiencies are the leading cause of post-payment recovery in DME MAC audits of infusion pump claims. Collect the paperwork before the pump is delivered, not once an audit opens. A signed order and a clear <a href=\"https:\/\/pabau.com\/templates\/medical-necessity-letter\/\">medical necessity letter<\/a> from the prescriber anchor the file.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Collecting that paperwork on <a href=\"https:\/\/pabau.com\/features\/patient-intake-software\/\">digital forms<\/a> removes the missing signatures and blank fields that cause denials. Every K0455 claim needs the following on file.<\/p>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Physician&#8217;s written order:<\/strong> Specifies the medication name, concentration, rate, route (IV or subcutaneous), and pump specifications. Must be dated before delivery.<\/li>\n\n\n\n<li><strong>Medical-record documentation of necessity:<\/strong> Chart notes addressing every LCD L33794 clinical criterion the KX modifier attests to. CMS retired the CMN and Form 484 for dates of service from January 1, 2023.<\/li>\n\n\n\n<li><strong>Clinical notes establishing diagnosis:<\/strong> Records from the treating cardiologist, pulmonologist, or oncologist confirming the covered ICD-10-CM diagnosis.<\/li>\n\n\n\n<li><strong>Documentation of alternative therapy failure:<\/strong> For PAH claims, records showing why oral or inhaled alternatives are insufficient or contraindicated. The notes should name the parenteral prostacyclin prescribed.<\/li>\n\n\n\n<li><strong>Pump delivery confirmation:<\/strong> Proof that the equipment was delivered to the patient (delivery receipt signed by patient or authorized representative).<\/li>\n\n\n\n<li><strong>Ongoing follow-up notes:<\/strong> For rental claims running past the initial period, documentation of continued medical necessity at each renewal.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Retain every record for at least seven years. DME MAC post-payment audits reach back several years, and an incomplete file leaves the supplier liable for full recoupment.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-k0455-infusion-pump-for-parenteral-medication\/digital-forms.webp\" alt=\"Pabau digital forms template library with a patient form preview\"\/><figcaption class=\"wp-element-caption\"><em>Pabau digital forms capture the order details and necessity statement as structured fields, so a K0455 file is complete before delivery.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 id=\"h-prior-authorization-for-k0455\" class=\"wp-block-heading\">Prior authorization for K0455<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Traditional Medicare has no national prior authorization requirement for K0455, but the answer changes by payer. Many commercial payers and Medicaid managed care plans do require authorization before an infusion pump is delivered. Even under traditional Medicare, the DME MAC may request pre-claim review for high-cost or high-volume suppliers.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Authorization rules are payer-specific, as anyone handling <a href=\"https:\/\/pabau.com\/blog\/iv-hydration-business-requirements-arizona\/\">IV hydration compliance<\/a> already knows. Check the payer policy for every new patient before you schedule delivery. Submitting a commercial claim without the authorization on file usually means a full denial with no appeal path.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Traditional Medicare (Fee-for-Service):<\/strong> No universal prior authorization requirement, but DME MACs may conduct pre-claim review programs for selected DME categories. Check your jurisdiction&#8217;s DME MAC website for active review programs.<\/li>\n\n\n\n<li><strong>Medicare Advantage Plans:<\/strong> Prior authorization is required by most Medicare Advantage plans for K0455. Contact the plan directly before delivery.<\/li>\n\n\n\n<li><strong>Commercial payers:<\/strong> Most commercial insurers require prior authorization for ambulatory infusion pumps. Timelines range from 3 to 10 business days.<\/li>\n\n\n\n<li><strong>Medicaid (state-by-state):<\/strong> Prior authorization requirements and covered indications vary significantly. Verify with the state Medicaid program or managed care plan.<\/li>\n<\/ul>\n\n\n\n<h2 id=\"h-modifiers-used-with-k0455\" class=\"wp-block-heading\">Modifiers used with K0455<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Modifier selection determines both whether the claim processes and what the allowed amount will be. Every K0455 claim requires at least two modifiers. One indicates purchase or rental status, and the KX modifier confirms that LCD criteria are met. Submitting without KX is the single most common reason clean-looking K0455 claims deny on first submission.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">What it means<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to use<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">KX<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Supplier attests all LCD coverage criteria are met and documentation is on file<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Required on every K0455 claim; without it, the claim denies automatically<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">RR<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Equipment is being rented to the beneficiary<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Most K0455 pumps for PAH are billed as monthly rentals<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">NU<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Equipment is a new purchase<\/td>\n<td style=\"padding:12px 16px;color:#374151\">When the beneficiary purchases the pump outright<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">UE<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Equipment is a used purchase<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Refurbished pump sale; reimbursed at 75% of the purchase allowed amount<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">GA<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Waiver of liability on file<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use when the item may not meet coverage criteria but patient has been informed and signed an ABN<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h2 id=\"h-related-hcpcs-codes-in-the-k0455-k0605-infusion-pump-range\" class=\"wp-block-heading\">Related HCPCS codes in the K0455-K0605 infusion pump range<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">K0455 covers the pump hardware only. Suppliers need additional codes from the K0455-K0605 range for the associated supplies, accessories, and disposables. Billing K0455 for a supply item that has its own code is a compliance error that can trigger recoupment. Mapping every item in the kit to its own code before submission prevents that, and <a href=\"https:\/\/pabau.com\/blog\/ehr-integration\/\">EHR integration<\/a> keeps the mapping in one place.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">HCPCS code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to use instead of or alongside K0455<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">K0455<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Infusion pump, uninterrupted parenteral administration<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The pump unit itself, for PAH and other continuous infusion indications<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">E0779<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ambulatory infusion pump, mechanical, reusable<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Mechanical pump not requiring electricity; lower-acuity continuous infusion<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">E0781<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ambulatory infusion pump, single or multiple channels, electric or battery operated<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Electronic ambulatory pumps where delivery is continuous but can be interrupted safely<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A4221<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Supplies for maintenance of drug infusion catheter<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Catheter maintenance supplies billed separately from the pump<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A4222<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Infusion supplies for external drug infusion pump, per cassette or bag<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Cassettes and bags billed as a supply item alongside the pump code<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h2 id=\"h-common-billing-errors-and-compliance-tips-for-k0455\" class=\"wp-block-heading\">Common billing errors and compliance tips for K0455<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">DME infusion pump claims carry one of the highest post-payment audit recovery rates in the Part B DME benefit. Most recoveries trace back to a small set of repeatable errors. Anyone <a href=\"https:\/\/pabau.com\/blog\/how-to-open-an-iv-therapy-clinic\/\">opening an IV therapy clinic<\/a> with a DME supply line should build checks around these failure points from day one.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Missing KX modifier:<\/strong> The most common denial. KX must appear on every K0455 claim to signal that documentation supporting LCD coverage is on file. Its absence results in automatic denial with no right of appeal.<\/li>\n\n\n\n<li><strong>Insufficient medical necessity documentation:<\/strong> Claims clear front-end edits but fail on audit when the notes skip the reasoning. They must say why the parenteral route is required and why alternatives are inadequate. &#8220;Patient needs IV medication&#8221; is not enough.<\/li>\n\n\n\n<li><strong>Wrong payer routing:<\/strong> K0455 for Medicare patients goes to the DME MAC for the patient&#8217;s region, not the A\/B MAC that handles physician claims. The wrong contractor means denial or redirection.<\/li>\n\n\n\n<li><strong>Rental and purchase modifier mismatch:<\/strong> Billing NU when the arrangement is a rental, or the reverse, creates a billing integrity issue. It can also trigger fraud and abuse scrutiny.<\/li>\n\n\n\n<li><strong>Unsupported ICD-10-CM code:<\/strong> Using a diagnosis code not on the LCD L33794 covered diagnosis list, even with strong clinical documentation, results in denial. The code must match the LCD list exactly.<\/li>\n\n\n\n<li><strong>Missing delivery documentation:<\/strong> Suppliers must retain proof of delivery signed by the patient. Without it, payment is recoupable on audit regardless of the clinical justification.<\/li>\n<\/ul>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Build a K0455 pre-submission checklist into your billing workflow. Confirm the KX modifier, a covered ICD-10-CM code, and a physician order signed and dated before delivery. Then confirm the notes address the LCD clinical criteria and the delivery receipt is on file. Running this check before submission cuts first-pass denials.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-how-practice-management-software-supports-k0455-billing\" class=\"wp-block-heading\">How practice management software supports K0455 billing<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">DME infusion pump billing pairs strict documentation rules with modifier logic and payer-specific authorization. Tracking that by hand across a caseload is where suppliers lose money. Each patient has their own review dates, authorization expiry, and ICD-10-CM crosswalk to keep straight.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pabau.com\/industry\/iv-therapy-emr-software\/\">IV therapy EMR software<\/a> built for infusion practices takes over the parts of that workload that break down first. Pabau&#8217;s <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">claims management software<\/a> attaches documentation to each claim, flags a missing modifier before submission, and shows prior authorization status by payer.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pabau.com\/features\/automated-workflows-software\/\">Automated workflows<\/a> cover the calendar side, with reminders for reauthorization and documentation reviews. Nothing submits without the paperwork K0455 requires. Pabau also works as <a href=\"https:\/\/pabau.com\/industry\/wellness-clinic-software\/\">wellness practice software<\/a>, so a practice adding infusion services keeps notes and billing in one record.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Digital intake and clinical forms capture physician orders and medical necessity statements as structured fields from the start of care. That matters when a DME MAC auditor asks for the record three years after delivery.<\/p>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Streamline your DME billing and prior authorization tracking                <\/h3>\n\n                <p class=\"description\">\n                    Pabau tracks prior authorization status, stores compliance documentation, and flags missing modifiers before submission. Infusion practices and DME suppliers get accurate HCPCS claims without the paperwork burden.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau claims management dashboard\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">K0455 rewards suppliers who treat documentation as part of delivery, not paperwork to chase later. The order, the covered diagnosis, and the notes justifying the parenteral route all have to exist before the pump leaves the warehouse.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The trade-off worth remembering is timing. Collecting the records up front costs a few minutes per patient. Rebuilding them for an audit three years later can cost the whole payment. <a href=\"https:\/\/pabau.com\/book-demo\/\">Book a demo<\/a> to see how Pabau keeps K0455 documentation, modifiers, and authorizations in one place.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Need the prescriber letter that carries the necessity argument?<\/strong> <a href=\"https:\/\/pabau.com\/templates\/medical-necessity-letter\/\">Medical necessity letter template<\/a> gives you a structure auditors can follow.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Billing other durable medical equipment alongside the pump?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-e0371\/\">E0371<\/a> walks through the coverage criteria and documentation a DME MAC expects.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Working through another LCD-governed DME claim?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-l0622\/\">L0622<\/a> covers the order, the modifiers, and the records that support payment.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Billing the drug as well as the device?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-j1562\/\">J1562<\/a> explains units, documentation, and the errors that hold up payment.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Running an infusion suite with mixed payers?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-j1450\/\">J1450<\/a> shows how unit-based drug billing works next to a device claim.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1786698633197\"><h3 class=\"schema-faq-question\">What is HCPCS code K0455 used for?<\/h3> <p class=\"schema-faq-answer\">HCPCS code K0455 is used to bill for infusion pumps that deliver medication continuously via the parenteral route without interruption. Most claims cover pulmonary arterial hypertension patients receiving epoprostenol (Flolan) or treprostinil (Remodulin). LCD L33794 also covers intractable pain management and certain chemotherapy infusions.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786698633198\"><h3 class=\"schema-faq-question\">Is K0455 covered under Medicare Part B or Part D?<\/h3> <p class=\"schema-faq-answer\">K0455 falls under Medicare Part B as durable medical equipment, not under the Part D drug benefit. The pump hardware is billed to the DME Medicare Administrative Contractor for the patient&#8217;s region. The drug itself, epoprostenol or treprostinil, is billed separately under Part B as a DME-related medication.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786698633199\"><h3 class=\"schema-faq-question\">What modifiers are required when billing K0455?<\/h3> <p class=\"schema-faq-answer\">Every K0455 claim requires the KX modifier, which attests that documentation supporting LCD L33794 coverage criteria is on file. You also need a rental or purchase modifier. Use RR for monthly rental, which is the norm for PAH pumps, NU for a new purchase, or UE for used equipment. Missing the KX modifier results in automatic claim denial.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786698633200\"><h3 class=\"schema-faq-question\">What documentation is required to bill K0455?<\/h3> <p class=\"schema-faq-answer\">You need a signed physician order naming the medication, route, and pump. You also need chart notes that establish the covered ICD-10-CM diagnosis and explain why alternatives are insufficient, plus a signed delivery receipt. CMS no longer requires a Certificate of Medical Necessity for dates of service from January 1, 2023. Keep the records for at least seven years.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786698633201\"><h3 class=\"schema-faq-question\">Does K0455 require prior authorization from Medicare?<\/h3> <p class=\"schema-faq-answer\">Traditional Medicare Fee-for-Service has no universal prior authorization requirement for K0455. Individual DME MACs may still run pre-claim review programs for high-cost equipment. Medicare Advantage plans and most commercial payers do require prior authorization. Always verify with the specific payer before delivering equipment to avoid denial without appeal rights.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786698633202\"><h3 class=\"schema-faq-question\">What is the difference between K0455 and E0779 or E0781?<\/h3> <p class=\"schema-faq-answer\">K0455 applies to pumps used for uninterrupted parenteral administration, where stopping the pump would cause immediate harm. PAH treatment with epoprostenol is the clearest example. E0779 covers reusable mechanical ambulatory pumps for less acute continuous infusion needs. E0781 covers electronic ambulatory pumps where the infusion can be temporarily interrupted without clinical consequence. The distinction must be documented by the treating physician.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>HCPCS code K0455 is the billable code for an infusion pump used for uninterrupted parenteral administration of medication, such as epoprostenol or treprostinil. Suppliers bill it to Medicare Part B as durable medical equipment. Most claims cover pulmonary arterial hypertension patients on continuous prostacyclin therapy. K codes are temporary HCPCS Level II codes maintained by [&hellip;]<\/p>\n","protected":false},"author":82,"featured_media":180305,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"69","_yoast_wpseo_content_score":"30","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1548],"tags":[1606,3224,1582,3476,1826],"class_list":["post-180106","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-hcpcs","tag-dme-billing","tag-dme-mac","tag-hcpcs","tag-infusion-billing","tag-prior-authorization"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>HCPCS code K0455: Coverage, modifiers, and denials<\/title>\n<meta name=\"description\" content=\"K0455 covers infusion pumps for uninterrupted parenteral therapy. Bill it to the DME MAC with the KX modifier or the claim denies.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/pabau.com\/nl\/procedure-codes\/hcpcs-code-k0455\/\" \/>\n<meta property=\"og:locale\" content=\"nl_NL\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"HCPCS code K0455: Coverage, modifiers, and denials\" \/>\n<meta property=\"og:description\" content=\"K0455 covers infusion pumps for uninterrupted parenteral therapy. Bill it to the DME MAC with the KX modifier or the claim denies.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/pabau.com\/nl\/procedure-codes\/hcpcs-code-k0455\/\" \/>\n<meta property=\"og:site_name\" content=\"Pabau\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/Pabau\/\" \/>\n<meta property=\"article:published_time\" content=\"2026-08-14T10:36:11+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-08-14T10:53:26+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/08\/hcpcs-code-k0455-infusion-pump-for-parenteral-medication.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"630\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Maja Popovska\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:site\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:label1\" content=\"Geschreven door\" \/>\n\t<meta name=\"twitter:data1\" content=\"Maja Popovska\" \/>\n\t<meta name=\"twitter:label2\" content=\"Geschatte leestijd\" \/>\n\t<meta name=\"twitter:data2\" content=\"12 minuten\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-k0455\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-k0455\\\/\"},\"author\":{\"name\":\"Maja Popovska\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/#\\\/schema\\\/person\\\/b00aec1dd379f0ddcf6137d78e2a21db\"},\"headline\":\"HCPCS code K0455: Infusion pump for parenteral medication\",\"datePublished\":\"2026-08-14T10:36:11+00:00\",\"dateModified\":\"2026-08-14T10:53:26+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-k0455\\\/\"},\"wordCount\":2594,\"publisher\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-k0455\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/hcpcs-code-k0455-infusion-pump-for-parenteral-medication.webp\",\"keywords\":[\"Dme Billing\",\"Dme Mac\",\"Hcpcs\",\"Infusion Billing\",\"Prior authorization\"],\"articleSection\":[\"Billing Codes\",\"HCPCS\"],\"inLanguage\":\"nl-NL\"},{\"@type\":[\"WebPage\",\"FAQPage\"],\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-k0455\\\/\",\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-k0455\\\/\",\"name\":\"HCPCS code K0455: Coverage, modifiers, and denials\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-k0455\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/hcpcs-code-k0455\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/hcpcs-code-k0455-infusion-pump-for-parenteral-medication.webp\",\"datePublished\":\"2026-08-14T10:36:11+00:00\",\"dateModified\":\"2026-08-14T10:53:26+00:00\",\"description\":\"K0455 covers infusion pumps for uninterrupted parenteral therapy. 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