CPT code 62362 – Programmable implantable infusion pump

Key takeaways

CPT 62362 reports implanting or replacing a programmable intrathecal or epidural drug pump, including pump preparation, with or without programming.

62360 is a subcutaneous reservoir and 62361 a non-programmable pump; 62362 is the programmable pump.

Medicare covers the implant under NCD 280.14 (Infusion Pumps) once a trial dose has worked, for both intractable pain and severe spasticity.

A new catheter is billed separately with 62350 or 62351, and 62367-62370 cover refill and reprogramming visits after implant day.

CPT code 62362 covers implanting or replacing a programmable drug pump

CPT code 62362 reports implantation or replacement of a device for intrathecal or epidural drug infusion, where the device is a programmable pump. The descriptor adds “including preparation of pump, with or without programming.” In the AMA’s CPT code set, it sits in the reservoir/pump implantation range, 62360-62370.

The three implant codes split by device type. Before you pick one, check the operative note for the pump model. Then match it to the table below, as with any code in our CPT code library.

Programming the pump at implant is part of 62362. That means 62367-62370 are not reported separately on the implant date. The Medtronic SynchroMed II is the programmable pump you will see most often under this code.

What 62362 includes, and what you bill on top of it

Getting the bundle right is where most coding errors on this procedure start. Here is the split.

Included in 62362:

• Surgical implantation or replacement of the programmable pump
• Creating the pocket for the pump
• Preparing the pump before it goes in
• Any programming done at the time of implant

Reported separately:

• A new intrathecal or epidural catheter, with 62350 (without laminectomy) or 62351 (with laminectomy)
• Removal of an old catheter, with 62355
• The infused drug, with its own HCPCS J-code
• The pump hardware in the hospital outpatient setting, with C1772 (infusion pump, programmable, implantable), billed by the facility
• Refill and reprogramming visits on later dates, with 62367-62370

When the catheter goes in at the same session, 62350 and 62362 can both appear on the claim. Check the current NCCI procedure-to-procedure edits before you add a modifier, since they update every quarter.

Follow-up codes trip up coders more than the implant itself. The map below shows which code fits each visit.

Pain and spasticity each need their own successful trial

CPT code 62362 is used for two clinical groups. Payers review them separately at prior authorization.

Chronic intractable pain

For pain, the pump delivers an opioid, typically morphine or hydromorphone, into the intrathecal space. Typical diagnoses include cancer pain with spinal involvement, failed back surgery syndrome and complex regional pain syndrome.

Under Medicare, less invasive treatment must have failed first. The patient also needs a life expectancy of at least three months and a successful temporary trial.

Severe spasticity

For spasticity, the pump delivers intrathecal baclofen. Common conditions are multiple sclerosis, spinal cord injury, cerebral palsy and acquired brain injury.

Medicare expects that noninvasive spasm control no longer works. The patient must also respond well to a trial intrathecal dose before implant.

ICD-10 codes that prove medical necessity for 62362

Every 62362 claim needs a diagnosis the payer accepts for the indication. A clinically sound procedure is still denied when the linked code is not on the payer’s list.

Multiple sclerosis changed on October 1, 2025, when G35 was split into type-specific codes. An old G35 template in your system will now reject, so code to the documented type, or G35.D when the type is not recorded.

Payer lists still vary. Check the payer’s current policy before you submit, and avoid unspecified low back pain codes without documented failed conservative care.

Documentation that holds up from trial to operative note

A clean claim for 62362 rests on records from three points in the patient’s care. A missing piece at any point can mean a denial or a post-payment recoupment.

Before surgery, the record should show:

• Failed conservative treatments, with dates and outcomes
• The trial result: acceptable pain relief for opioids, or a favorable response for baclofen
• Baseline scores, such as the Ashworth scale for spasticity
• How the patient meets the NCD 280.14 criteria

The operative note should record:

• Pump manufacturer, model and serial number
• Surgical approach and pocket location
• Catheter tip level and how placement was confirmed
• Initial drug, concentration and programmed flow rate
• Whether a new catheter was placed, to support 62350 or 62351

Medicare covers 62362 under NCD 280.14

Medicare pays the physician under Part B and the hospital under the outpatient prospective payment system (OPPS). Coverage follows NCD 280.14 (Infusion Pumps).

The national coverage rules come down to four conditions:

• Pain: severe chronic intractable pain unresponsive to less invasive therapy, with a life expectancy of at least three months
• Pain: a temporary intrathecal or epidural trial showing acceptable relief and tolerable side effects
• Spasticity: spasm control by noninvasive methods has failed, and a trial intrathecal dose worked
• The pump’s FDA-approved labeling must list the drug and its purpose as an indicated use

Commercial payers publish their own medical policies on implantable pumps. Most mirror Medicare, but some add a psychological evaluation or a multidisciplinary review before approval.

How 62362 gets paid, and who bills the pump

Physician payment for 62362 depends on its relative value units, the conversion factor and your locality’s geographic index. Because the result changes by locality and year, look up your rate rather than relying on a national figure.

Pull current physician rates from the CMS Physician Fee Schedule Look-Up Tool, using your Medicare locality. Device C-code status can change each calendar year, so the facility should confirm C1772 before billing.

Prior authorization: Build the packet before you book surgery

Medicare Advantage plans and nearly all commercial payers require prior authorization for 62362. Traditional Medicare does not, but the record must still meet NCD 280.14.

Good billing compliance habits mean the packet is ready before the surgery date is set. A typical 62362 request includes:

• A letter of medical necessity from the implanting physician
• The procedure note from the intrathecal trial
• Functional scores from before and after the trial
• Dated records of failed conservative therapy
• Device details: manufacturer, model and reservoir size
• The proposed drug, concentration and starting flow rate

Turnaround varies by payer, so request approval as soon as the trial result is documented. Always work from the payer’s current published policy, not last year’s version.

A worked example: From implant day to the first refill

Here is how one claim moves. A patient with relapsing-remitting MS had a positive baclofen trial and is scheduled for a SynchroMed II implant.

1. Implant day: the surgeon places the pump and a new catheter without laminectomy. The physician claim carries 62362 and 62350, linked to G35.A.
2. Same day, facility side: the hospital bills 62362 and 62350 under OPPS, plus C1772 for the pump.
3. Same day, programming: the surgeon sets the starting dose in the operating room. That work is already in 62362, so no 62367-62370.
4. Six weeks later: a nurse analyzes the pump, refills it and adjusts the rate. That visit is 62369.
5. If the physician’s own skill were needed for that refill and reprogramming, the visit would be 62370 instead.

Common denial triggers for 62362, and how to head them off

Expensive devices, strict coverage rules and prior authorization make 62362 claims a common denial target. Strong denial management starts by fixing these causes before the claim leaves the practice.

Before you submit: A six-point 62362 checklist

Run these checks on every claim before it goes out:

1. The operative note names the pump model and serial number.
2. A new catheter, if placed, is documented and coded as 62350 or 62351.
3. The trial note and scores are on file.
4. The diagnosis is on the payer’s list and coded to its current subtype.
5. The prior authorization number is entered on the claim.
6. No 62367-62370 code shares the implant date of service.

How claims software keeps 62362 claims clean

Today, many pain practices build a 62362 claim by hand. Someone copies codes from the operative note and chases the authorization number by email. Then they key the claim into a separate clearinghouse portal.

Pabau, the practice management platform we build, removes most of that retyping. Its pain practice claims software fills the claim form from the patient record. It also checks required fields, such as the authorization number, before the claim can be sent.

Claims then go out through a medical claims clearinghouse connection to Claim.MD, with eligibility checks, claim-status tracking and remittance posting. The result is fewer bounced claims and less time spent on rework.

Send cleaner 62362 claims the first time

Pabau fills the claim from the patient record, checks required fields like authorization numbers, and sends it through Claim.MD with eligibility and remittance tracking.

Book a demo

Conclusion

CPT code 62362 rewards coders who read the device, not the procedure name. Confirm a programmable pump, keep programming codes off implant day, and code the diagnosis to its current subtype.

The bigger win sits upstream. Assemble the trial note and authorization before surgery is booked, and the claim is mostly written by the time the patient is discharged.

If you want that process to run from one record, Book a demo to see how Pabau handles pump-implant claims from trial to remittance.

Continue your research

Want to see how your 62362 claim travels to the payer? 837 electronic claim file guide explains how 837P files carry CPT codes, modifiers and diagnosis pointers through the clearinghouse.

Building a prior authorization packet for a pump implant? UnitedHealthcare prior authorization form gives you a ready-made form to request approval before you schedule surgery.

Reconciling the facility payment for the pump separately? Electronic remittance advice guide shows how to read an ERA line by line and match it to the claim.

Capturing every billable service from implant day? Medical superbill guide covers how to structure a superbill for high-cost procedure codes.

Enrolling with payers that cover implantable pumps? Insurance credentialing guide walks through enrollment with commercial payers step by step.

Frequently asked questions