HCPCS Code K0607: Replacement battery for AED

Key takeaways

HCPCS Code K0607 covers a replacement battery for a garment-type automated external defibrillator, billed as one unit under HCPCS Level II

The garment-type qualifier matters, because K0607 is the battery for a wearable defibrillator vest rather than a wall-mounted public-access AED

Medicare coverage follows CMS Policy Article A52458, which limits payment to beneficiaries who survived ventricular fibrillation arrest or face high arrhythmia risk

Every K0607 line needs modifier KF for the FDA Class III device, plus KX to affirm that medical necessity documentation is on file

Pabau’s claims management software keeps patient records and claim status in one place, so DME billing teams can track each submission

HCPCS Code K0607 is the Level II code for a replacement battery for an automated external defibrillator, garment type only, each. That garment-type qualifier decides how the code is used. K0607 covers the battery for a wearable defibrillator vest, not a wall-mounted public-access AED.

Medicare pays it only for beneficiaries who meet the cardiac criteria in CMS Policy Article A52458, and only when an enrolled DMEPOS supplier bills it. This reference covers the code details, coverage criteria, 2026 fee schedule guidance, documentation, modifiers, and the denial patterns behind most K0607 rejections.

HCPCS Code K0607: definition and code details

HCPCS Code K0607 describes a replacement battery for an automated external defibrillator, garment type only, billed per unit. It sits in the K-codes section of HCPCS Level II. That classification is maintained by the Centers for Medicare and Medicaid Services (CMS) for durable medical equipment and supplies. The garment-type AED range occupies a narrow band of the wider HCPCS Level II codes set, which CMS revises each year.

K-codes cover DME items and supplies that do not fit the other HCPCS sections. Only Medicare-enrolled DMEPOS suppliers may bill K0607 to Medicare. A clinical provider who is not separately enrolled as a DMEPOS supplier cannot submit this code for reimbursement.

Medicare coverage criteria for K0607

Coverage for HCPCS Code K0607 is governed by CMS Policy Article A52458, which covers the full garment-type AED supply range from K0606 through K0609. Medicare Part B pays for a replacement battery only where the beneficiary meets one of two cardiac criteria.

• Survived ventricular fibrillation (VF) cardiac arrest. The beneficiary has a documented history of surviving a cardiac arrest caused by ventricular fibrillation. The episode must not have been due to a transient or reversible cause.
• High risk for life-threatening ventricular arrhythmia. The beneficiary has documented clinical evidence placing them at high risk for a life-threatening ventricular arrhythmia, as confirmed by the treating physician.
• DMEPOS supplier enrollment. Only enrolled DMEPOS suppliers may deliver and bill AED supplies under Medicare Part B, so unenrolled providers cannot submit K0607 claims.
• Medical necessity established. The ordering physician must document medical necessity in the patient record before the replacement battery is dispensed.

Screening the patient record for that cardiac history before accepting the order is the cheapest control available on this code. Medicaid coverage for K0607 varies by state, so confirm the rules with the relevant state program before billing. Criteria and reimbursement differ widely across jurisdictions.

Documentation requirements for K0607 claims

Incomplete documentation is the fastest path to a K0607 denial. DME MAC auditors look first for the physician order and the medical necessity narrative. The documents below must be in the supplier’s file before the claim is submitted.

Keep all records for a minimum of seven years from the date of service. DME MAC post-payment audits often request documentation years after a claim is paid, and a missing record at that stage means recoupment.

2026 Medicare fee schedule for K0607

Medicare payment rates for HCPCS Code K0607 are updated annually as part of the DMEPOS fee schedule published by CMS. Reimbursement is the lower of the supplier’s submitted charge or the applicable fee schedule amount, adjusted by geographic locality. Check the CMS DMEPOS fee schedule for the 2026 rate in your MAC jurisdiction before billing.

K0607 is priced as a DME supply, so its rate reflects the purchase price of the item rather than work and practice expense RVUs. The Physician Fee Schedule lookup tool does not price DME supply codes. Searching there is one of the more common reasons a biller quotes the wrong expected payment.

Electronic remittance advice files, received after adjudication, show how the DME MAC applied that rate. Reading the adjustment codes on a K0607 remittance identifies short-pays tied to geographic locality or pricing indicators.

Billing modifiers applicable to K0607

Modifiers decide how the DME MAC adjudicates a K0607 claim. One missing pair of characters turns a payable line into a rejection. The AAPC HCPCS code reference lists the approved modifier set, and the coverage implications below are what a billing team needs before submission.

Every K0607 line carries KF. A52458 treats the AED supply range as a group of FDA Class III devices. A line submitted without KF is rejected as missing information rather than denied on the merits. KX then affirms that the medical necessity documentation is on file. The two do different jobs, and one never substitutes for the other.

Only one liability modifier belongs on a line. The chart below maps the file you are holding to the modifier that follows from it.

Verify the modifier set with your specific DME MAC before you build it into a claim scrubber rule. Local coverage determinations can add requirements beyond the national policy.

How to bill K0607: step-by-step claim submission

Clean K0607 claim submission follows a predictable sequence. A step skipped at delivery becomes a documentation failure at DME MAC review, often months after the claim was paid.

1. Verify beneficiary eligibility. Confirm active Medicare Part B coverage with DMEPOS benefits. Check the patient’s Medicare claim history for AED equipment already on record.
2. Obtain a valid physician order. Secure a signed and dated written order from the treating physician specifying the K0607 replacement battery. The order must predate the delivery date.
3. Collect medical necessity documentation. Gather the physician’s narrative documenting the cardiac arrest history or high-risk arrhythmia status per CMS Policy Article A52458. This must be in the supplier’s file before submission.
4. Deliver the item and confirm receipt. Obtain a signed delivery confirmation from the beneficiary or authorized representative. Retain the original document in the patient’s DME file.
5. Apply the correct modifiers. Put KF on every line. Add KX when the coverage criteria are met and documentation is on file, or GA if an ABN was issued. Do not stack KX and GA on the same line item.
6. Submit via your DME MAC. File the claim on a CMS-1500 or through your electronic billing system. Run it past a claim scrubber first, so a missing modifier is caught before the payer sees it.
7. Monitor the remittance. Review the ERA after adjudication. Denial reason codes identify the specific failure, and rebilling inside the timely filing window preserves the revenue.

First-pass acceptance shortens the cycle from delivery to payment and removes the administrative cost of an appeal. That is easier to sustain when claims management software holds the order, the delivery proof, and the claim status against one patient record.

Common denial reasons for K0607 and how to avoid them

K0607 denial rates run high for a single-unit supply code, because the coverage criteria are narrow and every claim needs affirmative documentation. The table below reflects the failure patterns that denial management teams report most often on DME accounts.

Related AED HCPCS codes: K0606, K0608, and K0609

HCPCS Code K0607 sits inside the four-code garment-type range, K0606 through K0609. CMS Policy Article A52458 governs all four, alongside E0617 for the non-garment automated external defibrillator. Each code in the K0606 to K0609 group describes a different part of the same wearable system. The table below shows what each one actually covers.

Two of these codes are commonly swapped in practice. K0608 is the garment, and K0609 is the electrodes that sit inside it, which is the reverse of what many billing sheets assume. All four codes carry the same coverage criteria and the same KF requirement, whichever supply item is being billed.

How Pabau keeps K0607 documentation and claim status together

In most DME operations, the pieces of a K0607 claim live in different places. The physician order arrives by fax, and the medical necessity narrative sits in the referring practice’s notes. The signed delivery receipt is scanned into a shared drive. When the DME MAC asks for the file two years later, someone rebuilds it by hand.

Practice management software like Pabau keeps the patient record, the uploaded documents, and the claim status against one profile. Billing staff can see what was ordered, what was delivered, and where the claim sits without leaving that record. Pabau’s claims management tools run pre-submission field checks, then submit and track the claim from the same place.

The outcome is a shorter path from a denial notice to the document that answers it. An audit request stops being a search across three systems and becomes a look at one patient record.

Keep DME claims and their documents together

Pabau’s claims management software keeps patient records, documents, and claim status in one place. DME billing teams can submit and track each claim from the record it came from.

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Conclusion

The garment-type qualifier decides most K0607 questions. The code belongs to a wearable defibrillator vest, not a wall-mounted public-access AED. Once that is settled, the coverage criteria, the sibling codes, and the modifier set all follow from it.

Three checkpoints are worth building into the workflow. Put KF on every line, back KX with a narrative naming the A52458 criteria, and date every physician order before delivery. Suppliers who hold those three rarely see a first-pass rejection on this code.

The harder part is keeping the file together for an audit that arrives long after payment. Book a demo to see how Pabau holds K0607 orders, delivery proof, and claim status against one patient record.

Continue your research

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Want a cleaner claims workflow from intake to remittance? Revenue cycle management fundamentals covers the end-to-end process for DME and clinical billing teams.

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