`E0776` Iv pole

Iv pole

Medicare coverage: Carrier judgment
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 0 units per day (clinical), rationale: CMS Policy
Outpatient hospital: max 0 units per day (clinical), rationale: CMS Policy
DME supplier: max 1 units per day (clinical), rationale: Nature of Equipment

Medicare pricing for E0776

DMEPOS fee schedule, July 2026 (DME26-C) and PEN fee schedule, January 2026 (DME26-A)

NU (purchased, new), inexpensive or routinely purchased (IN): non-rural $173.42 to $183.72 in the contiguous states; $173.42 to $194.69 in AK, HI, PR and VI; rural $173.42 to $193.87
RR (rental), inexpensive or routinely purchased (IN): non-rural $18.37 in the contiguous states; $20.48 to $34.18 in AK, HI, PR and VI; rural $20.48 to $22.47
UE (purchased, used), inexpensive or routinely purchased (IN): non-rural $127.60 to $137.80 in the contiguous states; $127.60 to $146.04 in AK, HI, PR and VI; rural $127.60 to $143.96
NU-BA, parenteral and enteral nutrition: non-rural $62.04 to $66.10 in the contiguous states; $102.55 in AK, HI, PR and VI; rural $102.55
NU-KE, parenteral and enteral nutrition: non-rural $112.28 in AK, HI, PR and VI; rural $112.28
RR-BA, parenteral and enteral nutrition: non-rural $6.21 to $6.61 in the contiguous states; $20.52 in AK, HI, PR and VI; rural $20.52
RR-KE, parenteral and enteral nutrition: non-rural $22.98 in AK, HI, PR and VI; rural $22.98
UE-BA, parenteral and enteral nutrition: non-rural $46.53 to $49.57 in the contiguous states; $76.92 in AK, HI, PR and VI; rural $76.92
UE-KE, parenteral and enteral nutrition: non-rural $84.22 in AK, HI, PR and VI; rural $84.22

Payer policies and prior authorization for E0776

1 of 1 payer prior-auth lists that name E0776 require prior authorization or set conditions: Passport by Molina Healthcare (Kentucky).

Payer	Plan	State	Prior auth	Conditions	Since	Source
Passport by Molina Healthcare (Kentucky)	Medicaid	KY	prior auth under conditions	State exception; PA above quantity limits	Jul 1, 2026	Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026

Payer coverage policies that name E0776

E0776 appears in 1 coverage policy from Anthem.

Payer	Policy	Role in policy	Reviewed	Document
Anthem	External Infusion Pumps for the Administration of Drugs in the Home or Residential Care Settings (CG-DME-21)	covered if criteria are met	Nov 6, 2025	payer document

Recent prior-auth changes

Jul 1, 2023: PA removed, Blue Shield of California Promise Health Plan

Medicaid fee-for-service

Prior authorization required or conditional in CO, IL, LA, MA, MS, ND, NY, VA.

AZ: $201.05 (dme), effective Oct 1, 2026
CO: $15.46 (dme), effective Jul 1, 2026
FL: $11.45 (dme), effective Jul 1, 2026
IL: $77.57 (dme), effective Jan 1, 2026
IN: $152.06 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026
KS: $14.70 (default), effective Jul 1, 2026
KY: $11.64 (dme), effective Jan 1, 2026
LA: $6.40 (dme), effective Jul 1, 2012
MD: $53.33 (dme), effective Apr 1, 2026
MS: $15.51 (comprehensive), effective Jul 1, 2026
ND: $180.96 (dme), effective Aug 1, 2026
NE: $6.36 (dme), effective Jul 1, 2026
NY: $5.61 (dme), effective Jul 1, 2026
OH: $75.00 (dme), effective Apr 1, 2006
OK: $18.37 (dme), effective Jan 1, 2026
TX: $9.69 (dmepos_tos_9_e_j_l_and_r, Medical Supplier (Dme)), effective Apr 1, 2017
VA: $165.35 (dme), effective Dec 1, 2026
VT: $145.37 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $17.73 (crt), effective Jul 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

E0776 Iv pole