Summary & Overview
HCPCS C1891: Implantable Non-Programmable Infusion Pump
HCPCS Level II code C1891 denotes an implantable, non-programmable infusion pump used for long-term medication delivery. The code identifies a permanent, surgically implanted device that provides continuous or intermittent infusions of therapeutics directly into a target site. Nationally, this code matters for procedural billing, durable medical equipment classification, and coverage determinations tied to implantable drug delivery systems.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how C1891 is classified, the typical clinical settings for implantation and follow-up, and common billing considerations. The publication summarizes reimbursement benchmarks, payer policy variations, and coding contexts relevant to device implantation and long-term management.
The report also provides clinical context on indications for implantable infusion pumps, examples of service lines that use the device, and guidance on where to look for payer-specific coverage policies. Data not available in the input are noted explicitly where applicable.
Billing Code Overview
HCPCS Level II code C1891 describes an infusion pump, non-programmable, permanent (implantable). This device is a surgically implanted infusion pump designed for long-term, continuous delivery of medications directly into the body.
Service type: Implantable infusion device placement and maintenance, including services related to the use of a permanent, non-programmable pump for therapeutic medication delivery.
Typical site of service: Hospital inpatient or outpatient surgical center for implantation; physician office or hospital outpatient setting for device programming checks and routine follow-up care.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with chronic, refractory cancer-related pain or spasticity who has failed conservative therapies (oral opioids, adjuvant analgesics, physical therapy). The patient is evaluated by a multidisciplinary pain management team and deemed an appropriate candidate for an implantable, non-programmable infusion pump (C1891) to deliver continuous intrathecal medication (eg, morphine, baclofen). The clinical workflow includes pre-procedure evaluation (history, medication review, informed consent), baseline pain/spasticity scoring, imaging to assess anatomy, perioperative anesthesia assessment, device implantation in an operating room or ambulatory surgical center, intraoperative confirmation of catheter and pump position, initial reservoir fill, wound closure, and postoperative monitoring for complications (infection, cerebrospinal fluid leak, catheter malfunction). Postoperative care includes wound checks, programming verification if applicable, reservoir refill visits, and coordination with home health or pain clinic for ongoing medication management and documentation of effectiveness and adverse effects.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than usual for pump implantation due to complexity (extensive adhesions, prior instrumentation). |