Summary & Overview

HCPCS C9804: Elastomeric Infusion Pump for Post-Surgical Non-Opioid Pain

HCPCS Level II code C9804 identifies an elastomeric infusion pump system — including catheter and all disposable components — designated as a qualifying non-opioid medical device for post-surgical pain relief under section 4135 of the CAA, 2023. The code captures use of single-use, disposable elastomeric pumps that deliver local or regional non-opioid analgesia in the immediate perioperative and recovery period. Nationally, the code matters because it formalizes billing for approved non-opioid pain devices, supporting broader adoption of opioid-sparing protocols and aligning coverage with the CAA provision.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and expected sites of service, plus guidance on what to expect in payer coverage discussions. The publication covers benchmarking points, relevant policy updates tied to the CAA, and clinical implications for post-surgical pain management workflows.

This summary equips billing managers, hospital administrators, and policy teams with the essential facts about HCPCS Level II code C9804, where it applies, and why it is relevant to national efforts to expand non-opioid postoperative analgesia.

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Billing Code Overview

HCPCS Level II code C9804 describes an elastomeric infusion pump (e.g., on-q pump with bolus), including catheter and all disposable system components, non-opioid medical device*. The device is identified as a qualifying Medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the CAA, 2023.

Service Type: Durable medical device infusion therapy for post-surgical analgesia

Typical Site of Service: Post-surgical settings, including inpatient hospital post-anesthesia care, outpatient surgery centers, and monitored recovery areas where non-opioid pain management devices are used

Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service line.

Clinical & Coding Specifications

Clinical Context

A 56-year-old female undergoes elective total knee arthroplasty for advanced osteoarthritis. Postoperatively in the ambulatory surgery center, the surgical team places a qualifying elastomeric infusion pump for continuous local non-opioid analgesia (for example, an on‑q® style pump with bolus capability) connected to a wound catheter prior to discharge. The device is intended to deliver a local anesthetic infusion for the first 48–72 hours to reduce systemic opioid requirements and improve early mobility. Nursing documents device programming, catheter site condition, patient education on pump care and bolus use, and a plan for device return or disposal. Follow-up with the surgeon is arranged within 48–72 hours for wound check and device removal if externally retained.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, or technical difficulty for device placement substantially exceeds usual.
`23`	Unusual anesthesia	Use when general anesthesia was required for a procedure that normally does not require it (if applicable to device placement in rare cases).
`52`	Reduced services	Use when a partial application of the device or truncated service was provided.
`53`	Discontinued procedure	Use when device placement was initiated but discontinued due to unforeseen circumstances.
`54`	Surgical care only	Use when reporting only the surgeon's active intraoperative portion, distinct from postoperative management.
`55`	Postoperative management only	Use when reporting only postoperative management related to the device (e.g., postoperative clinic care).
`56`	Preoperative management only	Use when reporting only preoperative evaluation and management related to the procedure.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons on the operative encounter involving device placement.
`AS`	Patient is anesthetized at outpatient facility	Use when the device is placed while the patient is anesthetized in an ambulatory surgical center.
`CQ`	Service furnished under qualifying Access to Care program	Use when the service is furnished under a qualifying program requiring this modifier.
`QK`	Medical direction of two or more CRNAs	Use when physician provides medical direction for multiple CRNAs during anesthesia associated with the procedure.
`QX`	CRNA service furnished under personal supervision of a physician	Use when a CRNA furnishes anesthesia under the supervising physician’s personal provision during device placement.
`QY`	Anesthesia services furnished by an anesthesiologist medically directing one CRNA	Use when an anesthesiologist medically directs a single CRNA for the case.

Taxonomy Code	Specialty	Notes
`208800000X`	Orthopaedic Surgery	Primary surgeons placing the device during joint arthroplasty.
`207L00000X`	Pain Medicine	Specialists initiating or managing continuous local analgesic devices postoperatively.
`207P00000X`	Physical Medicine & Rehabilitation	Clinicians coordinating postoperative functional recovery and analgesia.
`207K00000X`	Anesthesiology	Providers responsible for regional/local analgesia planning and anesthesia management.
`163W00000X`	General Surgery	Surgeons placing devices for postoperative analgesia in abdominal or general surgical procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M17.11`	Unilateral primary osteoarthritis, right knee	Common indication for total knee arthroplasty where a local elastomeric pump may be used for postoperative analgesia.
`M17.12`	Unilateral primary osteoarthritis, left knee	Same relevance for left knee arthroplasty with device use for pain control.
`M16.11`	Unilateral primary osteoarthritis, right hip	Hip arthroplasty cases where continuous local infusion devices can reduce opioid use.
`M16.12`	Unilateral primary osteoarthritis, left hip	Indicates hip arthroplasty on the left with similar analgesic strategy.
`G89.18`	Other acute postprocedural pain	Directly describes acute postoperative pain management and supports use of non-opioid infusion devices.
`T81.4XXA`	Infection following a procedure, initial encounter	Relevant as a contraindication or complication monitoring code if catheter- or device-related infection is suspected.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`20610`	Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., shoulder, hip, knee)	May be used for diagnostic/therapeutic joint injections pre- or postoperatively in the perioperative pain plan.
`64450`	Injection, anesthetic agent; other peripheral nerve or branch	Used for peripheral nerve blocks that may be performed in conjunction with device placement for multimodal analgesia.
`97607`	Negative pressure wound therapy (e.g., vacuum assisted drainage), topical application	Occasionally used when wound management and device placement overlap in complex surgical wounds (device not a substitute).
`20550`	Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., trigger point)	Used for local anesthetic injections in perioperative pain management alongside continuous infusion devices.
`99070`	Supplies and materials (e.g., drugs, sutures, dressings), provided by the physician over and above those usually included with the service	May be used to report additional disposable supplies associated with pump placement if payer allows.