Summary & Overview
HCPCS Level II K1013: Enema Tube, Replacement Only
HCPCS Level II code K1013 identifies an enema tube (with or without adapter) supplied as a replacement item, billed per each unit. Nationally, this code matters because it standardizes billing for a common bowel-care supply used across outpatient clinics, home health agencies, and ambulatory care settings, impacting coverage determinations and durable medical equipment supply workflows. Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn what K1013 represents clinically and operationally, which payers commonly cover it, and the typical contexts for its use. The report provides benchmarks and policy context relevant to durable medical equipment replacement supplies, outlines common billing practices for replacement items, and summarizes variations in payer coverage approaches. The summary also highlights supply classification, expected sites of service, and the administrative considerations that affect claims for replacement enema tubes. Data not available in the input is noted where specific details (such as associated taxonomies, ICD-10 diagnosis pairings, and payer-specific reimbursement rates) are missing.
Billing Code Overview
HCPCS Level II code K1013 describes an enema tube, with or without adapter, any type, replacement only, each. This item is a disposable or reusable conduit used to deliver enemas for bowel evacuation or medication administration. Service type: Durable Medical Equipment (replacement supply). Typical site of service: outpatient settings, home health care, and other ambulatory care locations where patients receive bowel care supplies.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or pediatric home-care or long-term care resident requiring replacement of an enema tube used for bowel management. The patient may have chronic constipation, neurogenic bowel (e.g., spinal cord injury), fecal impaction, or require frequent rectal irrigation to manage bowel incontinence. A nurse or trained caregiver identifies a damaged, clogged, or malfunctioning enema tube during routine catheter or bowel care and orders a replacement. The facility (home health, skilled nursing facility, outpatient durable medical equipment supplier) verifies the prescription and supplies the replacement enema tube K1013 to the patient. The workflow includes clinical assessment, documentation of indication and necessity, verification of device specifications (tube with or without adapter), delivery or dispense to the patient or caregiver, and documentation of replacement as a single item supply. Billing is submitted to the patient’s payor with the HCPCS Level II code K1013 for the replacement item; the encounter typically occurs in the patient’s home, a skilled nursing facility, or outpatient clinic where durable medical equipment is dispensed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when replacement required additional, documented work beyond typical supply dispensing (rare for simple supply). |