HCPCS K0552 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Durable medical equipment (DME) Medicare administrative contractors (MACs) • INFUSION PUMPS AND SUPPLIES |
| Complexity Level | Low |
National average reimbursement for HCPCS K0552 by major payers:
$2.87
$1.94
$2.19
$3.04
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS K0552 | ||||||
United | K0552 | $1.70 | 1780672055 - THE PATIENT'S ANESTHESIA GROUP PA | 10586664 - THE PATIENT'S ANESTHESIA GROUP, P.A. | TX | Multi-Specialty Group (193200000X) |
United | K0552 | $2.25 | 1720490758 - HOLLIS BARTELS | 650578395 | TX | Obstetrics & Gynecology Physician (207V00000X) |
United | K0552 | $1.65 | 1851450969 - RADIOLOGY ASSOCIATES OF NORTH TEXAS PA | 751286819 - RADIOLOGY ASSOCIATES OF NORTH TEXAS, P.A. | TX | Multi-Specialty Group (193200000X) |
United | K0552 | $1.74 | 1538117742 - MEDICAL CLINIC OF NORTH TEXAS, PLLC | 752566987 | TX | Multi-Specialty Group (193200000X) |
United | K0552 | $1.66 | 1316957731 - PROFESSIONAL ASSN FOR PEDIATRICS | 751371323 - PROFESSIONAL ASSOCIATION FOR PEDIATRICS 401K PROFIT SHARING PLAN | TX | Pediatrics Physician (208000000X) |
United | K0552 | $1.58 | 1962768507 - ZEESHAN AFZAL | 831005828 - DOCTORS DERMATOLOGY AND ASSOCIATES | TX | Dermatology Physician (207N00000X) |
United | K0552 | $2.83 | 1164468088 - WASSILA AMARI | 752536818 - HEALTHTEXAS PROVIDER NETWORK | TX | Rheumatology Physician (207RR0500X) |
United | K0552 | $2.83 | 1093779704 - SCOTT & WHITE CLINIC | 742958277 - SCOTT & WHITE CLINIC | TX | Internal Medicine Physician (207R00000X) |
United | K0552 | $1.74 | 1194992537 - TEXAS ONCOLOGY PA | 752131429 - TEXAS ONCOLOGY, P.A. | TX | Medical Oncology Physician (207RX0202X) |
United | K0552 | $1.94 | 1346645066 - KATY SUPPORTIVE MEDICINE, P.A. | 472078589 - KATY SUPPORTIVE MEDICINE PA | TX | Multi-Specialty Group (193200000X) |
United | K0552 | $2.83 | 1659357093 - SCOTT MARSHALL | 942854057 - IHC HEALTH SERVICES INC | TX | Neurology Physician (2084N0400X) |
United | K0552 | $1.42 | 1740803113 - IMPACT PHYSICIAN GROUP, TEXAS LLC | 851092492 - IMPACT PHYSICIAN GROUP TEXAS LLC | TX | Internal Medicine Physician (207R00000X) |
United | K0552 | $1.74 | 1972094928 - SPRING BRANCH COMMUNITY HEALTH CENTER | 300198705 - SPRING BRANCH COMMUNITY HEALTH CENTER | TX | General Practice Dentistry (1223G0001X) |
United | K0552 | $1.67 | 1073817755 - EMERGENCY SERVICES FOUNDATION OF TEXAS | 261296369 - EMERGENCY SERVICES FOUNDATION OF TEXAS INC | TX | Internal Medicine Physician (207R00000X) |
United | K0552 | $1.66 | 1073056297 - CHAITANYA TUMMALA MD PA | 812758161 - CHAITANYA TUMMALA MD PA | TX | Infectious Disease Physician (207RI0200X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS K0552 vs. Other INFUSION PUMPS AND SUPPLIES Codes
The HCPCS K0552 code is part of the Durable medical equipment (DME) Medicare administrative contractors (MACs) services used for INFUSION PUMPS AND SUPPLIES. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS K0552 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| K0462-HCPCS | Low | Temporary replacement for patient owned equipment being repaired, any type |
| K0552-HCPCS | Low | Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each |
| K0601-HCPCS | Low | Replacement battery for external infusion pump owned by patient, silver oxide, 1.5 volt, each |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS K0552. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the K0552 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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