E0471 HCPCS code: Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)
E0471 is the HCPCS Level II code for respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device). The 2026 Medicare DMEPOS fee schedule pays $324.35 to $642.07 (RR, rental (monthly)) depending on the state. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 1 per day on DME suppliers. Medicare volume rose 10% from 2022 to 2024 (170,581 to 188,380 services). In 2024, 3,173 suppliers billed Medicare for E0471 (rentals), serving 32,920 beneficiaries; California, Florida, Texas accounted for 21% of services. Its average fee ranks 10 of 19 E04 codes billed RR (family range $5.28–$1,572.12); rural fees run 56% higher.
Code details
| Field | Value |
|---|---|
| Section | E codes — Durable medical equipment |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 36 — DMEPOS: capped rental item |
| BETOS category | D1E — Other durable medical equipment |
| Added | 2004-01-01 |
| Last action effective | 2006-04-01 |
2026 Medicare DMEPOS fee schedule for E0471
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| RR | rental (monthly) | $324.35 | $642.07 | — | — |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | RR | $589.44 | — |
| AL | RR | $329.87 | $520.32 |
| AR | RR | $329.87 | $520.32 |
| AZ | RR | $324.35 | $579.71 |
| CA | RR | $329.72 | $579.71 |
| CO | RR | $347.40 | $529.99 |
| CT | RR | $336.67 | $579.71 |
| DC | RR | $325.75 | $520.32 |
| DE | RR | $325.75 | $520.32 |
| FL | RR | $329.87 | $520.32 |
| GA | RR | $329.87 | $579.71 |
| HI | RR | $617.57 | — |
| IA | RR | $337.54 | $520.32 |
| ID | RR | $347.40 | $579.71 |
| IL | RR | $344.03 | $559.02 |
| IN | RR | $344.03 | $520.32 |
| KS | RR | $337.54 | $579.71 |
| KY | RR | $329.87 | $579.71 |
| LA | RR | $329.87 | $520.32 |
| MA | RR | $336.67 | $579.71 |
| MD | RR | $325.75 | $579.71 |
| ME | RR | $336.67 | $579.71 |
| MI | RR | $344.03 | $579.71 |
| MN | RR | $337.54 | $536.89 |
| MO | RR | $337.54 | $579.71 |
| MS | RR | $329.87 | $540.55 |
| MT | RR | $347.40 | $520.32 |
| NC | RR | $329.87 | $579.71 |
| ND | RR | $337.54 | $520.32 |
| NE | RR | $337.54 | $579.71 |
| NH | RR | $336.67 | $579.71 |
| NJ | RR | $325.75 | $520.32 |
| NM | RR | $324.35 | $520.32 |
| NV | RR | $329.72 | $579.71 |
| NY | RR | $325.75 | $579.71 |
| OH | RR | $344.03 | $579.71 |
| OK | RR | $324.35 | $520.32 |
| OR | RR | $329.72 | $579.71 |
| PA | RR | $325.75 | $520.32 |
| PR | RR | $642.07 | — |
| RI | RR | $336.67 | $579.71 |
| SC | RR | $329.87 | $579.71 |
| SD | RR | $337.54 | $520.32 |
| TN | RR | $329.87 | $579.71 |
| TX | RR | $324.35 | $520.32 |
| UT | RR | $347.40 | $520.32 |
| VA | RR | $329.87 | $548.36 |
| VI | RR | $578.13 | — |
| VT | RR | $336.67 | $579.71 |
| WA | RR | $329.72 | $579.71 |
| WI | RR | $344.03 | $520.32 |
| WV | RR | $329.87 | $579.71 |
| WY | RR | $347.40 | $520.32 |
How the E0471 fee compares
| Measure | Value |
|---|---|
| Rank among 19 E04 codes billed RR (lowest = 1) | 10 |
| Family fee range (average of state fees) | $5.28–$1,572.12 |
| Rural fee uplift | 55.9% |
Who bills E0471 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | 3,173 |
| Suppliers billing purchases | — |
| Referring clinicians | 10,413 |
| Medicare beneficiaries | 32,920 |
| States with claims | 55 |
| Share of services in top 3 states (California, Florida, Texas) | 21% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 3,164 | 29,644 |
| 2023 | 3,161 | 31,703 |
| 2024 | 3,173 | 32,920 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for E0471, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 170,581 | 29,644 | $289.37 | $220.65 |
| 2023 | 193,054 | 31,703 | $311.40 | $236.98 |
| 2024 | 188,380 | 32,920 | $298.55 | $226.52 |
States with the most E0471 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 15,193 | $214.02 |
| Florida | 12,662 | $207.09 |
| Texas | 11,783 | $216.09 |
| Colorado | 11,097 | $228.52 |
| Arizona | 8,032 | $212.42 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 1 | Nature of Equipment |
Medicare policy articles for this code
- A52467: Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
- A52517: Respiratory Assist Devices - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (1 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| G47.33 | Obstructive sleep apnea (adult) (pediatric) | 1 |
What changed for E0471
- 2026-01-01: Average state fee (RR) rose 2.6%: $345.54 to $354.65
- 2004-01-01: E0471 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code E0471?
E0471 is the HCPCS Level II code for respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device). Short descriptor: "Rad w/backup non inv intrfc".
How much does Medicare pay for E0471?
Under the 2026 DMEPOS fee schedule, non-rural state fees are RR (rental (monthly)): $324.35–$642.07. Rural fees can be higher.
Does Medicare cover E0471?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for E0471?
Medicare policy articles that cite E0471 list 1 covered ICD-10-CM diagnosis codes across 2 articles. The most cited include G47.33 (Obstructive sleep apnea (adult) (pediatric)). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
Did the Medicare fee for E0471 change in 2026?
The average non-rural state fee for RR moved from $345.54 in 2025 to $354.65 in 2026 (+2.6%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of E0471 can be billed per day?
1 on DME suppliers (NCCI medically unlikely edits).
Related E04 codes
- E0424 — Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing ($94.56–$177.16)
- E0425 — Stationary compressed gas system, purchase; includes regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing
- E0430 — Portable gaseous oxygen system, purchase; includes regulator, flowmeter, humidifier, cannula or mask, and tubing
- E0431 — Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing ($21.24–$88.58)
- E0433 — Portable liquid oxygen system, rental; home liquefier used to fill portable liquid oxygen containers, includes portable containers, regulator, flowmeter, humidifier, cannula or mask and tubing, with or without supply reservoir and contents gauge ($46.28–$88.58)
- E0434 — Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing ($46.28–$88.58)
- E0435 — Portable liquid oxygen system, purchase; includes portable container, supply reservoir, flowmeter, humidifier, contents gauge, cannula or mask, tubing and refill adaptor
- E0439 — Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing ($94.56–$177.16)
- E0440 — Stationary liquid oxygen system, purchase; includes use of reservoir, contents indicator, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing
- E0441 — Stationary oxygen contents, gaseous, 1 month's supply = 1 unit ($61.92–$75.90)
- E0442 — Stationary oxygen contents, liquid, 1 month's supply = 1 unit ($61.92–$75.90)
- E0443 — Portable oxygen contents, gaseous, 1 month's supply = 1 unit ($56.56–$72.51)
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under E0471
- Watch E0471 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for E0471
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.