E0472 HCPCS code: Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pressure device)
E0472 is the HCPCS Level II code for respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pressure device). The 2026 Medicare DMEPOS fee schedule pays $438.33 to $734.03 (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 9% from 2022 to 2024 (11 to 12 services). In 2024, 2 suppliers billed Medicare for E0472 (rentals), serving 0 beneficiaries. Its average fee ranks 12 of 19 E04 codes billed RR (family range $5.28–$1,572.12); rural fees run 25% 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 E0472
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| RR | rental (monthly) | $438.33 | $734.03 | — | — |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | RR | $681.41 | — |
| AL | RR | $498.67 | $612.28 |
| AR | RR | $498.67 | $612.28 |
| AZ | RR | $493.84 | $671.68 |
| CA | RR | $547.42 | $671.68 |
| CO | RR | $482.85 | $621.96 |
| CT | RR | $483.34 | $671.68 |
| DC | RR | $438.33 | $612.28 |
| DE | RR | $438.33 | $612.28 |
| FL | RR | $498.67 | $612.28 |
| GA | RR | $498.67 | $671.68 |
| HI | RR | $709.54 | — |
| IA | RR | $542.74 | $612.28 |
| ID | RR | $482.85 | $671.68 |
| IL | RR | $533.97 | $650.98 |
| IN | RR | $533.97 | $612.28 |
| KS | RR | $542.74 | $671.68 |
| KY | RR | $498.67 | $671.68 |
| LA | RR | $498.67 | $612.28 |
| MA | RR | $483.34 | $671.68 |
| MD | RR | $438.33 | $671.68 |
| ME | RR | $483.34 | $671.68 |
| MI | RR | $533.97 | $671.68 |
| MN | RR | $542.74 | $628.85 |
| MO | RR | $542.74 | $671.68 |
| MS | RR | $498.67 | $632.51 |
| MT | RR | $482.85 | $612.28 |
| NC | RR | $498.67 | $671.68 |
| ND | RR | $542.74 | $612.28 |
| NE | RR | $542.74 | $671.68 |
| NH | RR | $483.34 | $671.68 |
| NJ | RR | $438.33 | $612.28 |
| NM | RR | $493.84 | $612.28 |
| NV | RR | $547.42 | $671.68 |
| NY | RR | $438.33 | $671.68 |
| OH | RR | $533.97 | $671.68 |
| OK | RR | $493.84 | $612.28 |
| OR | RR | $547.42 | $671.68 |
| PA | RR | $438.33 | $612.28 |
| PR | RR | $734.03 | — |
| RI | RR | $483.34 | $671.68 |
| SC | RR | $498.67 | $671.68 |
| SD | RR | $542.74 | $612.28 |
| TN | RR | $498.67 | $671.68 |
| TX | RR | $493.84 | $612.28 |
| UT | RR | $482.85 | $612.28 |
| VA | RR | $498.67 | $640.33 |
| VI | RR | $670.09 | — |
| VT | RR | $483.34 | $671.68 |
| WA | RR | $547.42 | $671.68 |
| WI | RR | $533.97 | $612.28 |
| WV | RR | $498.67 | $671.68 |
| WY | RR | $482.85 | $612.28 |
How the E0472 fee compares
| Measure | Value |
|---|---|
| Rank among 19 E04 codes billed RR (lowest = 1) | 12 |
| Family fee range (average of state fees) | $5.28–$1,572.12 |
| Rural fee uplift | 24.9% |
Who bills E0472 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | 2 |
| Suppliers billing purchases | — |
| Referring clinicians | 2 |
| Medicare beneficiaries | 0 |
| States with claims | 0 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 3 | 0 |
| 2024 | 2 | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for E0472, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 11 | 0 | $362.73 | $266.43 |
| 2024 | 12 | 0 | $412.42 | $323.34 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 1 | Nature of Equipment |
What changed for E0472
- 2026-01-01: Average state fee (RR) rose 2.7%: $502.82 to $516.18
- 2004-01-01: E0472 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 E0472?
E0472 is the HCPCS Level II code for respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pressure device). Short descriptor: "Rad w backup invasive intrfc".
How much does Medicare pay for E0472?
Under the 2026 DMEPOS fee schedule, non-rural state fees are RR (rental (monthly)): $438.33–$734.03. Rural fees can be higher.
Does Medicare cover E0472?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Did the Medicare fee for E0472 change in 2026?
The average non-rural state fee for RR moved from $502.82 in 2025 to $516.18 in 2026 (+2.7%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of E0472 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)
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Next steps
- Run a reimbursement report for a device billed under E0472
- Watch E0472 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for E0472
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.