E0486 HCPCS code: Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment
E0486 is the HCPCS Level II code for oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment. In 2024 Medicare paid an average of $1,278.19 per service for E0486 across 14,636 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 1 per day on DME suppliers. Medicare volume rose 35% from 2022 to 2024 (10,881 to 14,636 services). In 2024, 816 suppliers billed Medicare for E0486 (purchases), serving 14,616 beneficiaries; California, Texas, Florida accounted for 36% of services.
Code details
| Field | Value |
|---|---|
| Section | E codes — Durable medical equipment |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 32 — DMEPOS: inexpensive or routinely purchased item |
| BETOS category | D1E — Other durable medical equipment |
| Added | 2006-01-01 |
| Last action effective | 2006-01-01 |
Who bills E0486 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 816 |
| Referring clinicians | 5,084 |
| Medicare beneficiaries | 14,616 |
| States with claims | 47 |
| Share of services in top 3 states (California, Texas, Florida) | 36% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 833 | 10,865 |
| 2023 | 810 | 12,082 |
| 2024 | 816 | 14,616 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for E0486, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 10,881 | 10,865 | $1,487.03 | $1,163.84 |
| 2023 | 12,106 | 12,082 | $1,611.89 | $1,254.93 |
| 2024 | 14,636 | 14,616 | $1,639.99 | $1,278.19 |
States with the most E0486 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 2,756 | $1,291.35 |
| Texas | 1,418 | $1,029.46 |
| Florida | 1,117 | $1,100.19 |
| Illinois | 924 | $1,219.54 |
| New York | 908 | $1,771.17 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 1 | Code Descriptor / CPT Instruction |
Medicare policy articles for this code
- A52512: Oral Appliances for Obstructive Sleep Apnea - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
- A52519: Suction Pumps - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
- A53497: Billing and Coding: Oral Maxillofacial Prosthesis (Palmetto GBA (MAC - Part A, MAC - Part B))
Covered diagnoses (9 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 |
| J95.00 | Unspecified tracheostomy complication | 1 |
| J95.01 | Hemorrhage from tracheostomy stoma | 1 |
| J95.02 | Infection of tracheostomy stoma | 1 |
| J95.03 | Malfunction of tracheostomy stoma | 1 |
| J95.04 | Tracheo-esophageal fistula following tracheostomy | 1 |
| J95.09 | Other tracheostomy complication | 1 |
| Z43.0 | Encounter for attention to tracheostomy | 1 |
| Z93.0 | Tracheostomy status | 1 |
What changed for E0486
- 2006-01-01: E0486 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 E0486?
E0486 is the HCPCS Level II code for oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment. Short descriptor: "Oral device/appliance cusfab".
How much does Medicare pay for E0486?
In 2024, the average Medicare payment was $1,278.19 per service (average allowed $1,639.99).
Does Medicare cover E0486?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for E0486?
Medicare policy articles that cite E0486 list 9 covered ICD-10-CM diagnosis codes across 3 articles. The most cited include G47.33 (Obstructive sleep apnea (adult) (pediatric)), J95.00 (Unspecified tracheostomy complication), J95.01 (Hemorrhage from tracheostomy stoma). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of E0486 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 E0486
- Watch E0486 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for E0486
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; 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.