J43.9: Emphysema, unspecified
J43.9, emphysema, unspecified, is listed as a covered diagnosis in 4 Medicare billing and coding articles that apply to 63 HCPCS Level II codes, including K0730 (Controlled dose inhalation drug delivery system), E1372 (Immersion external heater for nebulizer), A7017 (Nebulizer, durable, glass or autoclavable plastic, bottle…). 20 of these codes have a 2026 DMEPOS fee schedule amount; K0730 pays $245.69 (RR) depending on the state. The articles come from 2 Medicare contractors. A listed diagnosis supports medical necessity only; coverage still depends on the LCD's criteria and on documentation in the medical record.
HCPCS Level II codes with J43.9 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| K0730 | Controlled dose inhalation drug delivery system | Carrier judgment | $245.69 (RR) | 1 |
| E1372 | Immersion external heater for nebulizer | Special coverage instructions apply | $136.61–$208.94 (NU) | 1 |
| A7017 | Nebulizer, durable, glass or autoclavable plastic, bottle type, not used with oxygen | Special coverage instructions apply | $130.82–$194.58 (NU) | 1 |
| E0580 | Nebulizer, durable, glass or autoclavable plastic, bottle type, for use with regulator or flowmeter | Special coverage instructions apply | $164.65–$182.27 (NU) | 1 |
| E0575 | Nebulizer, ultrasonic, large volume | Special coverage instructions apply | $124.51–$159.48 (RR) | 1 |
| E0565 | Compressor, air power source for equipment which is not self-contained or cylinder driven | Carrier judgment | $42.74–$82.96 (RR) | 1 |
| E0574 | Ultrasonic/electronic aerosol generator with small volume nebulizer | Carrier judgment | $48.76–$67.63 (RR) | 1 |
| E0585 | Nebulizer, with compressor and heater | Special coverage instructions apply | $32.06–$60.76 (RR) | 1 |
| E0572 | Aerosol compressor, adjustable pressure, light duty for intermittent use | Carrier judgment | $29.16–$51.74 (RR) | 1 |
| A7005 | Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable | Carrier judgment | $11.77–$29.20 (NU) | 1 |
| A7008 | Large volume nebulizer, disposable, prefilled, used with aerosol compressor | Carrier judgment | $12.46–$18.09 (NU) | 1 |
| A7016 | Dome and mouthpiece, used with small volume ultrasonic nebulizer | Carrier judgment | $9.31–$17.75 (NU) | 1 |
| E0570 | Nebulizer, with compressor | Special coverage instructions apply | $6.09–$15.43 (RR) | 1 |
| A7006 | Administration set, with small volume filtered pneumatic nebulizer | Carrier judgment | $8.19–$14.94 (NU) | 1 |
| A7007 | Large volume nebulizer, disposable, unfilled, used with aerosol compressor | Carrier judgment | $3.47–$5.87 (NU) | 1 |
| A7012 | Water collection device, used with large volume nebulizer | Carrier judgment | $3.25–$5.03 (NU) | 1 |
| A4217 | Sterile water/saline, 500 ml | Special coverage instructions apply | $2.18–$4.93 | 1 |
| A7003 | Administration set, with small volume nonfiltered pneumatic nebulizer, disposable | Carrier judgment | $1.86–$3.26 (NU) | 1 |
| A7004 | Small volume nonfiltered pneumatic nebulizer, disposable | Carrier judgment | $1.51–$2.08 (NU) | 1 |
| A7018 | Water, distilled, used with large volume nebulizer, 1000 ml | Carrier judgment | $0.38–$0.59 | 1 |
| J7677 | Revefenacin inhalation solution, fda-approved final product, non-compounded, administered through dme, 1 microgram | Carrier judgment | — | 1 |
| J7613 | Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg | Special coverage instructions apply | — | 1 |
| J7620 | Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme | Special coverage instructions apply | — | 1 |
| J7626 | Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 0.5 mg | Carrier judgment | — | 1 |
| J7605 | Arformoterol, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 15 micrograms | Carrier judgment | — | 1 |
38 more codes are listed. See every code with payment by region in Caduvo.
Medicare policy articles listing J43.9
- A52466: Nebulizers - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC); 53 Level II codes). LCD with the same title: L33370
- A56717: Billing and Coding: Respiratory Therapy (Respiratory Care) (Palmetto GBA (MAC - Part A); 3 Level II codes). LCD with the same title: L34430
- A53057: Billing and Coding: Home Health Occupational Therapy (Palmetto GBA (HHH MAC); 5 Level II codes). LCD with the same title: L34560
- A53064: Billing and Coding: Outpatient Occupational Therapy (Palmetto GBA (MAC - Part A); 3 Level II codes). LCD with the same title: L34427
A diagnosis listed as covered in a billing and coding article supports medical necessity for the article's codes; it does not guarantee payment. Coverage depends on the LCD's criteria, the contractor's jurisdiction and documentation in the medical record.
Other J43 diagnoses (Emphysema)
- J43.0 — Unilateral pulmonary emphysema [MacLeod's syndrome]
- J43.1 — Panlobular emphysema
- J43.2 — Centrilobular emphysema
- J43.8 — Other emphysema
Frequently asked questions
Does Medicare cover J43.9 (Emphysema, unspecified)?
Medicare covers items and services, not diagnoses. 4 Medicare billing and coding articles list J43.9 as a covered diagnosis for 63 HCPCS Level II codes: the diagnosis can support medical necessity for those codes, but payment still depends on the LCD's coverage criteria and the medical record.
Which HCPCS codes can be billed with ICD-10 J43.9?
The Level II codes from the policies most specific to this diagnosis are K0730 (Controlled dose inhalation drug delivery system, 1 article); E1372 (Immersion external heater for nebulizer, 1 article); A7017 (Nebulizer, durable, glass or autoclavable plastic, bottle…, 1 article); E0580 (Nebulizer, durable, glass or autoclavable plastic, bottle…, 1 article); E0575 (Nebulizer, ultrasonic, large volume, 1 article). Code choice depends on the item supplied; check each code's descriptor.
What does Medicare pay for equipment billed with J43.9?
Under the 2026 DMEPOS fee schedule (non-rural state fees): K0730 $245.69 (RR); E1372 $136.61 to $208.94 (NU); A7017 $130.82 to $194.58 (NU); E0580 $164.65 to $182.27 (NU). Medicare pays 80% of the allowed amount after the Part B deductible.
Which Medicare policy articles list J43.9?
A52466 (Nebulizers - Policy Article); A56717 (Billing and Coding: Respiratory Therapy (Respiratory Care)); A53057 (Billing and Coding: Home Health Occupational Therapy), and 1 more article.
What is ICD-10-CM code J43.9?
J43.9 is the ICD-10-CM code for emphysema, unspecified, in category J43 (Emphysema), chapter 10: Diseases of the respiratory system.
Next steps
- Run a reimbursement report for a device billed under K0730
- Watch K0730 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for K0730
Sources: CMS Medicare Coverage Database billing and coding articles (covered ICD-10 code lists and HCPCS links); ICD-10-CM FY2026; CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026 (non-rural state fees). Not billing or legal advice.
Chapter 10: Diseases of the respiratory system · All diagnoses · HCPCS lookup