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HCPCS E0465 · Level II · DME code

E0465: Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube), HCPCS Level II DME code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); DMEPOS fee schedule: DME26-D (October 2026) (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update).

Key facts for E0465

Medicare payment
$1,156.28 to $1,360.33
DMEPOS non-rural state fees (RR)
Coverage code
D
special coverage instructions apply
DME supplier MUE
2
MAI 3
OPPS status
SI Y
Non-implantable DME
NCCI PTP pairs
0
practitioner file
LCDs and articles
0 / 0

TL;DR

HCPCS Level II E0465 reads "Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube)" in the October 2026 file; it dates from 2016. DMEPOS fees for E0465, a FS (frequently serviced items) item, run RR (rental) $1,156.28 in AL, CA, CO and 5 more to $1,360.33 in AZ, CT, DE and 22 more (floor $1,156.28, ceiling $1,360.33) in the October 2026 file. Its 2026 Q4 MUEs per date of service: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 2 (MAI 3, Nature of Equipment). No current LCD or billing article lists E0465; its HCPCS coverage code is D (special coverage instructions apply). OPPS status indicator Y: Non-implantable DME. HCPCS record: BETOS D1E (other DME); pricing indicator 31; type of service R (rental of DME). 3 other active codes open with "Home ventilator"; related codes: E0466, E0467, E0468, E0470.

E0465 descriptor and code status

The October 2026 HCPCS Level II file describes E0465 as “Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube)”. It sits in the E section (durable medical equipment), listed with the other E codes. Although searches often call it the "E0465 CPT code", E0465 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of E0465
FieldValue
Short descriptorHome vent invasive interface
Added to HCPCS2016-01-01
Last actionN (no maintenance), effective 2016-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator31: DMEPOS frequently serviced DME (floors and ceilings)
BETOS categoryD1E: other DME
Type of serviceR: rental of DME

Medicare payment for E0465

DMEPOS fees for E0465, a FS (frequently serviced items) item, run RR (rental) $1,156.28 in AL, CA, CO and 5 more to $1,360.33 in AZ, CT, DE and 22 more (floor $1,156.28, ceiling $1,360.33) in the October 2026 file. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

DMEPOS fee schedule (DME26-D)

Jurisdiction D (DME MAC), payment category FS (frequently serviced items). Fees are set per state; AK, HI, PR and VI are not subject to the national ceiling and floor and are listed separately. A rural fee applies only in ZIP codes on the CMS rural ZIP list.

DMEPOS fees for E0465 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
RR (rental)$1,156.28 / $1,360.33$1,156.28 (AL, CA, CO…) to $1,360.33 (AZ, CT, DE…)—AK $1,113.72, HI $1,190.93, PR $2,261.71, VI $1,360.33

Hospital outpatient (OPPS Addendum B)

Status indicator Y (Non-implantable DME), with no separate OPPS payment rate.

Medically Unlikely Edits for E0465

Its 2026 Q4 MUEs per date of service: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 2 (MAI 3, Nature of Equipment). The DME supplier MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for E0465 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalCMS Policy
Facility outpatient hospital03 Date of Service Edit: ClinicalCMS Policy
DME supplier23 Date of Service Edit: ClinicalNature of Equipment

The MUE lookup for E0465 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists E0465 in v323r0.

E0465 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check E0465 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for E0465

No current LCD or billing and coding article lists E0465. The HCPCS coverage code D means special coverage instructions apply, and any National Coverage Determination for the service still applies.

Denials to expect on E0465

CARC 50 · N115

the service is not reasonable and necessary for the diagnosis on the claim

CARC 151 · N362

units of E0465 exceed the DME supplier MUE of 2 per date of service

CARC 4

the RR payment modifier is missing or does not match the item

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for E0465 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for E0465 depend on, with human review of each case, and QuickRCM carries claim readiness and the CARC 50, 151 and modifier denials these items draw.

See QuickAuth for requirement checksSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS E0465

What does HCPCS code E0465 describe?

"Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube)" (short descriptor "Home vent invasive interface"), in the E section (durable medical equipment). Added 2016-01-01.

Is E0465 a CPT code?

No. E0465 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set. Searches for "E0465 CPT code" mean this Level II code.

What does Medicare pay for E0465?

DMEPOS fees for E0465, a FS (frequently serviced items) item, run RR (rental) $1,156.28 in AL, CA, CO and 5 more to $1,360.33 in AZ, CT, DE and 22 more (floor $1,156.28, ceiling $1,360.33) in the October 2026 file.

How many units of E0465 can be billed per day?

Its 2026 Q4 MUEs per date of service: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 2 (MAI 3, Nature of Equipment). For the DME supplier MUE (MAI 3), units above 2 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover E0465?

No current LCD or billing article lists E0465; its HCPCS coverage code is D (special coverage instructions apply).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.