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HCPCS E0468 · Level II · DME code

E0468: Home ventilator, dual-function respiratory device, 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 E0468

Medicare payment
$1,247.81 to $1,462.47
DMEPOS non-rural state fees (RR)
Coverage code
D
special coverage instructions apply
DME supplier MUE
2
MAI 2
OPPS status
SI Y
Non-implantable DME
NCCI PTP pairs
0
practitioner file
LCDs and articles
0 / 0

TL;DR

HCPCS Level II E0468 reads "Home ventilator, dual-function respiratory device, also performs additional function of cough stimulation, includes all accessories, components and supplies for all functions" in the October 2026 file; it dates from 2024. DMEPOS fees for E0468, a FS (frequently serviced items) item, run RR (rental) $1,247.81 in MS to $1,462.47 in CT, IL, KY and 7 more in the October 2026 file. Its 2026 Q4 MUEs per date of service: DME supplier 2 (MAI 2, CMS Policy). E0468 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code D (special coverage instructions apply) and any NCD. 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, E0465, E0467, E0470.

E0468 descriptor and code status

The October 2026 HCPCS Level II file describes E0468 as “Home ventilator, dual-function respiratory device, also performs additional function of cough stimulation, includes all accessories, components and supplies for all functions”. It sits in the E section (durable medical equipment), listed with the other E codes.

HCPCS file attributes of E0468
FieldValue
Short descriptorHome vent dual fnct incl all
Added to HCPCS2024-04-01
Last actionN (no maintenance), effective 2024-04-01
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 E0468

DMEPOS fees for E0468, a FS (frequently serviced items) item, run RR (rental) $1,247.81 in MS to $1,462.47 in CT, IL, KY and 7 more 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 E0468 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
RR (rental)—$1,247.81 (MS) to $1,462.47 (CT, IL, KY…)—AK $1,229.81, HI $1,287.05, PR $2,381.50, VI $1,462.47

Hospital outpatient (OPPS Addendum B)

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

Medically Unlikely Edits for E0468

Its 2026 Q4 MUEs per date of service: DME supplier 2 (MAI 2, CMS Policy). The DME supplier MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.

MUE values for E0468 by setting
SettingMUE (units/DOS)MAICMS rationale
DME supplier22 Date of Service Edit: PolicyCMS Policy

The MUE lookup for E0468 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists E0468 in v323r0.

E0468 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 E0468 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for E0468

No current LCD or billing and coding article lists E0468. The HCPCS coverage code D means special coverage instructions apply, and any National Coverage Determination for the service still applies.

Denials to expect on E0468

CARC 50 · N115

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

CARC 151 · N362

units of E0468 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 E0468 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for E0468 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 E0468

What does HCPCS code E0468 describe?

"Home ventilator, dual-function respiratory device, also performs additional function of cough stimulation, includes all accessories, components and supplies for all functions" (short descriptor "Home vent dual fnct incl all"), in the E section (durable medical equipment). Added 2024-04-01.

Is E0468 a CPT code?

No. E0468 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set.

What does Medicare pay for E0468?

DMEPOS fees for E0468, a FS (frequently serviced items) item, run RR (rental) $1,247.81 in MS to $1,462.47 in CT, IL, KY and 7 more in the October 2026 file.

How many units of E0468 can be billed per day?

Its 2026 Q4 MUEs per date of service: DME supplier 2 (MAI 2, CMS Policy). For the DME supplier MUE (MAI 2), units above 2 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover E0468?

E0468 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code D (special coverage instructions apply) and any NCD.

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.