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HCPCS E0470 · Level II · DME code

E0470: Respiratory assist device, bi-level pressure capability, without backup rate feature, 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); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and DMEPOS fee schedule and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for E0470

Medicare payment
$129.84 to $136.68
DMEPOS non-rural state fees (RR)
Coverage code
D
special coverage instructions apply
DME supplier MUE
1
MAI 3
OPPS status
SI Y
Non-implantable DME
NCCI PTP pairs
0
practitioner file
LCDs and articles
2 / 0

TL;DR

E0470 is a Level II code from the E section (durable medical equipment), in use since 2004: "Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)". The October 2026 DMEPOS fee schedule (category CR, capped rental items) sets E0470 at RR (rental) $129.84 in DC, DE, MD and 3 more to $136.68 in CO, ID, MT and 2 more, rural $208.36 to $232.10. CMS caps E0470 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 1 (MAI 3, Nature of Equipment) units per day in the 2026 Q4 MUE tables. 2 active LCDs list E0470: L33718 (Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea), L33800 (Respiratory Assist Devices). OPPS status indicator Y: Non-implantable DME. HCPCS record: BETOS D1E (other DME); pricing indicator 36; type of service R (rental of DME). 2 other active codes open with "Respiratory assist device"; related codes: E0471, E0472, E0466, E0465.

E0470 descriptor and code status

The October 2026 HCPCS Level II file describes E0470 as “Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)”. It sits in the E section (durable medical equipment), listed with the other E codes. Although searches often call it the "E0470 CPT code", E0470 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 E0470
FieldValue
Short descriptorRad w/o backup non-inv intfc
Added to HCPCS2004-01-01
Last actionN (no maintenance), effective 2004-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator36: DMEPOS capped rental DME (floors and ceilings)
BETOS categoryD1E: other DME
Type of serviceR: rental of DME

Medicare payment for E0470

The October 2026 DMEPOS fee schedule (category CR, capped rental items) sets E0470 at RR (rental) $129.84 in DC, DE, MD and 3 more to $136.68 in CO, ID, MT and 2 more, rural $208.36 to $232.10. 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 CR (capped rental 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 E0470 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
RR (rental)—$129.84 (DC, DE, MD…) to $136.68 (CO, ID, MT…)$208.36 (AZ, DC, DE…) to $232.10 (AR, CO, GA…)AK $226.66, HI $237.27, PR $134.93, VI $231.46

Hospital outpatient (OPPS Addendum B)

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

Medically Unlikely Edits for E0470

CMS caps E0470 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 1 (MAI 3, Nature of Equipment) units per day in the 2026 Q4 MUE tables. 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 E0470 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 supplier13 Date of Service Edit: ClinicalNature of Equipment

The MUE lookup for E0470 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists E0470 in v323r0.

E0470 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 E0470 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for E0470

2 active Local Coverage Determinations and 0 billing and coding articles list E0470. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Denials to expect on E0470

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists E0470

CARC 151 · N362

units of E0470 exceed the DME supplier MUE of 1 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 E0470 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for E0470 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 E0470

What does HCPCS code E0470 describe?

"Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)" (short descriptor "Rad w/o backup non-inv intfc"), in the E section (durable medical equipment). Added 2004-01-01.

Is E0470 a CPT code?

It is not. E0470 belongs to the E section (durable medical equipment) of HCPCS Level II, the CMS code set, not to AMA CPT. "E0470 CPT code" searches refer to it.

What does Medicare pay for E0470?

The October 2026 DMEPOS fee schedule (category CR, capped rental items) sets E0470 at RR (rental) $129.84 in DC, DE, MD and 3 more to $136.68 in CO, ID, MT and 2 more, rural $208.36 to $232.10.

How many units of E0470 can be billed per day?

CMS caps E0470 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 1 (MAI 3, Nature of Equipment) units per day in the 2026 Q4 MUE tables. For the DME supplier MUE (MAI 3), units above 1 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover E0470?

Coverage code D (special coverage instructions apply). 2 active LCDs list E0470: L33718 (Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea), L33800 (Respiratory Assist Devices).

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.