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HCPCS E0472 · Level II · DME code

E0472: Respiratory assist device, bi-level pressure capability, with 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). Next CMS release: January 1, 2027 (quarterly update).

Key facts for E0472

Medicare payment
$438.33 to $547.42
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
0 / 0

TL;DR

CMS describes HCPCS E0472, added in 2004, as "Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pressure device)". E0472 is paid from the DMEPOS fee schedule as capped rental items (CR): RR (rental) $438.33 in DC, DE, MD and 3 more to $547.42 in CA, NV, OR and 1 more, rural $612.28 to $671.68, October 2026. MUE limits for E0472: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 1 (MAI 3, Nature of Equipment). No current LCD or billing article lists E0472; 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 36; type of service R (rental of DME). 2 other active codes open with "Respiratory assist device"; related codes: E0471, E0470, E0466, E0465.

E0472 descriptor and code status

The October 2026 HCPCS Level II file describes E0472 as “Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pressure device)”. It sits in the E section (durable medical equipment), listed with the other E codes.

HCPCS file attributes of E0472
FieldValue
Short descriptorRad w backup invasive intrfc
Added to HCPCS2004-01-01
Last actionN (no maintenance), effective 2006-04-01
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 E0472

E0472 is paid from the DMEPOS fee schedule as capped rental items (CR): RR (rental) $438.33 in DC, DE, MD and 3 more to $547.42 in CA, NV, OR and 1 more, rural $612.28 to $671.68, October 2026. 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 E0472 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
RR (rental)—$438.33 (DC, DE, MD…) to $547.42 (CA, NV, OR…)$612.28 (AL, AR, DC…) to $671.68 (AZ, CA, CT…)AK $681.41, HI $709.54, PR $734.03, VI $670.09

Hospital outpatient (OPPS Addendum B)

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

Medically Unlikely Edits for E0472

MUE limits for E0472: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 1 (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 E0472 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 E0472 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists E0472 in v323r0.

E0472 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 E0472 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for E0472

No current LCD or billing and coding article lists E0472. The HCPCS coverage code D means special coverage instructions apply, and any National Coverage Determination for the service still applies.

Denials to expect on E0472

CARC 50 · N115

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

CARC 151 · N362

units of E0472 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 E0472 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for E0472 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 E0472

What does HCPCS code E0472 describe?

"Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pressure device)" (short descriptor "Rad w backup invasive intrfc"), in the E section (durable medical equipment). Added 2004-01-01; last action N (no maintenance) effective 2006-04-01.

Is E0472 a CPT code?

No: CMS maintains E0472 in HCPCS Level II, while the AMA maintains CPT. It goes in the same procedure-code field.

What does Medicare pay for E0472?

E0472 is paid from the DMEPOS fee schedule as capped rental items (CR): RR (rental) $438.33 in DC, DE, MD and 3 more to $547.42 in CA, NV, OR and 1 more, rural $612.28 to $671.68, October 2026.

How many units of E0472 can be billed per day?

MUE limits for E0472: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 1 (MAI 3, Nature of Equipment). 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 E0472?

No current LCD or billing article lists E0472; 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.