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HCPCS E0485 · Level II · DME code

E0485: Oral device/appliance used to reduce upper airway collapsibility, 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 E0485

Medicare payment
no DMEPOS fee
DMEPOS category IN, no ceiling or state fee
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
DME supplier MUE
1
MAI 2
OPPS status
SI Y
Non-implantable DME
NCCI PTP pairs
0
practitioner file
LCDs and articles
2 / 1

TL;DR

E0485 is a Level II code from the E section (durable medical equipment), in use since 2006: "Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes fitting and adjustment". The October 2026 DMEPOS fee schedule lists E0485 in category IN (inexpensive and other routinely purchased items) without a ceiling, floor or state fee; its HCPCS pricing indicator is 32 (DMEPOS inexpensive and routinely purchased DME (floors and ceilings)). CMS caps E0485 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. 2 active LCDs and 1 billing and coding article list E0485 across 4 states: L33611 (Oral Appliances for Obstructive Sleep Apnea), L33428 (Cosmetic and Reconstructive Surgery), A53497. OPPS status indicator Y: Non-implantable DME. HCPCS record: BETOS D1E (other DME); pricing indicator 32; type of service P (lump-sum purchase of DME, prosthetics or orthotics). 1 other active code opens with "Oral device/appliance used to reduce upper airway collapsibility"; related codes: E0486, E0483, E0482, E0471.

E0485 descriptor and code status

The October 2026 HCPCS Level II file describes E0485 as “Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes fitting and adjustment”. It sits in the E section (durable medical equipment), listed with the other E codes. Although searches often call it the "E0485 CPT code", E0485 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 E0485
FieldValue
Short descriptorOral device/appliance prefab
Added to HCPCS2006-01-01
Last actionN (no maintenance), effective 2006-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator32: DMEPOS inexpensive and routinely purchased DME (floors and ceilings)
BETOS categoryD1E: other DME
Type of serviceP: lump-sum purchase of DME, prosthetics or orthotics

Medicare payment for E0485

The October 2026 DMEPOS fee schedule lists E0485 in category IN (inexpensive and other routinely purchased items) without a ceiling, floor or state fee; its HCPCS pricing indicator is 32 (DMEPOS inexpensive and routinely purchased DME (floors and ceilings)). 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 IN (inexpensive and other routinely purchased 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 E0485 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
NU (purchased, new)————
RR (rental)————
UE (purchased, used)————

Hospital outpatient (OPPS Addendum B)

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

Medically Unlikely Edits for E0485

CMS caps E0485 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. 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 E0485 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 supplier12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction

The MUE lookup for E0485 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists E0485 in v323r0.

E0485 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 E0485 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for E0485

2 active Local Coverage Determinations and 1 billing and coding article list E0485. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Billing and Coding Articles listing E0485
ArticleTitleContractor(s)Related LCD
A53497Billing and Coding: Oral Maxillofacial ProsthesisPalmetto GBAL33428

Denials to expect on E0485

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists E0485

CARC 151 · N362

units of E0485 exceed the DME supplier MUE of 1 per date of service

CARC 4

the NU, RR, UE 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 E0485 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for E0485 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 E0485

What does HCPCS code E0485 describe?

"Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes fitting and adjustment" (short descriptor "Oral device/appliance prefab"), in the E section (durable medical equipment). Added 2006-01-01.

Is E0485 a CPT code?

It is not. E0485 belongs to the E section (durable medical equipment) of HCPCS Level II, the CMS code set, not to AMA CPT. "E0485 CPT code" searches refer to it.

What does Medicare pay for E0485?

The October 2026 DMEPOS fee schedule lists E0485 in category IN (inexpensive and other routinely purchased items) without a ceiling, floor or state fee; its HCPCS pricing indicator is 32 (DMEPOS inexpensive and routinely purchased DME (floors and ceilings)).

How many units of E0485 can be billed per day?

CMS caps E0485 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. For the DME supplier MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover E0485?

Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 2 active LCDs and 1 billing and coding article list E0485 across 4 states: L33611 (Oral Appliances for Obstructive Sleep Apnea), L33428 (Cosmetic and Reconstructive Surgery), A53497.

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.