MyMedi-AI

E0433 — Portable liquid oxygen system, rental; home liquefier used to fill portable liquid oxygen containers, includes portable containers, regulator, flowmeter, humidifier, cannula or mask and tubing, with or without supply reservoir and contents gauge

HCPCS Level II E-code · short descriptor: “Portable liquid oxygen sys”

Code system
HCPCS Level II
Family
E — Durable medical equipment
Medicare coverage status
Carrier judgment — coverage decided by the DME MAC
DMEPOS payment category
Oxygen & oxygen equipment
Prior authorization
Not on Medicare required-PA list
Face-to-face & WOPD
Required (Oxygen equipment)
MUE unit limit
1
Status
Active (HCPCS Level II October 2026)

Prior authorization

Not on the Medicare required-PA list (CMS Required Prior Authorization List — 74 items in force on 2026-10-25; 8 more from 2026-10-28; sources: CMS list updated 2026-01-13, CMS-6109-N (91 FR 47972)). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.

Order readiness — what the written order must contain

Every Medicare DMEPOS claim needs a Standard Written Order with all six elements (42 CFR 410.38(d)):

  • Beneficiary name or Medicare Beneficiary Identifier (MBI) (42 CFR 410.38(d)(1)(i)(A))
  • General description of the item (42 CFR 410.38(d)(1)(i)(B))
  • Quantity to be dispensed, if applicable (42 CFR 410.38(d)(1)(i)(C))
  • Order date (42 CFR 410.38(d)(1)(i)(D))
  • Treating practitioner name or NPI (42 CFR 410.38(d)(1)(i)(E))
  • Treating practitioner signature (42 CFR 410.38(d)(1)(i)(F))

F2F + WOPD REQUIRED E0433 is on Medicare's Required Face-to-Face & WOPD List (Oxygen equipment — CMS Required F2F & WOPD List — 83 items in force on 2026-10-25; 22 more from 2026-10-28; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). Two extra conditions of payment apply:

  • Face-to-face encounter (in-person or telehealth) with the treating practitioner within the 6 months before the order date
  • Written order communicated to the supplier before delivery (WOPD)

Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.

E0433 Medicare fee schedule (October 2026)

RR — Monthly rental Oxygen & oxygen equipment

Medicare allowable ranges from $46.28 to $51.63 depending on state and rural status.

StateNon-ruralRural
AK$51.63—
AL$47.94$51.63
AR$47.94$51.63
AZ$47.17$51.63
CA$48.20$51.63
CO$50.70$51.63
CT$50.81$51.63
DC$49.59$51.63
DE$49.59$51.63
FL$47.94$51.63
GA$47.94$51.63
HI$51.63—
IA$49.53$51.63
ID$50.70$51.63
IL$46.28$51.63
IN$46.28$51.63
KS$49.53$51.63
KY$47.94$51.63
LA$47.94$51.63
MA$50.81$51.63
MD$49.59$51.63
ME$50.81$51.63
MI$46.28$51.63
MN$49.53$51.63
MO$49.53$51.63
MS$47.94$51.63
MT$50.70$51.63
NC$47.94$51.63
ND$49.53$51.63
NE$49.53$51.63
NH$50.81$51.63
NJ$49.59$51.63
NM$47.17$51.63
NV$48.20$51.63
NY$49.59$51.63
OH$46.28$51.63
OK$47.17$51.63
OR$48.20$51.63
PA$49.59$51.63
PR$51.63—
RI$50.81$51.63
SC$47.94$51.63
SD$49.53$51.63
TN$47.94$51.63
TX$47.17$51.63
UT$50.70$51.63
VA$47.94$51.63
VI$51.63—
VT$50.81$51.63
WA$48.20$51.63
WI$46.28$51.63
WV$47.94$51.63
WY$50.70$51.63

RR + QB — Monthly rental Oxygen & oxygen equipment

Medicare allowable ranges from $48.20 to $88.58 depending on state and rural status.

StateNon-ruralRural
AK$88.58—
AL$50.11$88.58
AR$50.11$88.58
AZ$49.08$88.58
CA$48.20$88.58
CO$50.70$88.58
CT$50.81$88.58
DC$49.59$88.58
DE$49.59$88.58
FL$50.11$88.58
GA$50.11$88.58
HI$88.58—
IA$50.08$88.58
ID$50.70$88.58
IL$49.66$88.58
IN$49.66$88.58
KS$50.08$88.58
KY$50.11$88.58
LA$50.11$88.58
MA$50.81$88.58
MD$49.59$88.58
ME$50.81$88.58
MI$49.66$88.58
MN$50.08$88.58
MO$50.08$88.58
MS$50.11$88.58
MT$50.70$88.58
NC$50.11$88.58
ND$50.08$88.58
NE$50.08$88.58
NH$50.81$88.58
NJ$49.59$88.58
NM$49.08$88.58
NV$48.20$88.58
NY$49.59$88.58
OH$49.66$88.58
OK$49.08$88.58
OR$48.20$88.58
PA$49.59$88.58
PR$88.58—
RI$50.81$88.58
SC$50.11$88.58
SD$50.08$88.58
TN$50.11$88.58
TX$49.08$88.58
UT$50.70$88.58
VA$50.11$88.58
VI$88.58—
VT$50.81$88.58
WA$48.20$88.58
WI$49.66$88.58
WV$50.11$88.58
WY$50.70$88.58

RR + QF — Monthly rental Oxygen & oxygen equipment

Medicare allowable ranges from $48.20 to $88.58 depending on state and rural status.

StateNon-ruralRural
AK$88.58—
AL$50.11$88.58
AR$50.11$88.58
AZ$49.08$88.58
CA$48.20$88.58
CO$50.70$88.58
CT$50.81$88.58
DC$49.59$88.58
DE$49.59$88.58
FL$50.11$88.58
GA$50.11$88.58
HI$88.58—
IA$50.08$88.58
ID$50.70$88.58
IL$49.66$88.58
IN$49.66$88.58
KS$50.08$88.58
KY$50.11$88.58
LA$50.11$88.58
MA$50.81$88.58
MD$49.59$88.58
ME$50.81$88.58
MI$49.66$88.58
MN$50.08$88.58
MO$50.08$88.58
MS$50.11$88.58
MT$50.70$88.58
NC$50.11$88.58
ND$50.08$88.58
NE$50.08$88.58
NH$50.81$88.58
NJ$49.59$88.58
NM$49.08$88.58
NV$48.20$88.58
NY$49.59$88.58
OH$49.66$88.58
OK$49.08$88.58
OR$48.20$88.58
PA$49.59$88.58
PR$88.58—
RI$50.81$88.58
SC$50.11$88.58
SD$50.08$88.58
TN$50.11$88.58
TX$49.08$88.58
UT$50.70$88.58
VA$50.11$88.58
VI$88.58—
VT$50.81$88.58
WA$48.20$88.58
WI$49.66$88.58
WV$50.11$88.58
WY$50.70$88.58
Amounts are the Medicare DMEPOS fee-schedule allowables effective October 2026 (CMS DMEPOS Fee Schedule October 2026 (DME26-D)). Medicare typically pays 80% of the allowable after the Part B deductible; the patient owes 20%. A 2% sequestration reduction applies to the Medicare share. Former competitive-bidding-area adjustments and non-continental rates can differ — verify with your DME MAC.

Unit limit (MUE)

Medicare's Medically Unlikely Edit caps E0433 at 1 unit per date of service (absolute). Units above the MUE deny — typically as CO-151. Rationale: Code Descriptor / CPT Instruction.

Common denial codes to watch

CO-50 medical necessityCO-151 frequency/units

Related E-codes

E0424E0425E0430E0431E0434E0435E0439E0440E0441E0442E0443E0444

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