E0468 — Home ventilator, dual-function respiratory device, also performs additional function of cough stimulation, includes all accessories, components and supplies for all functions
HCPCS Level II E-code · short descriptor: “Home vent dual fnct incl all”
- Code system
- HCPCS Level II
- Family
- E — Durable medical equipment
- Medicare coverage status
- Special coverage instructions apply
- DMEPOS payment category
- Frequently serviced
- Prior authorization
- Not on Medicare required-PA list
- Face-to-face & WOPD
- Required from 2026-10-28 (Home ventilators)
- MUE unit limit
- 2
- 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 FROM 2026-10-28 E0468 joins Medicare's Required Face-to-Face & WOPD List for dates of service on or after 2026-10-28 (Home ventilators — CMS-6109-N, 91 FR 47972 (published 2026-07-30)). From that date 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.
E0468 Medicare fee schedule (October 2026)
RR — Monthly rental Frequently serviced
Medicare allowable ranges from $1229.81 to $2381.50 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $1229.81 | — |
| AL | $1256.30 | — |
| AR | $1430.05 | — |
| AZ | $1455.14 | — |
| CA | $1253.58 | — |
| CO | $1258.42 | — |
| CT | $1462.47 | — |
| DC | $1327.01 | — |
| DE | $1460.04 | — |
| FL | $1453.83 | — |
| GA | $1459.41 | — |
| HI | $1287.05 | — |
| IA | $1393.83 | — |
| ID | $1268.75 | — |
| IL | $1462.47 | — |
| IN | $1258.42 | — |
| KS | $1411.89 | — |
| KY | $1462.47 | — |
| LA | $1293.30 | — |
| MA | $1462.47 | — |
| MD | $1252.62 | — |
| ME | $1367.20 | — |
| MI | $1458.01 | — |
| MN | $1462.47 | — |
| MO | $1370.22 | — |
| MS | $1247.81 | — |
| MT | $1280.37 | — |
| NC | $1462.47 | — |
| ND | $1452.30 | — |
| NE | $1416.82 | — |
| NH | $1462.47 | — |
| NJ | $1456.18 | — |
| NM | $1401.63 | — |
| NV | $1457.43 | — |
| NY | $1459.37 | — |
| OH | $1462.47 | — |
| OK | $1462.47 | — |
| OR | $1435.30 | — |
| PA | $1458.22 | — |
| PR | $2381.50 | — |
| RI | $1447.16 | — |
| SC | $1254.64 | — |
| SD | $1460.51 | — |
| TN | $1456.09 | — |
| TX | $1462.47 | — |
| UT | $1351.38 | — |
| VA | $1455.32 | — |
| VI | $1462.47 | — |
| VT | $1295.81 | — |
| WA | $1258.42 | — |
| WI | $1266.39 | — |
| WV | $1459.02 | — |
| WY | $1460.18 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps E0468 at 2 units per date of service (absolute). Units above the MUE deny — typically as CO-151. Rationale: CMS Policy.
Common denial codes to watch
Related E-codes
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