MyMedi-AI

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.

StateNon-ruralRural
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—
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 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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