E0472 — 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)
HCPCS Level II E-code · short descriptor: “Rad w backup invasive intrfc”
- Code system
- HCPCS Level II
- Family
- E — Durable medical equipment
- Medicare coverage status
- Special coverage instructions apply
- DMEPOS payment category
- Capped rental
- Prior authorization
- Not on Medicare required-PA list
- Face-to-face & WOPD
- Not on the required list
- 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))
Not on the F2F/WOPD list (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)). The standard written order must reach the supplier before claim submission.
Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.
E0472 Medicare fee schedule (October 2026)
RR — Monthly rental Capped rental
Medicare allowable ranges from $438.33 to $734.03 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $681.41 | — |
| AL | $498.67 | $612.28 |
| AR | $498.67 | $612.28 |
| AZ | $493.84 | $671.68 |
| CA | $547.42 | $671.68 |
| CO | $482.85 | $621.96 |
| CT | $483.34 | $671.68 |
| DC | $438.33 | $612.28 |
| DE | $438.33 | $612.28 |
| FL | $498.67 | $612.28 |
| GA | $498.67 | $671.68 |
| HI | $709.54 | — |
| IA | $542.74 | $612.28 |
| ID | $482.85 | $671.68 |
| IL | $533.97 | $650.98 |
| IN | $533.97 | $612.28 |
| KS | $542.74 | $671.68 |
| KY | $498.67 | $671.68 |
| LA | $498.67 | $612.28 |
| MA | $483.34 | $671.68 |
| MD | $438.33 | $671.68 |
| ME | $483.34 | $671.68 |
| MI | $533.97 | $671.68 |
| MN | $542.74 | $628.85 |
| MO | $542.74 | $671.68 |
| MS | $498.67 | $632.51 |
| MT | $482.85 | $612.28 |
| NC | $498.67 | $671.68 |
| ND | $542.74 | $612.28 |
| NE | $542.74 | $671.68 |
| NH | $483.34 | $671.68 |
| NJ | $438.33 | $612.28 |
| NM | $493.84 | $612.28 |
| NV | $547.42 | $671.68 |
| NY | $438.33 | $671.68 |
| OH | $533.97 | $671.68 |
| OK | $493.84 | $612.28 |
| OR | $547.42 | $671.68 |
| PA | $438.33 | $612.28 |
| PR | $734.03 | — |
| RI | $483.34 | $671.68 |
| SC | $498.67 | $671.68 |
| SD | $542.74 | $612.28 |
| TN | $498.67 | $671.68 |
| TX | $493.84 | $612.28 |
| UT | $482.85 | $612.28 |
| VA | $498.67 | $640.33 |
| VI | $670.09 | — |
| VT | $483.34 | $671.68 |
| WA | $547.42 | $671.68 |
| WI | $533.97 | $612.28 |
| WV | $498.67 | $671.68 |
| WY | $482.85 | $612.28 |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps E0472 at 1 unit per date of service (clinical). Units above the MUE deny — typically as CO-151. Rationale: Nature of Equipment.
Common denial codes to watch
Related E-codes
Bill E0472 with confidence
Track prior-authorization requests with AI pre-fill and deadline tracking, and draft PA appeal letters — built for DME teams, PHI-free: no patient data is collected or stored.
Start free trial Run a CMS-0057-F readiness checkPrefer DIY compliance? Self-audit documentation kits for DME suppliers →
Building an AI agent? Try the agent API in the playground — free PA-required lookups, E0472 included, and starter credits via POST /bot-marketplace/register.