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
- Status
- Active (April 2026 HCPCS)
Prior authorization
Not on the Medicare required-PA list as of the January 13, 2026 update (74 items). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.
E0472 Medicare fee schedule (April 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 |
Amounts are the Medicare DMEPOS fee-schedule allowables effective April 2026.
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.
Common denial codes to watch
Related E-codes
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