E0484 — Oscillatory positive expiratory pressure device, non-electric, any type, each
HCPCS Level II E-code · short descriptor: “Non-elec oscillatory pep dvc”
- Code system
- HCPCS Level II
- Family
- E — Durable medical equipment
- Medicare coverage status
- Carrier judgment — coverage decided by the DME MAC
- DMEPOS payment category
- Inexpensive or routinely purchased
- 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.
E0484 Medicare fee schedule (October 2026)
NU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $52.64 to $63.10 depending on state and rural status.
Former-CBA payment limits: ceiling $52.64 · floor $44.74
| State | Non-rural | Rural |
|---|---|---|
| AK | $52.64 | — |
| AL | $52.64 | — |
| AR | $52.64 | — |
| AZ | $52.64 | — |
| CA | $52.64 | — |
| CO | $52.64 | — |
| CT | $52.64 | — |
| DC | $52.64 | — |
| DE | $52.64 | — |
| FL | $52.64 | — |
| GA | $52.64 | — |
| HI | $52.64 | — |
| IA | $52.64 | — |
| ID | $52.64 | — |
| IL | $52.64 | — |
| IN | $52.64 | — |
| KS | $52.64 | — |
| KY | $52.64 | — |
| LA | $52.64 | — |
| MA | $52.64 | — |
| MD | $52.64 | — |
| ME | $52.64 | — |
| MI | $52.64 | — |
| MN | $52.64 | — |
| MO | $52.64 | — |
| MS | $52.64 | — |
| MT | $52.64 | — |
| NC | $52.64 | — |
| ND | $52.64 | — |
| NE | $52.64 | — |
| NH | $52.64 | — |
| NJ | $52.64 | — |
| NM | $52.64 | — |
| NV | $52.64 | — |
| NY | $52.64 | — |
| OH | $52.64 | — |
| OK | $52.64 | — |
| OR | $52.64 | — |
| PA | $52.64 | — |
| PR | $63.10 | — |
| RI | $52.64 | — |
| SC | $52.64 | — |
| SD | $52.64 | — |
| TN | $52.64 | — |
| TX | $52.64 | — |
| UT | $52.64 | — |
| VA | $52.64 | — |
| VI | $52.64 | — |
| VT | $52.64 | — |
| WA | $52.64 | — |
| WI | $52.64 | — |
| WV | $52.64 | — |
| WY | $52.64 | — |
RR — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $5.26 to $6.30 depending on state and rural status.
Former-CBA payment limits: ceiling $5.26 · floor $4.47
| State | Non-rural | Rural |
|---|---|---|
| AK | $5.26 | — |
| AL | $5.26 | — |
| AR | $5.26 | — |
| AZ | $5.26 | — |
| CA | $5.26 | — |
| CO | $5.26 | — |
| CT | $5.26 | — |
| DC | $5.26 | — |
| DE | $5.26 | — |
| FL | $5.26 | — |
| GA | $5.26 | — |
| HI | $5.26 | — |
| IA | $5.26 | — |
| ID | $5.26 | — |
| IL | $5.26 | — |
| IN | $5.26 | — |
| KS | $5.26 | — |
| KY | $5.26 | — |
| LA | $5.26 | — |
| MA | $5.26 | — |
| MD | $5.26 | — |
| ME | $5.26 | — |
| MI | $5.26 | — |
| MN | $5.26 | — |
| MO | $5.26 | — |
| MS | $5.26 | — |
| MT | $5.26 | — |
| NC | $5.26 | — |
| ND | $5.26 | — |
| NE | $5.26 | — |
| NH | $5.26 | — |
| NJ | $5.26 | — |
| NM | $5.26 | — |
| NV | $5.26 | — |
| NY | $5.26 | — |
| OH | $5.26 | — |
| OK | $5.26 | — |
| OR | $5.26 | — |
| PA | $5.26 | — |
| PR | $6.30 | — |
| RI | $5.26 | — |
| SC | $5.26 | — |
| SD | $5.26 | — |
| TN | $5.26 | — |
| TX | $5.26 | — |
| UT | $5.26 | — |
| VA | $5.26 | — |
| VI | $5.26 | — |
| VT | $5.26 | — |
| WA | $5.26 | — |
| WI | $5.26 | — |
| WV | $5.26 | — |
| WY | $5.26 | — |
UE — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $39.48 to $47.37 depending on state and rural status.
Former-CBA payment limits: ceiling $39.48 · floor $33.56
| State | Non-rural | Rural |
|---|---|---|
| AK | $39.48 | — |
| AL | $39.48 | — |
| AR | $39.48 | — |
| AZ | $39.48 | — |
| CA | $39.48 | — |
| CO | $39.48 | — |
| CT | $39.48 | — |
| DC | $39.48 | — |
| DE | $39.48 | — |
| FL | $39.48 | — |
| GA | $39.48 | — |
| HI | $39.48 | — |
| IA | $39.48 | — |
| ID | $39.48 | — |
| IL | $39.48 | — |
| IN | $39.48 | — |
| KS | $39.48 | — |
| KY | $39.48 | — |
| LA | $39.48 | — |
| MA | $39.48 | — |
| MD | $39.48 | — |
| ME | $39.48 | — |
| MI | $39.48 | — |
| MN | $39.48 | — |
| MO | $39.48 | — |
| MS | $39.48 | — |
| MT | $39.48 | — |
| NC | $39.48 | — |
| ND | $39.48 | — |
| NE | $39.48 | — |
| NH | $39.48 | — |
| NJ | $39.48 | — |
| NM | $39.48 | — |
| NV | $39.48 | — |
| NY | $39.48 | — |
| OH | $39.48 | — |
| OK | $39.48 | — |
| OR | $39.48 | — |
| PA | $39.48 | — |
| PR | $47.37 | — |
| RI | $39.48 | — |
| SC | $39.48 | — |
| SD | $39.48 | — |
| TN | $39.48 | — |
| TX | $39.48 | — |
| UT | $39.48 | — |
| VA | $39.48 | — |
| VI | $39.48 | — |
| VT | $39.48 | — |
| WA | $39.48 | — |
| WI | $39.48 | — |
| WV | $39.48 | — |
| WY | $39.48 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps E0484 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
Related E-codes
Bill E0484 with confidence
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