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E0486 — Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment

HCPCS Level II E-code · short descriptor: “Oral device/appliance cusfab”

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
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.

E0486 Medicare fee schedule (April 2026)

NU — New purchase Inexpensive or routinely purchased

No fee-schedule amount is published for this line (carrier-priced or not separately payable).

RR — Monthly rental Inexpensive or routinely purchased

No fee-schedule amount is published for this line (carrier-priced or not separately payable).

UE — Used purchase Inexpensive or routinely purchased

No fee-schedule amount is published for this line (carrier-priced or not separately payable).

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

CO-50 medical necessity

Related E-codes

E0424E0425E0430E0431E0433E0434E0435E0439E0440E0441E0442E0443

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