MyMedi-AI

E1390 — Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate

HCPCS Level II E-code · short descriptor: “Oxygen concentrator”

Code system
HCPCS Level II
Family
E — Durable medical equipment
Medicare coverage status
Special coverage instructions apply
DMEPOS payment category
Oxygen & oxygen equipment
Prior authorization
Not on Medicare required-PA list
Face-to-face & WOPD
Required (Oxygen equipment)
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))

F2F + WOPD REQUIRED E1390 is on Medicare's Required Face-to-Face & WOPD List (Oxygen equipment — 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)). 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.

E1390 Medicare fee schedule (October 2026)

RR — Monthly rental Oxygen & oxygen equipment

Medicare allowable ranges from $94.56 to $177.16 depending on state and rural status.

StateNon-ruralRural
AK$177.16—
AL$100.21$177.16
AR$100.21$177.16
AZ$98.16$177.16
CA$94.56$177.16
CO$101.12$177.16
CT$99.53$177.16
DC$96.39$177.16
DE$96.39$177.16
FL$100.21$177.16
GA$100.21$177.16
HI$177.16—
IA$100.16$177.16
ID$101.12$177.16
IL$99.31$177.16
IN$99.31$177.16
KS$100.16$177.16
KY$100.21$177.16
LA$100.21$177.16
MA$99.53$177.16
MD$96.39$177.16
ME$99.53$177.16
MI$99.31$177.16
MN$100.16$177.16
MO$100.16$177.16
MS$100.21$177.16
MT$101.12$177.16
NC$100.21$177.16
ND$100.16$177.16
NE$100.16$177.16
NH$99.53$177.16
NJ$96.39$177.16
NM$98.16$177.16
NV$94.56$177.16
NY$96.39$177.16
OH$99.31$177.16
OK$98.16$177.16
OR$94.56$177.16
PA$96.39$177.16
PR$177.16—
RI$99.53$177.16
SC$100.21$177.16
SD$100.16$177.16
TN$100.21$177.16
TX$98.16$177.16
UT$101.12$177.16
VA$100.21$177.16
VI$177.16—
VT$99.53$177.16
WA$94.56$177.16
WI$99.31$177.16
WV$100.21$177.16
WY$101.12$177.16

RR + QB — Monthly rental Oxygen & oxygen equipment

Medicare allowable ranges from $94.56 to $177.16 depending on state and rural status.

StateNon-ruralRural
AK$177.16—
AL$100.21$177.16
AR$100.21$177.16
AZ$98.16$177.16
CA$94.56$177.16
CO$101.12$177.16
CT$99.53$177.16
DC$96.39$177.16
DE$96.39$177.16
FL$100.21$177.16
GA$100.21$177.16
HI$177.16—
IA$100.16$177.16
ID$101.12$177.16
IL$99.31$177.16
IN$99.31$177.16
KS$100.16$177.16
KY$100.21$177.16
LA$100.21$177.16
MA$99.53$177.16
MD$96.39$177.16
ME$99.53$177.16
MI$99.31$177.16
MN$100.16$177.16
MO$100.16$177.16
MS$100.21$177.16
MT$101.12$177.16
NC$100.21$177.16
ND$100.16$177.16
NE$100.16$177.16
NH$99.53$177.16
NJ$96.39$177.16
NM$98.16$177.16
NV$94.56$177.16
NY$96.39$177.16
OH$99.31$177.16
OK$98.16$177.16
OR$94.56$177.16
PA$96.39$177.16
PR$177.16—
RI$99.53$177.16
SC$100.21$177.16
SD$100.16$177.16
TN$100.21$177.16
TX$98.16$177.16
UT$101.12$177.16
VA$100.21$177.16
VI$177.16—
VT$99.53$177.16
WA$94.56$177.16
WI$99.31$177.16
WV$100.21$177.16
WY$101.12$177.16

RR + QF — Monthly rental Oxygen & oxygen equipment

Medicare allowable ranges from $94.56 to $177.16 depending on state and rural status.

StateNon-ruralRural
AK$177.16—
AL$100.21$177.16
AR$100.21$177.16
AZ$98.16$177.16
CA$94.56$177.16
CO$101.12$177.16
CT$99.53$177.16
DC$96.39$177.16
DE$96.39$177.16
FL$100.21$177.16
GA$100.21$177.16
HI$177.16—
IA$100.16$177.16
ID$101.12$177.16
IL$99.31$177.16
IN$99.31$177.16
KS$100.16$177.16
KY$100.21$177.16
LA$100.21$177.16
MA$99.53$177.16
MD$96.39$177.16
ME$99.53$177.16
MI$99.31$177.16
MN$100.16$177.16
MO$100.16$177.16
MS$100.21$177.16
MT$101.12$177.16
NC$100.21$177.16
ND$100.16$177.16
NE$100.16$177.16
NH$99.53$177.16
NJ$96.39$177.16
NM$98.16$177.16
NV$94.56$177.16
NY$96.39$177.16
OH$99.31$177.16
OK$98.16$177.16
OR$94.56$177.16
PA$96.39$177.16
PR$177.16—
RI$99.53$177.16
SC$100.21$177.16
SD$100.16$177.16
TN$100.21$177.16
TX$98.16$177.16
UT$101.12$177.16
VA$100.21$177.16
VI$177.16—
VT$99.53$177.16
WA$94.56$177.16
WI$99.31$177.16
WV$100.21$177.16
WY$101.12$177.16
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 E1390 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

CO-50 medical necessityCO-151 frequency/units

Related E-codes

E1300E1301E1310E1352E1353E1354E1355E1356E1357E1358E1372E1391

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