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E0424 |
 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing
| short | Stationary compressed gas 02 |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
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E0425 |
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Stationary compressed gas system, purchase; includes regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing
| short | Gas system stationary compre |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
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E0430 |
|
Portable gaseous oxygen system, purchase; includes regulator, flowmeter, humidifier, cannula or mask, and tubing
| short | Oxygen system gas portable |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
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E0431 |
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Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing
| short | Portable gaseous 02 |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
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E0433 |
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Portable liquid oxygen system, rental; home liquefier used to fill portable liquid oxygen containers, includes portable containers, regulator, flowmeter, humidifier, cannula or mask and tubing, with or without supply reservoir and contents gauge
| short | Portable liquid oxygen sys |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
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E0434 |
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Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing
| short | Portable liquid 02 |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
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E0435 |
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Portable liquid oxygen system, purchase; includes portable container, supply reservoir, flowmeter, humidifier, contents gauge, cannula or mask, tubing and refill adaptor
| short | Oxygen system liquid portabl |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
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E0439 |
|
Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing
| short | Stationary liquid 02 |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
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E0440 |
|
Stationary liquid oxygen system, purchase; includes use of reservoir, contents indicator, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing
| short | Oxygen system liquid station |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
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E0441 |
|
Stationary oxygen contents, gaseous, 1 month's supply = 1 unit
| short | Stationary o2 contents, gas |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
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E0442 |
|
Stationary oxygen contents, liquid, 1 month's supply = 1 unit
| short | Stationary o2 contents, liq |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
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E0443 |
|
Portable oxygen contents, gaseous, 1 month's supply = 1 unit
| short | Portable 02 contents, gas |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
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E0444 |
|
Portable oxygen contents, liquid, 1 month's supply = 1 unit
| short | Portable 02 contents, liquid |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
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E0445 |
|
Oximeter device for measuring blood oxygen levels non-invasively
| short | Oximeter non-invasive |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
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E0446 |
|
Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories
| short | Topical ox deliver sys, nos |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
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E0447 |
|
Portable oxygen contents, liquid, 1 month's supply = 1 unit, prescribed amount at rest or nighttime exceeds 4 liters per minute (lpm)
| short | Port o2 cont, liq over 4 lpm |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
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E0450 |
|
Volume control ventilator, without pressure support mode, may include pressure control mode, used with invasive interface (e.g., tracheostomy tube)
| short | Vol control vent invasiv int |
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E0455 |
|
Oxygen tent, excluding croup or pediatric tents
| short | Oxygen tent excl croup/ped t |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
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E0457 |
|
Chest shell (cuirass)
| short | Chest shell |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
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E0459 |
|
Chest wrap
| short | Chest wrap |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
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E0460 |
|
Negative pressure ventilator; portable or stationary
| short | Neg press vent portabl/statn |
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E0461 |
|
Volume control ventilator, without pressure support mode, may include pressure control mode, used with non-invasive interface (e.g., mask)
| short | Vol control vent noninv int |
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E0462 |
|
Rocking bed with or without side rails
| short | Rocking bed w/ or w/o side r |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
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E0463 |
|
Pressure support ventilator with volume control mode, may include pressure control mode, used with invasive interface (e.g., tracheostomy tube)
| short | Press supp vent invasive int |
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E0464 |
|
Pressure support ventilator with volume control mode, may include pressure control mode, used with non-invasive interface (e.g., mask)
| short | Press supp vent noninv int |
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E0465 |
|
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube)
| short | Home vent invasive interface |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
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E0466 |
|
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell)
| short | Home vent non-invasive inter |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 2.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
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E0467 |
|
Home ventilator, multi-function respiratory device, also performs any or all of the additional functions of oxygen concentration, drug nebulization, aspiration, and cough stimulation, includes all accessories, components and supplies for all functions
| short | Home vent multi-function |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
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E0470 |
|
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)
| short | Rad w/o backup non-inv intfc |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
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E0471 |
|
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)
| short | Rad w/backup non inv intrfc |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
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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)
| short | Rad w backup invasive intrfc |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 3 Date of Service Edit: Clinical | Nature of Equipment |
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E0480 |
|
Percussor, electric or pneumatic, home model
| short | Percussor elect/pneum home m |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
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E0481 |
|
Intrapulmonary percussive ventilation system and related accessories
| short | Intrpulmnry percuss vent sys |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
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E0482 |
|
Cough stimulating device, alternating positive and negative airway pressure
| short | Cough stimulating device |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
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E0483 |
|
High frequency chest wall oscillation system, includes all accessories and supplies, each
| short | Hi freq chest wall oscil sys |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
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E0484 |
|
Oscillatory positive expiratory pressure device, non-electric, any type, each
| short | Non-elec oscillatory pep dvc |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
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E0485 |
|
Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes fitting and adjustment
| short | Oral device/appliance prefab |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
|
|
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E0486 |
|
Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment
| short | Oral device/appliance cusfab |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
|
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E0487 |
|
Spirometer, electronic, includes all accessories
| short | Electronic spirometer |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
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