CPAP / PAP Therapy
E0470 HCPCS Code Description and Medicare Billing
E0470 is a HCPCS Level II code for respiratory assist device, bilevel pressure capability, without backup rate. It describes a respiratory assist device with bilevel pressure capability and no backup rate. It is not a CPT code. For OSA, Medicare requires the PAP criteria and a supported E0601 trial that proved ineffective; other diagnoses use the separate RAD policy pathway. Review Medicare coverage, documentation, modifiers, frequency, fee references, policy links, and denial risks.
Quick answer
What is the E0470 HCPCS code description?
E0470 is the HCPCS Level II code for a respiratory assist device with bilevel pressure capability and no backup rate. It is not a CPT code. For obstructive sleep apnea, Medicare applies the PAP policy and requires a supported E0601 trial that proved ineffective; for other covered respiratory conditions, the separate Respiratory Assist Devices policy applies.
Coverage status
conditional
Documentation required
Yes
F2F/WOPD required list
unknown
Prescription/order
yes
Prior authorization list
unknown
Rental or purchase
capped rental
Fee schedule
Available
Same/similar risk
Review required
Code Summary
Respiratory assist device, bilevel pressure capability, without backup rate
For OSA, E0470 is conditionally covered when the PAP criteria are met and E0601 has been tried and proven ineffective under LCD L33718. For other covered respiratory conditions, apply the diagnosis-specific criteria in RAD LCD L33800.
Before billing, verify medical necessity, order requirements, proof of delivery, supplier eligibility, correct modifiers, frequency limits, and any applicable LCD or policy article.
Official Sources
officialPositive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea (L33718)
CMS Medicare Coverage Database / Effective 2024-01-01 / Reviewed 2026-08-09
Initial and continued coverage, replacement, accessory frequency, refill, order, and proof-of-delivery requirements.
Positive Airway Pressure (PAP) Devices Policy Article (A52467)
CMS Medicare Coverage Database / Reviewed 2026-08-09
Coding, modifier, documentation, and policy-specific PAP billing instructions.
Respiratory Assist Devices (L33800)
CMS Medicare Coverage Database / Effective 2025-06-09 / Reviewed 2026-08-09
Diagnosis-specific initial and continued coverage criteria for E0470 and E0471 outside the OSA PAP pathway.
Respiratory Assist Devices Policy Article (A52517)
CMS Medicare Coverage Database / Reviewed 2026-08-09
Coding, modifier, documentation, and benefit-category rules for respiratory assist devices and related accessories.
Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426)
CMS Medicare Coverage Database / Reviewed 2026-08-09
General order, medical record, continued need/use, refill, and proof-of-delivery requirements.
July 2026 DMEPOS Fee Schedule (DME26-C)
Centers for Medicare & Medicaid Services / Effective 2026-07-01 / Reviewed 2026-08-09
Official state and rural/non-rural fee schedule amounts and payment category codes.
Is E0470 a CPT code?
No. E0470 is a HCPCS Level II code, although people often search for "E0470 CPT code." CPT is HCPCS Level I and is maintained separately by the American Medical Association. Always verify the code set and payer instructions effective for the date of service.
E0601 vs E0470 vs E0471
These codes describe different pressure capabilities and are not interchangeable. For obstructive sleep apnea, Medicare uses the PAP LCD; E0470 substitution requires a supported E0601 trial that was ineffective. Other E0470 and E0471 indications follow diagnosis-specific Respiratory Assist Devices policy criteria.
| Code | Device distinction | Research checkpoint |
|---|---|---|
| E0601 | Continuous airway pressure device | Use the OSA PAP coverage pathway. |
| E0470 | Bilevel pressure capability, without backup rate | Select the OSA PAP or diagnosis-specific RAD pathway. |
| E0471 | Bilevel pressure capability, with backup rate | Not covered for primary OSA under the PAP LCD; research the RAD pathway. |
Reimbursement Status
Coverage is marked conditional. Publication status is verified. This describes the source record, not a claim-specific coverage decision.
Documentation Requirements
Standard written order
A completed SWO must be communicated to the supplier before the claim is submitted.
Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea (L33718)Proof of delivery
Maintain proof of delivery that supports the item, quantity, delivery method, and date furnished.
Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426)Qualifying clinical and sleep-test record
Document the applicable clinical evaluation, qualifying sleep test, and device-specific medical necessity criteria.
Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea (L33718)Continued coverage timing and adherence
For E0601 or E0470 beyond the initial three months, verify the timely treating-practitioner re-evaluation and objective adherence record when applicable.
Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea (L33718)Standard Written Order / Prescription
A standard written order is required before claim submission.
Clinical Evaluation / Conditions of Payment
Do not combine the OSA PAP and non-OSA RAD pathways. The applicable diagnosis and policy determine the evaluation, testing, trial, and continued-coverage requirements.
Rental, Purchase, Replacement, or Supply Logic
Payment category: capped rental. Check same or similar equipment history and replacement eligibility before billing.
E0470 Frequency and Replacement Limits
Frequency and replacement limits are pending research.
The PAP LCD describes usual maximum quantities, not automatic shipment schedules. Document an affirmative refill request, remaining supply, continued need, and delivery timing.
Modifiers
NU New equipment
Verify the current licensed code set, CMS guidance, payer policy, and claim documentation before use.
RR Rental
Verify the current licensed code set, CMS guidance, payer policy, and claim documentation before use.
UE Used durable medical equipment
Verify the current licensed code set, CMS guidance, payer policy, and claim documentation before use.
KX Requirements specified in medical policy have been met
Verify the current licensed code set, CMS guidance, payer policy, and claim documentation before use.
GA Waiver of liability statement issued
Verify the current licensed code set, CMS guidance, payer policy, and claim documentation before use.
GY Item or service statutorily excluded
Verify the current licensed code set, CMS guidance, payer policy, and claim documentation before use.
GZ Item or service expected to be denied
Verify the current licensed code set, CMS guidance, payer policy, and claim documentation before use.
RA Replacement of DME item
Verify the current licensed code set, CMS guidance, payer policy, and claim documentation before use.
Fee Schedule
DME26-C / Effective 2026-07-01
- Non-rural range across fee rows and states
- $129.84 - $237.27
- Rural range where listed
- $208.36 - $232.10
Fee schedule amounts are payment references and do not prove coverage or guarantee payment.
Common Denials
CARC 16: Missing or Invalid Claim Information
Validate required claim loops, provider roles, identifiers, diagnosis pointers, modifiers, units, charges, and payer-specific companion-guide edits before release.
CARC 18: Duplicate Claim or Service
Lock resubmission while a claim is pending, reconcile clearinghouse and payer claim IDs, and require replacement or void indicators for true corrections.
CARC 22: Coordination of Benefits and Payer Order
Ask current coverage and employment questions, verify payer order for the date of service, and transmit complete primary adjudication data on secondary claims.
CARC 29: Timely Filing Denial
Track deadlines from the service-date rule, reconcile payer receipt rather than only transmission, and escalate unaccepted claims well before expiration.
CARC 97: Service Included in Another Payment
Check code-pair edits, global periods, status indicators, payment packaging, and modifier documentation before submitting separate lines.
CARC 109: Claim Sent to the Wrong Payer or Contractor
Validate plan, network, product, payer ID, contractor jurisdiction, and date-specific routing before submission.
Diagnosis and medical necessity research
These diagnoses are educational research relationships, not a coverage crosswalk or coding recommendation. Open the diagnosis guide and validate the complete clinical record and applicable policy.
Frequently Asked Questions
What is the E0470 HCPCS code description?
E0470 is the HCPCS Level II code for a respiratory assist device with bilevel pressure capability and no backup rate. It is not a CPT code.
Is E0470 a CPT code?
No. E0470 is a HCPCS Level II code. People commonly search for an E0470 CPT code, but CPT is HCPCS Level I and is maintained separately.
What is the difference between E0470 and E0601?
E0601 describes continuous airway pressure, while E0470 provides two pressure levels without a backup rate. For OSA, Medicare requires E0601 to be tried and proven ineffective before an E0470 substitution is covered under the PAP pathway.
What is the difference between E0470 and E0471?
E0470 has no backup rate; E0471 has a backup rate. Their coverage depends on the diagnosis and applicable PAP or Respiratory Assist Devices policy, so the codes are not interchangeable.
Publication and Review Status
Code-level statements have attached official sources. Last reviewed: Aug 9, 2026.