Correct Coding - Integrated Respiratory Products - JA DME

Joint DME MAC Publication

The Durable Medical Equipment Medicare Administrative Contractors (DME MACs) have recently had multiple inquiries about the coding of products where multiple functions, each with a separate HCPCS code, are incorporated into a single product.  For example, there are positive airway pressure (PAP) and respiratory assist devices (RAD) that include integrated humidification.  The correct codes for the integrated product are code E0601 (Continuous positive airway pressure (CPAP) device) for the base CPAP device and code E0562 (Humidifier, heated, used with positive airway pressure device) for the integrated humidification. The same principle applies to respiratory assist devices with integrated humidification. The correct codes for the integrated RAD products are code 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), or 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) for the base RAD device and code E0562 for the integrated humidification.

For questions about correct coding, contact the Pricing, Data Analysis and Coding (PDAC) Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form.