Lung Expansion Airway Clearance, Continuous High Frequency Oscillation, and Nebulization Device (HCPCS Code E0469) - Correct Coding and Billing of HCPCS - JD DME

Joint DME MAC Publication
Posted July 10, 2025

HCPCS code E0469 (LUNG EXPANSION AIRWAY CLEARANCE, CONTINUOUS HIGH FREQUENCY OSCILLATION, AND NEBULIZATION DEVICE) represents a specialized respiratory device that integrates three essential functions: lung expansion, airway clearance with continuous high frequency oscillation, and nebulization. As a capped rental item, HCPCS code E0469 must be billed with the modifier RR, along with the appropriate monthly rental modifier (KH, KI, or KJ).

There is no specific Local Coverage Determination (LCD) or National Coverage Determination (NCD) for E0469, and therefore each claim is reviewed on a claim-by-claim basis. The treating practitioner must provide thorough documentation to substantiate the medical necessity and appropriate use of the device. Documentation must include a valid order, valid proof of delivery, and valid medical records that support the E0469 was ordered as part of the beneficiary’s treatment plan. This documentation must be available to the DME MACs upon request. HCPCS Codes E0570, E0482, and/or E0483 are considered included in the payment for E0469 and will only be paid for dates of service prior to billing E0469. If these HCPCS codes are billed for dates of service after initiating the E0469 rental, claims will be denied as unbundling (i.e., included in E0469's function).

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