HCPCS E0431 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Durable Medical Equipment • Oxygen Delivery Systems and Related Supplies |
| Common Place of Service | |
| Common Modifiers | |
| Complexity Level | Moderate |
National average reimbursement for HCPCS E0431 by major payers:
$36.41
$150.86
$126.19
$178.08
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS E0431 | ||||||
United | E0431 | $249.92 | 1023116985 - SPECTRUM HEALTH HOSPITALS, SPECTRUM HEALTH URGENT CARE BROADMOOR | 381358164 - SPECTRUM HEALTH PRIMARY CARE PARTNERS | MI | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | E0431 | $9.81 | 1891015160 - THE PAIN CENTER USA PLLC | 680547008 - (MI) THE PAIN CENTER USA PLLC | MI | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | E0431 | $21.03 | 1073040879 - BINSON'S HOSPITAL SUPPLIES, INC., BINSON'S HOME HEALTH CARE CENTERS | 382236525 - BINSON'S HOSPITAL SUPPLIES, INC. WRAP PLAN | MI | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | E0431 | $172.61 | 1194762575 - WRIGHT & FILIPPIS, INC. | 381747499 - WRIGHT & FILIPPIS, INC. | MI | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | E0431 | $17.65 | 1114072311 - PROMPT CARE EXPRESS P.C. | 383543609 - (MI) PROMPT CARE EXPRESS PC | MI | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | E0431 | $15.71 | 1225656291 - DELTA MEDICAL EQUIPMENT LLC | 851688740 - (MI) DELTA MEDICAL EQUIPMENT LLC | MI | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | E0431 | $186.55 | 1811179492 - BINSON'S HOSPITAL SUPPLIES, INC., BINSON'S INFUSION SERVICES | 382236525 - BINSON'S HOSPITAL SUPPLIES, INC. WRAP PLAN | MI | Parenteral & Enteral Nutrition Supplies (DME) (332BP3500X) |
United | E0431 | $132.94 | 1801334610 - MICHIGAN ORTHOPAEDIC SURGEONS PLLC, OAKLAND OAKLAND ORTHOPAEDIC SURGEONS | 452118278 - (MI) MICHIGAN ORTHOPAEDIC SURGEONS PLLC | MI | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | E0431 | $16.04 | 1952651820 - SPARROW COMMUNITY CARE, SPARROW MEDICAL SUPPLY | 382543305 - (MI) SPARROW COMMUNITY CARE | MI | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | E0431 | $23.02 | 1740532035 - ORTHOPAEDIC ASSOCIATES OF GRAND RAPIDS PC, ORTHOPAEDIC ASSOCIATES OF MICHIGAN | 381971253 - (MI) ORTHOPAEDIC ASSOCIATES OF GRAND RAPIDS PC | MI | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | E0431 | $11.77 | 1649394339 - BIG RAPIDS ORTHOPAEDICS, PC | 382020732 - (MI) BIG RAPIDS ORTHOPAEDICS PC | MI | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | E0431 | $143.85 | 1851337604 - NORTHWOOD INC, CARE CONNECTION PLUS | 383064979 - / 180 MEDICAL INC / ABC HOME MEDICAL SUPPLY INC | MI | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | E0431 | $17.26 | 1013959295 - WRIGHT & FILIPPIS, INC. | 381747499 - WRIGHT & FILIPPIS, INC. | MI | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | E0431 | $93.88 | 1063609113 - AIRLINK HOMECARE LLC | 201582708 - (MI) AIRLINK HOMECARE LLC | MI | Oxygen Equipment & Supplies (DME) (332BX2000X) |
United | E0431 | $143.85 | 1851337604 - NORTHWOOD INC, CARE CONNECTION PLUS | 383064979 - / 180 MEDICAL INC / ABC HOME MEDICAL SUPPLY INC | MI | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
HCPCS E0431 vs. Other Oxygen Delivery Systems and Related Supplies Codes
The HCPCS E0431 code is part of the Durable Medical Equipment services used for Oxygen Delivery Systems and Related Supplies. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS E0431 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| E0430 | Moderate | Portable gaseous oxygen system, purchase; includes regulator, flowmeter, humidifier, cannula or mask, and tubing |
| E0431 | Low | Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
| E0433 | Low | 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 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS E0431. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the E0431 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like HCPCS E0431) and we'll show you how you compare in 15 minutes or less.
Medicare Reimbursement Lookup Tool
PayerPrice provides a free medicare lookup tool for physician fee schedule, drug ASP, MS-DRG weights, anesthesia conversion factors and other medicare related data.