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See a sample rate comparisonHCPCS E0472 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
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)
| Key Fact | Detail |
|---|---|
| Service Type | Durable Medical Equipment Oxygen Delivery Systems and Related Supplies |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for E0472 |
National average reimbursement for HCPCS E0472 by major payers:
$3,739.62
$2,917.22
$3,682.77
$4,901.41
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HCPCS E0472
5 of 25 sample ratesHigher to lower in this preview
Atl Colorectal Surgery
$6,347.93Published rateThe Hospital Authority Of Habersham County
$4,257.79Published rateEffingham Hospital, Inc., Effingham Health System
Effingham Hospital Inc
$2,747.14Published rateAugusta Vamc
$513.73Published rateNortheast Georgia Medical Center, Inc.
Gainesville Radiology Group
$238.80Published rate
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See a sample payer proposalHCPCS E0472 vs. Other Oxygen Delivery Systems and Related Supplies Codes
The HCPCS E0472 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 E0472 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 |
|---|---|---|
| E0471-HCPCS | High | 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) |
| E0472-HCPCS | High | 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) |
| E0480-HCPCS | Moderate | Percussor, electric or pneumatic, home model |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS E0472. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the E0472 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.
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