HCPCS E0486 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Durable Medical Equipment • Oxygen Delivery Systems and Related Supplies |
| Complexity Level | High |
National average reimbursement for HCPCS E0486 by major payers:
$1,782.51
$939.09
$1,904.20
$1,783.07
| 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 E0486 | ||||||
United | E0486 | $660.00 | 1205230596 - GAZELLE HEALTHCARE SOLUTIONS, LLC, CY FAIR MEDICAL SUPPLY | 900652116 | TX | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | E0486 | $935.00 | 1821091158 - ARIZONA MEDSOURCE HOLDINGS LLC, H&L MEDICAL | 300815442 | AZ | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | E0486 | $935.00 | 1356433759 - RX EDGE PROFESSIONALS INC | 742615476 - (TX) RX EDGE PROFESSIONALS INC | TX | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | E0486 | $935.00 | 1841558160 - ONE SOURCE MEDICAL GROUP LLC | 260159522 - ONE SOURCE MEDICAL GROUP LLC | TX | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | E0486 | $1034.00 | 1366140469 - JFM SAL LLC | 921466249 - (IL) JFM SAL LLC | IL | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | E0486 | $672.09 | 1003150723 - GRAYMONT EQUIPMENT DISTRIBUTION, LLC | 371689099 - (IL) GRAYMONT EQUIPMENT DISTRIBUTION LLC | IL | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | E0486 | $1800.00 | 1104987478 - RICHARD DRAKE | 742559563 | TX | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | E0486 | $1034.00 | 1750356838 - THE NATIONAL MEDICAL RENTALS, INC., AMERICAN HOMEPATIENT | 710457738 | TX | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | E0486 | $935.00 | 1558507020 - RESPIRATORY QUALITY SERVICES, LLC | 263548111 - (TX) RESPIRATORY QUALITY SERVICES LLC | TX | Oxygen Equipment & Supplies (DME) (332BX2000X) |
United | E0486 | $935.00 | 1174577548 - RESPIRATORY PLUS OF TEXAS INC, RESPIRATORY PLUS | 710802269 | TX | Oxygen Equipment & Supplies (DME) (332BX2000X) |
United | E0486 | $775.50 | 1609014208 - KIDS DME, INC. | 264064101 - (TX) KIDS DME INC | TX | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | E0486 | $935.00 | 1356433759 - RX EDGE PROFESSIONALS INC | 742615476 - (TX) RX EDGE PROFESSIONALS INC | TX | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | E0486 | $935.00 | 1326591660 - NMS DME LLC, ONE SALON | 812598271 - (TX) NMS DME LLC | TX | Customized Equipment (DME) (332BC3200X) |
United | E0486 | $1034.00 | 1912042029 - LOYOLA UNIVERSITY MEDICAL CENTER, LOYOLA UNIVERSITY MEDICAL CENTER DURABLE MEDICAL EQUIPMENT | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Durable Medical Equipment & Medical Supplies (332B00000X) |
United | E0486 | $935.00 | 1356433759 - RX EDGE PROFESSIONALS INC | 742615476 - (TX) RX EDGE PROFESSIONALS INC | TX | 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 |
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HCPCS E0486 vs. Other Oxygen Delivery Systems and Related Supplies Codes
The HCPCS E0486 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 E0486 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 |
|---|---|---|
| E0485-HCPCS | Moderate | Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, prefabricated, includes fitting and adjustment |
| E0486-HCPCS | High | Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment |
| E0487-HCPCS | Moderate | Spirometer, electronic, includes all accessories |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS E0486. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the E0486 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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