HCPCS E0601: Continuous Positive Airway Pressure (CPAP) Device

Commercial payers pay $297 on average nationally for this procedure.

HCPCS Level II code E0601 represents a continuous positive airway pressure (CPAP) device used to provide positive airway pressure therapy for patients with obstructive sleep apnea; the service type is durable medical equipment and the typical site of service is home use for ongoing respiratory support.

For related coverage guidance, see recent payer policy updates: Interferential Stimulation Devices (for home use), Prior Authorization for Durable Medical Equipment (DME), Breast Pumps.

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National Reimbursement Benchmarks

National commercial reimbursement for HCPCS E0601 centers on BUCA’s average commercial rate of $296.70 as a mid-market benchmark, with individual payers showing meaningful differences in central tendency and upper-tail variation. Blue Cross Blue Shield posts the highest observed maximum at $1,452.70 and a mean of $295.70, while Aetna’s mean sits lower at $238.00 and Cigna’s at $290.50; UnitedHealth Group carries a higher mean of $365.70 and a median of $358.50, indicating more payments clustered at the upper end compared with other payers.

Rate dispersion measured by the interquartile spread (P75 minus P25) highlights relative tightness and volatility: Aetna’s IQR is $350.00 (P75 $395.00 minus P25 $45.00), Blue Cross Blue Shield’s IQR is $437.10 (P75 $510.00 minus P25 $62.90), Cigna’s IQR is $279.10 (P75 $335.80 minus P25 $58.90), UnitedHealth Group’s IQR is $412.80 (P75 $475.10 minus P25 $206.30), and BUCA’s IQR is $385.30 (P75 $463.70 minus P25 $80.40). Cigna shows the tightest interquartile dispersion while Blue Cross Blue Shield shows the widest.

National Payer Mean Reimbursement Rates

State Reimbursement Rates

State: Alaska1 / 51

Rate by payer

Clinical & Coding Specifications

Clinical Context

A 52-year-old patient with excessive daytime sleepiness, loud snoring, and witnessed apneas is evaluated by a pulmonologist. After a home sleep apnea test confirms moderate obstructive sleep apnea, diagnosis code G47.33 is documented. The clinician prescribes a E0601 continuous positive airway pressure (CPAP) device. The clinical workflow includes office evaluation by a pulmonary or sleep medicine specialist, documentation of symptoms and objective sleep testing results, a CPAP fitting and mask selection in the durable medical equipment (DME) setting, patient education on device use and cleaning, and a follow-up visit or remote adherence monitoring within the first 30–90 days to assess effectiveness and compliance. Typical sites of service include outpatient sleep clinics, DME supplier locations, home health setups for device delivery, and occasionally hospital discharge planning when OSA is newly diagnosed during an inpatient stay. Payors involved may include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare for coverage and prior authorization processes.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`E0470`	Bi-level respiratory assist device without backup rate	Used when `E0601` CPAP is ineffective and the patient requires bi-level support for OSA or hypoventilation.

Related Modifiers

9 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
54	Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…	- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
55	Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…	- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
82	Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…	- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
332B00000X	Durable Medical Equipment & Medical Supplies	A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for…
207RP1001X	Pulmonary Disease Physician	An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational an…
207RC0200X	Critical Care Medicine (Internal Medicine) Physician	An internist who diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for…
125Q00000X	Oral Medicine Dentistry	Oral Medicine is the specialty of dentistry responsible for the oral health care of medically complex patients and for the diagnosis and management of…
207VC0300X	Complex Family Planning Physician	A complex family planning physician specializes in the diagnosis and treatment of individuals with complex reproductive needs. These physicians are ex…
320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intelle…
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
207VX0201X	Gynecologic Oncology Physician	An obstetrician/gynecologist who provides consultation and comprehensive management of patients with gynecologic cancer, including those diagnostic an…

Related Payer Policy Updates

Specialty: Durable Medical Equipment (DME)1 / 3

10 rows

Policy	Payer	Effective Date
Interferential Stimulation Devices (for home use)	Moda Health	2026-10-01
Prior Authorization for Durable Medical Equipment (DME)	Blue Cross Blue Shield - Rhode Island	2026-10-01
Breast Pumps	Moda Health	2026-09-01
Personal Emergency Response Systems	CareSource Georgia	2026-09-01
Continuous Passive Motion (CPM) Devices	Cigna	2026-08-15
Push-Rim Activated Power-Assist Device (E0986) — Manual Wheelchair Accessory	moda_health_plan_inc	2026-08-13
Beds and Mattresses (for Ohio Only)	Colorado Rocky Mountain Health Plans	2026-08-01
Beds and Mattresses (for Kentucky Only)	UnitedHealthcare	2026-08-01
Pneumatic Compression Devices (for Nebraska Only)	UnitedHealthcare	2026-08-01
Indications for Coverage — Hospital beds, support surfaces, and safety enclosure beds (DME)	Colorado Rocky Mountain Health Plans	2026-08-01

HCPCS E0100: Cane, Adjustable or Fixed, With Tip

HCPCS-E0105-CANE-QUAD-THREE-PRONG-MOBILITY-AID

HCPCS Level II E0105: Cane, Quad or Three-Prong, Includes Tips

HCPCS-E0110-FOREARM-CRUTCHES-PAIR-DME-MOBILITY

HCPCS Level II E0110: Forearm Crutches, Pair, Complete with Tips and Handgrips

HCPCS-E0111-CRUTCH-FOREARM-DURABLE-MEDICAL-EQUIPMENT

HCPCS Level II E0111: Crutch, Forearm, With Tip and Handgrips

HCPCS-E0112-UNDERARM-WOOD-CRUTCHES-PAIR

HCPCS Level II E0112: Underarm Wooden Crutches, Pair

HCPCS-E0113-CRUTCH-UNDERARM-WOOD-ADJUSTABLE-FIXED-WITH-PAD-TIP-HANDGRIP

HCPCS Level II E0113: Crutch Underarm, Wood, Adjustable or Fixed

HCPCS-E0114-UNDERARM-CRUTCHES-PAIR-ADJUSTABLE-FIXED

HCPCS Level II E0114: Underarm (Axillary) Crutches, Adjustable or Fixed, Pair

HCPCS-E0116-UNDERARM-CRUTCH-NON-WOOD-ADJUSTABLE-FIXED

HCPCS E0116: Underarm Crutch, Non-Wood, Adjustable/Fixed with Pad

HCPCS-E0117-ARTICULATING-SPRING-ASSISTED-UNDERARM-CRUTCH

HCPCS Level II E0117: Crutch, Underarm, Articulating, Spring-Assisted

HCPCS-E0118-LOWER-LEG-PLATFORM-CRUTCH-SUBSTITUTE

HCPCS E0118: Crutch Substitute, Lower Leg Platform

Showing 1–10 of 670

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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State Reimbursement Rates

State: Alaska1 / 51

Rate by payer

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`E0470`	Bi-level respiratory assist device without backup rate	Used when `E0601` CPAP is ineffective and the patient requires bi-level support for OSA or hypoventilation.

Related Modifiers

9 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
54	Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…	- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
55	Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…	- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
82	Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…	- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
332B00000X	Durable Medical Equipment & Medical Supplies	A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for…
207RP1001X	Pulmonary Disease Physician	An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational an…
207RC0200X	Critical Care Medicine (Internal Medicine) Physician	An internist who diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for…
125Q00000X	Oral Medicine Dentistry	Oral Medicine is the specialty of dentistry responsible for the oral health care of medically complex patients and for the diagnosis and management of…
207VC0300X	Complex Family Planning Physician	A complex family planning physician specializes in the diagnosis and treatment of individuals with complex reproductive needs. These physicians are ex…
320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intelle…
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
207VX0201X	Gynecologic Oncology Physician	An obstetrician/gynecologist who provides consultation and comprehensive management of patients with gynecologic cancer, including those diagnostic an…

Related Payer Policy Updates

Specialty: Durable Medical Equipment (DME)1 / 3

10 rows

Policy	Payer	Effective Date
Interferential Stimulation Devices (for home use)	Moda Health	2026-10-01
Prior Authorization for Durable Medical Equipment (DME)	Blue Cross Blue Shield - Rhode Island	2026-10-01
Breast Pumps	Moda Health	2026-09-01
Personal Emergency Response Systems	CareSource Georgia	2026-09-01
Continuous Passive Motion (CPM) Devices	Cigna	2026-08-15
Push-Rim Activated Power-Assist Device (E0986) — Manual Wheelchair Accessory	moda_health_plan_inc	2026-08-13
Beds and Mattresses (for Ohio Only)	Colorado Rocky Mountain Health Plans	2026-08-01
Beds and Mattresses (for Kentucky Only)	UnitedHealthcare	2026-08-01
Pneumatic Compression Devices (for Nebraska Only)	UnitedHealthcare	2026-08-01
Indications for Coverage — Hospital beds, support surfaces, and safety enclosure beds (DME)	Colorado Rocky Mountain Health Plans	2026-08-01

HCPCS E0100: Cane, Adjustable or Fixed, With Tip

HCPCS-E0105-CANE-QUAD-THREE-PRONG-MOBILITY-AID

HCPCS Level II E0105: Cane, Quad or Three-Prong, Includes Tips

HCPCS-E0110-FOREARM-CRUTCHES-PAIR-DME-MOBILITY

HCPCS Level II E0110: Forearm Crutches, Pair, Complete with Tips and Handgrips

HCPCS-E0111-CRUTCH-FOREARM-DURABLE-MEDICAL-EQUIPMENT

HCPCS Level II E0111: Crutch, Forearm, With Tip and Handgrips

HCPCS-E0112-UNDERARM-WOOD-CRUTCHES-PAIR

HCPCS Level II E0112: Underarm Wooden Crutches, Pair

HCPCS-E0113-CRUTCH-UNDERARM-WOOD-ADJUSTABLE-FIXED-WITH-PAD-TIP-HANDGRIP

HCPCS Level II E0113: Crutch Underarm, Wood, Adjustable or Fixed

HCPCS-E0114-UNDERARM-CRUTCHES-PAIR-ADJUSTABLE-FIXED

HCPCS Level II E0114: Underarm (Axillary) Crutches, Adjustable or Fixed, Pair

HCPCS-E0116-UNDERARM-CRUTCH-NON-WOOD-ADJUSTABLE-FIXED

HCPCS E0116: Underarm Crutch, Non-Wood, Adjustable/Fixed with Pad

HCPCS-E0117-ARTICULATING-SPRING-ASSISTED-UNDERARM-CRUTCH

HCPCS Level II E0117: Crutch, Underarm, Articulating, Spring-Assisted

HCPCS-E0118-LOWER-LEG-PLATFORM-CRUTCH-SUBSTITUTE

HCPCS E0118: Crutch Substitute, Lower Leg Platform

Showing 1–10 of 670

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

HCPCS E0601: Continuous Positive Airway Pressure (CPAP) Device

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National Reimbursement Benchmarks

HCPCS E0601: Continuous Positive Airway Pressure (CPAP) Device

Sign up for hcpcs E0601 policy alerts

National Reimbursement Benchmarks

State Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

References

State Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

References

HCPCS E0601: Continuous Positive Airway Pressure (CPAP) Device

Sign up for hcpcs E0601 policy alerts

National Reimbursement Benchmarks

HCPCS E0601: Continuous Positive Airway Pressure (CPAP) Device

Sign up for hcpcs E0601 policy alerts

National Reimbursement Benchmarks

State Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

What does HCPCS code E0601 represent and where is it typically used?

What clinical documentation and workflow support medical necessity for E0601?

Are there related HCPCS codes to E0601 and when are they relevant?

Where is E0601 commonly provided and which payers are involved?

What follow-up and monitoring are described for patients after receiving an E0601 CPAP device?

References

State Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

Related Codes

What does HCPCS code E0601 represent and where is it typically used?

What clinical documentation and workflow support medical necessity for E0601?

Are there related HCPCS codes to E0601 and when are they relevant?

Where is E0601 commonly provided and which payers are involved?

What follow-up and monitoring are described for patients after receiving an E0601 CPAP device?

References