HCPCS Level II E0446: Topical Oxygen Delivery System, NOS

HCPCS Level II code E0446 describes a topical oxygen delivery system, not otherwise specified, and covers the device plus all supplies and accessories used to deliver topical oxygen therapy for wound care; service type is durable medical equipment / wound therapy device and the typical site of service is outpatient clinics, wound care centers, home health, or other non-acute care settings where topical oxygen is applied to support wound healing.

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HCPCS Level II E0446: Topical Oxygen Delivery System, NOS

Customize your policy alerts

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Get alerted when payer policies referencing E0446 are released or updated.

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Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with a chronic, nonhealing lower-extremity wound (for example, a diabetic foot ulcer or pressure injury) who has failed standard moist wound care and offloading. The patient is evaluated in a wound care clinic or outpatient specialty practice. The clinician documents wound size, depth, presence of exposed bone or tendon, signs of infection, prior therapies (debridement, advanced dressings, negative-pressure wound therapy), vascular status and glycemic control. After assessment, the clinician prescribes a topical oxygen delivery system E0446 when topical oxygen is clinically indicated as part of an advanced local therapy plan to promote granulation and wound closure.

The clinical workflow includes:

Initial wound assessment and documentation of diagnosis, measurements and prior treatments.
Trial of conservative measures; if inadequate response, ordering of a topical oxygen device E0446 with a supplier referral and durable medical equipment (DME) paperwork.
Supplier provides device, trains patient/caregiver on use, documents face-to-face education and supplies needed for treatment.
Follow-up visits in the wound clinic occur to monitor healing, adjust therapy, and document medical necessity for continued coverage. Ongoing documentation includes wound photographs, measurement trends, and objective evidence of improvement or plateau.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11042`	Debridement, subcutaneous tissue; first 20 sq cm or less	Sharp debridement often performed prior to starting topical oxygen to remove devitalized tissue and promote device efficacy.
`11043`	Debridement, muscle and/or fascia; first 20 sq cm or less	For deeper wounds requiring debridement before application of topical oxygen therapy.
`97597`	Debridement (e.g., high pressure waterjet, sharp) of open wound, without anesthesia; first 20 sq cm or less	Selective debridement by clinician that prepares wound bed for adjunctive topical oxygen treatment.
`29581`	Application of multi-layer compression system, unilateral, below-knee	For venous leg ulcers, compression therapy is commonly used alongside topical oxygen; coding reflects concomitant compression treatment.
`99070`	Supplies and materials (e.g., drugs, dressings), noncovered items or services, used by physician or other qualified health care professional, unlisted - specified by supplier	Used when billing for additional supplies related to topical oxygen not captured elsewhere; supplier billing practices vary.

Related Modifiers

6 rows

Modifier	Description	When to Use
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
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…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
207RH0000X	Hematology (Internal Medicine) Physician	An internist with additional training who specializes in diseases of the blood, spleen and lymph. This specialist treats conditions such as anemia, cl…
163W00000X	Registered Nurse	(1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive…
208D00000X	General Practice Physician	A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
2086X0206X	Surgical Oncology Physician	A surgical oncologist is a well-qualified surgeon who has obtained additional training and experience in the multidisciplinary approach to the prevent…
2084B0040X	Behavioral Neurology & Neuropsychiatry Physician	Behavioral Neurology & Neuropsychiatry is a medical subspecialty involving the diagnosis and treatment of neurologically based behavioral issues.
207VE0102X	Reproductive Endocrinology Physician	An obstetrician/gynecologist who is capable of managing complex problems relating to reproductive endocrinology and infertility.
225CA2500X	Assistive Technology Supplier Rehabilitation Counselor	Respiratory, Developmental, Rehabilitative and Restorative Service Providers · Rehabilitation Counselor

Related ICD-10-CM Codes

21 rows

ICD-10-CM Code	Description
A41.9	Sepsis, unspecified organism
E10.621	Type 1 diabetes mellitus with foot ulcer
E11.621	Type 2 diabetes mellitus with foot ulcer
E11.65	Type 2 diabetes mellitus with hyperglycemia
I50.9	Heart failure, unspecified
I87.312	Chronic venous hypertension (idiopathic) with ulcer of left lower extremity
K70.30	Alcoholic cirrhosis of liver without ascites
L89.309	Pressure ulcer of unspecified buttock, unspecified stage
L89.519	Pressure ulcer of right ankle, unspecified stage
L89.619	Pressure ulcer of right heel, unspecified stage

Showing 1–10 of 21

Related Payer Policy Updates

Specialty: Durable Medical Equipment (DME)1 / 3

10 rows

Policy	Payer	Effective Date
Prior Authorization for Durable Medical Equipment (DME)	Blue Cross Blue Shield - Rhode Island	2026-10-01
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
Enteral Nutrition (Oral and Tube Feeding) (for Pennsylvania Only)	UnitedHealthcare	2026-08-01
Pediatric Gait Trainers and Standing Systems (for Tennessee Only)	UnitedHealthcare	2026-08-01
Beds and Mattresses (for Kansas Only)	UnitedHealthcare	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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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

The clinical workflow includes:

Initial wound assessment and documentation of diagnosis, measurements and prior treatments.
Trial of conservative measures; if inadequate response, ordering of a topical oxygen device E0446 with a supplier referral and durable medical equipment (DME) paperwork.
Supplier provides device, trains patient/caregiver on use, documents face-to-face education and supplies needed for treatment.
Follow-up visits in the wound clinic occur to monitor healing, adjust therapy, and document medical necessity for continued coverage. Ongoing documentation includes wound photographs, measurement trends, and objective evidence of improvement or plateau.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11042`	Debridement, subcutaneous tissue; first 20 sq cm or less	Sharp debridement often performed prior to starting topical oxygen to remove devitalized tissue and promote device efficacy.
`11043`	Debridement, muscle and/or fascia; first 20 sq cm or less	For deeper wounds requiring debridement before application of topical oxygen therapy.
`97597`	Debridement (e.g., high pressure waterjet, sharp) of open wound, without anesthesia; first 20 sq cm or less	Selective debridement by clinician that prepares wound bed for adjunctive topical oxygen treatment.
`29581`	Application of multi-layer compression system, unilateral, below-knee	For venous leg ulcers, compression therapy is commonly used alongside topical oxygen; coding reflects concomitant compression treatment.
`99070`	Supplies and materials (e.g., drugs, dressings), noncovered items or services, used by physician or other qualified health care professional, unlisted - specified by supplier	Used when billing for additional supplies related to topical oxygen not captured elsewhere; supplier billing practices vary.

Related Modifiers

6 rows

Modifier	Description	When to Use
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
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…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
207RH0000X	Hematology (Internal Medicine) Physician	An internist with additional training who specializes in diseases of the blood, spleen and lymph. This specialist treats conditions such as anemia, cl…
163W00000X	Registered Nurse	(1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive…
208D00000X	General Practice Physician	A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
2086X0206X	Surgical Oncology Physician	A surgical oncologist is a well-qualified surgeon who has obtained additional training and experience in the multidisciplinary approach to the prevent…
2084B0040X	Behavioral Neurology & Neuropsychiatry Physician	Behavioral Neurology & Neuropsychiatry is a medical subspecialty involving the diagnosis and treatment of neurologically based behavioral issues.
207VE0102X	Reproductive Endocrinology Physician	An obstetrician/gynecologist who is capable of managing complex problems relating to reproductive endocrinology and infertility.
225CA2500X	Assistive Technology Supplier Rehabilitation Counselor	Respiratory, Developmental, Rehabilitative and Restorative Service Providers · Rehabilitation Counselor

Related ICD-10-CM Codes

21 rows

ICD-10-CM Code	Description
A41.9	Sepsis, unspecified organism
E10.621	Type 1 diabetes mellitus with foot ulcer
E11.621	Type 2 diabetes mellitus with foot ulcer
E11.65	Type 2 diabetes mellitus with hyperglycemia
I50.9	Heart failure, unspecified
I87.312	Chronic venous hypertension (idiopathic) with ulcer of left lower extremity
K70.30	Alcoholic cirrhosis of liver without ascites
L89.309	Pressure ulcer of unspecified buttock, unspecified stage
L89.519	Pressure ulcer of right ankle, unspecified stage
L89.619	Pressure ulcer of right heel, unspecified stage

Showing 1–10 of 21

Related Payer Policy Updates

Specialty: Durable Medical Equipment (DME)1 / 3

10 rows

Policy	Payer	Effective Date
Prior Authorization for Durable Medical Equipment (DME)	Blue Cross Blue Shield - Rhode Island	2026-10-01
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
Enteral Nutrition (Oral and Tube Feeding) (for Pennsylvania Only)	UnitedHealthcare	2026-08-01
Pediatric Gait Trainers and Standing Systems (for Tennessee Only)	UnitedHealthcare	2026-08-01
Beds and Mattresses (for Kansas Only)	UnitedHealthcare	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.

OpenPayer

HCPCS Level II E0446: Topical Oxygen Delivery System, NOS

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OpenPayer

HCPCS Level II E0446: Topical Oxygen Delivery System, NOS

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

References

HCPCS Level II E0446: Topical Oxygen Delivery System, NOS

Sign up for hcpcs E0446 policy alerts

HCPCS Level II E0446: Topical Oxygen Delivery System, NOS

Sign up for hcpcs E0446 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What does HCPCS code E0446 represent and where is it typically used?

Which patients and clinical workflow are described for use of E0446?

What CPT codes and services are commonly related to billing for topical oxygen (E0446)?

Which diagnoses are associated with the use of topical oxygen under E0446?

Which payers are listed as covering E0446 and does the page give reimbursement amounts or detailed coverage criteria?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What does HCPCS code E0446 represent and where is it typically used?

Which patients and clinical workflow are described for use of E0446?

What CPT codes and services are commonly related to billing for topical oxygen (E0446)?

Which diagnoses are associated with the use of topical oxygen under E0446?

Which payers are listed as covering E0446 and does the page give reimbursement amounts or detailed coverage criteria?

References