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    v1.0.30
    OpenPayerBilling CodesDurable Medical EquipmentHCPCS hcpcs-e0471-bilevel-respiratory-assist-device-noninvasive
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    HCPCS Level II E0471: Bi-level Respiratory Assist Device with Back-up Rate

    HCPCS Level II code E0471 describes a respiratory assist device with bi-level pressure capability and a back-up rate feature intended for use with a noninvasive interface (for example, nasal or facial mask); the service is the provision or setup of an intermittent assist device that provides bilevel positive airway support with backup rate, typically used as durable medical equipment for outpatient or home respiratory support and delivered or set up in durable medical equipment suppliers, outpatient clinics, or patient homes.

    For related coverage guidance, see recent payer policy updates: Hospital Beds Corporate Medical Policy, Bone Growth Stimulators, Prior Authorization for Durable Medical Equipment (DME).

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    Clinical & Coding Specifications

    Clinical Context

    A 62-year-old male with moderate-to-severe obstructive sleep apnea (OSA) and documented nocturnal hypoventilation is prescribed a bilevel positive airway pressure device with a back-up rate (E0471) for nocturnal noninvasive ventilatory support. The patient uses a nasal or full-face mask at home. The clinical workflow: outpatient sleep medicine or pulmonary clinic evaluates symptoms, reviews polysomnogram demonstrating hypoventilation and periods of central apnea with desaturation; the clinician documents medical necessity for bilevel support with back-up rate. A durable medical equipment (DME) supplier provisions the E0471 device, verifies mask fit and settings, provides patient education on device use and cleaning, and schedules follow-up to assess adherence, efficacy, and mask/interface issues. Routine clinical interactions include titration via in-lab or home autotitration, remote monitoring of usage and event data, and periodic physician review for continued medical necessity and billing documentation.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    95810Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologistPerformed prior to E0471 prescription to document OSA or nocturnal hypoventilation severity
    95811Polysomnography; with initiation of CPAP therapy, attended by a technologistMay be used when in-lab titration leads to the decision to prescribe bilevel support with back-up rate
    94660Continuous positive airway pressure ventilation (CPAP), initiation and managementUsed for initiation and management of positive airway pressure therapy; adjunct to E0471 workflow when documenting setup and management
    98960Education and training for patient self-management for a single chronic condition; 2-3 sessions, face-to-faceUsed for documented patient education sessions on device use, mask care, and troubleshooting
    G0398Home health respiratory therapy services, first 30 minutes of clinical respiratory therapy in the homeMay be billed when home respiratory therapy services support device initiation and monitoring

    Related Modifiers

    6 rows

    ModifierDescriptionWhen to Use
    22Modifier –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…
    52Modifier ‑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…
    53Modifier 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…
    62Modifier 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…
    78CPT 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…
    80CPT® 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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207RP1001X
    208D00000X
    163W00000X
    363A00000X
    261QA0005X
    324500000X
    364SP0809X
    177F00000X

    Related Payer Policy Updates

    Specialty: Durable Medical Equipment (DME)1 / 3

    10 rows

    PolicyPayerEffective Date
    Hospital Beds Corporate Medical Policybcbsvermont2027-01-01
    Bone Growth StimulatorsMass General Brigham Health Plan2026-12-01
    Prior Authorization for Durable Medical Equipment (DME)Blue Cross Blue Shield - Rhode Island2026-12-01
    Patient Liftsuniverahealthcare2026-11-16
    Medical Car SeatsCareSource2026-11-01
    Non-Invasive Home Mechanical Ventilation (E0466)CareSource2026-11-01
    Digestive Enzyme Cartridgeshusky_health2026-11-01
    Hearing Aids and Assistive Listening Devices for Children Enrolled in Birth-to-Threehusky_health2026-11-01
    Home Non-Invasive Positive Pressure Ventilation (NIPPV) Devices for Respiratory Insufficiency and Failureexcellus_health_plan_inc2026-10-15
    Prior Authorization for Durable Medical Equipment (DME)Blue Cross Blue Shield - Rhode Island2026-10-01

    Related Codes

    HCPCS-E0100-CANE-DURABLE-MEDICAL-EQUIPMENT-AMBULATION

    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

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    Frequently Asked Questions

    References

    1. 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. 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. 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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