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    v1.0.31
    OpenPayerBilling CodesDurable Medical EquipmentHCPCS hcpcs-e0491-oral-nerve-stimulation-tongue-appliance-90-day
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    HCPCS Level II E0491: Oral Neuromuscular Tongue Stimulation Device, 90-Day Supply

    HCPCS Level II code E0491 describes an oral device/appliance for neuromuscular electrical stimulation of the tongue muscle supplied as a 90-day device kit and intended to be used with a separate power source and control electronics unit controlled by a hardware remote; service type: durable medical equipment for neuromuscular stimulation therapy; typical site of service: outpatient clinics, speech-language pathology or rehabilitation settings, and home use when paired with the required power/control unit.

    For related coverage guidance, see recent payer policy updates: Hospital Beds Corporate Medical Policy, Continuous Passive Motion Devices with Remote Monitoring or Adaptive Capabilities, Bone Growth Stimulators.

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    Clinical & Coding Specifications

    Clinical Context

    A 62-year-old patient with chronic post-stroke dysphagia and persistent tongue weakness is evaluated by a speech-language pathologist and a physiatrist for neuromuscular rehabilitation. After clinical swallowing evaluation and instrumental assessment (videofluoroscopic swallow study) demonstrating reduced tongue base retraction and impaired swallow initiation, the interdisciplinary team prescribes a home-based neuromuscular electrical stimulation (NMES) program targeting the genioglossus and intrinsic tongue musculature. The oral device/appliance E0491 is issued as a 90-day supply and used in conjunction with a separate power source and control electronics unit; the patient receives device fitting, remote hardware training, and an individualized therapy plan with scheduled follow-up visits for progress assessment and device adjustments.

    Typical clinical workflow:

    • Referral and evaluation by primary care, physiatry, or otolaryngology with speech-language pathology involvement.

    • Instrumental assessment (e.g., videofluoroscopy) to document physiologic deficits and justify NMES targeting of tongue musculature.

    • Prescription of the oral NMES appliance E0491 with documentation of medical necessity, treatment goals, and expected duration (90 days).

    • Device fitting and patient/caregiver training on use of the appliance with the power/control unit and hardware remote.

    • Scheduled therapy sessions (in-person or telehealth) to monitor compliance, adjust stimulation parameters, and document clinical progress.

    • Periodic re-assessments to determine continued need, potential refill or device replacement, and to code services and supply billing appropriately.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    92526Treatment of swallowing dysfunction and/or oral function for feeding; individualSpeech-language pathology treatment sessions that commonly accompany use of the oral NMES appliance for tongue rehabilitation.
    92610Evaluation of oral and pharyngeal swallowing function (e.g., videofluoroscopic, cinefluoroscopic studies)Instrumental assessment used prior to prescribing E0491 to document physiologic deficits and baseline function.
    97110Therapeutic exercises to develop strength and endurance, range of motion and flexibilityPhysical therapy or SLP-delivered exercises often paired with NMES appliance use to improve tongue strength and swallow mechanics.
    97760Orthotic(s)/prosthetic(s) management and training, upper extremity, lower extremity, and trunk; initial or subsequent fitting and training (can be applied to oral appliance training per payer rules)

    Related Modifiers

    8 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…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    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…
    82Modifier 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
    235Z00000X
    207L00000X
    207K00000X
    208D00000X
    213E00000X
    207ZM0300X
    146N00000X
    2279P4000X

    Related Payer Policy Updates

    Specialty: Durable Medical Equipment (DME)1 / 3

    10 rows

    PolicyPayerEffective Date
    Hospital Beds Corporate Medical Policybcbsvermont2027-01-01
    Continuous Passive Motion Devices with Remote Monitoring or Adaptive CapabilitiesBlue Cross Blue Shield - Rhode Island2026-12-01
    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

    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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    Used by suppliers or rehabilitation clinicians for device fitting, adjustment, and patient training when billed for appliance management.
    99070Supplies and materials (except spectacles), provided by the physician over and above those usually included with the serviceMay be used to bill non-durable accessory supplies related to device maintenance or disposable components in the therapy course.