Summary & Overview
HCPCS Level II E1352: Oxygen Flow Regulator with Positive Inspiratory Pressure
HCPCS Level II code E1352 denotes an oxygen accessory: a flow regulator capable of providing positive inspiratory pressure. This equipment category supports patients who need controlled oxygen delivery with inspiratory pressure assistance and is a component of durable medical equipment used in home health, outpatient, and long-term care settings. Nationally, accurate coding for oxygen accessories affects coverage determinations, claims adjudication, and appropriate durable medical equipment provisioning for respiratory care.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of payer coverage scopes and common billing practices for E1352, typical sites of service where the device is used, and the clinical context in which the accessory is applied.
The publication outlines benchmarks for utilization and reimbursement where available, notes relevant policy considerations affecting durable medical equipment claims, and summarizes clinical scenarios that commonly prompt use of a flow regulator capable of positive inspiratory pressure. Data not provided in the input (such as specific fee schedules, associated taxonomies, and ICD-10 diagnosis pairings) are identified as unavailable. The content is designed for coders, billing managers, and policy analysts seeking a concise national reference for HCPCS Level II code E1352.
Billing Code Overview
HCPCS Level II code E1352 describes an oxygen accessory — a flow regulator capable of positive inspiratory pressure. This device is used to manage and regulate oxygen delivery while providing support during inhalation, commonly applied for patients requiring assisted oxygen therapy with controlled inspiratory pressure.
Service type: Durable medical equipment (oxygen accessory)
Typical site of service: Home health, outpatient clinics, and long-term care settings where oxygen therapy is administered
Clinical & Coding Specifications
Clinical Context
A patient with chronic hypoxemic respiratory failure who requires outpatient oxygen support presents for equipment setup and education. The device component billed with E1352 (oxygen accessory, flow regulator capable of positive inspiratory pressure) is provided when the home oxygen therapy plan requires a flow regulator that can deliver positive inspiratory pressure settings for patients with obstructive or restrictive lung disease, neuromuscular weakness, or complex sleep-disordered breathing. Typical workflow: a respiratory therapist or durable medical equipment (DME) supplier coordinates with the prescribing clinician (pulmonologist or primary care physician) to confirm the order specifying a flow regulator with positive inspiratory pressure capability; the supplier documents the physician order, verifies insurance coverage, delivers the accessory to the patient’s home or DME clinic, performs device setup and patient/caregiver instruction, and captures delivery and clinical notes for billing. Typical sites of service include the patient’s home, a DME supplier location, or an outpatient pulmonary clinic. Common clinical scenarios include chronic obstructive pulmonary disease exacerbation with persistent hypoxemia requiring titratable oxygen with inspiratory pressure support, amyotrophic lateral sclerosis with progressive respiratory muscle weakness needing assisted inspiratory flow control, or complex sleep apnea requiring home-based positive pressure adjuncts with supplemental oxygen.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |