HCPCS Code E0471: Respiratory Assist Device, Bi-Level Pressure Capability, With Back-Up Rate Feature, Used With Noninvasive Interface, e.g., Nasal or Facial Mask (Intermittent Assist Device With Continuous Positive Airway Pressure Device)

Learn about the HCPCS code E0471 for a type of respiratory assist device with bi-level pressure capability through this short guide.

Use Code

## **What is the HCPCS code E0471 for?** The HCPCS code E0471 is one of many codes classified under the HCPCS category Durable Medical Equipment. This code specifically designates the provision of a respiratory assist device that has bi-level pressure capability with a back-up rate feature. It is used with a noninvasive interface such as a nasal or facial mask (intermittent assist device with continuous positive airway pressure device). This specific device assists patients with breathing through two levels of positive airway pressure (inhalation and exhalation) at different levels. By providing the patient with pressurized air, their airways remain open. This ensures they get proper ventilation. This is provided to patients with sleep apnea, chronic obstructive pulmonary disease, respiratory failure, and hypoventilation syndromes. This device also comes with a backup respiratory rate feature that can help deliver timed breaths if the patient fails to initiate them on their own.

## **Documentation requirements for E0471** As with any HCPCS code, you'll need to prepare sufficient documentation before you decide to file a claim for it. And the documentation must satisfy the correct coding guidelines and requirements set by your insurer, as well as any related policy articles, local coverage determinations, and the Social Security Act. Here are examples of what you need: - The full name of the patient/beneficiary - The full names and credentials of the healthcare professionals who handled/are handling the patient/beneficiary - The name, address, and facility type where this was provided - Prescription/order for the device from the patient's handlers - Relevant information, test results, and indications related to the patient's condition (e.g., diagnoses, diagnostic sleep studies, tests conducted, clinical evaluation notes, etc.) to justify medical necessity - Proof of compliance and benefit, plus documentation of the patient's consent to undergo treatment using this device - Re-evaluation results after 60-90 days to confirm continued necessity (if needed) Incorrect coding procedures and documentation that fail to comply with payment rules and requirements will be rejected immediately.

## **Billing requirements for E0471** Besides the documentation requirements above, please make sure to take note of or have the following: - 1 device = 1 unit - Supplier information (they must also be Medicare/DMEPOS-certified) - The coverage for this is allowed if a standard CPAP or bi-level without backup is insufficient - If the device has been stolen, lost, or irreparably damaged, there must be documentation for it, just in case you are filing for a replacement item during the device's reasonable useful lifetime - E0471 is included in the functionality for E0467. Please note this CMS guideline: "Any claim for repair (HCPCS code K0739 for labor and any HCPCS code for replacement items) of beneficiary-owned equipment identified by HCPCS codes listed above is considered as unbundling if the date(s) of service for the repair overlaps any date(s) of service for code E0467."

## **Other similar codes for the same or similar equipment** - **E0601** - Continuous positive airway pressure (CPAP) device - **E0470** - Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) - **E1390** - Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate - **E1392** - Portable oxygen concentrator, rental - **E0467** - Home ventilator, multi-function respiratory device, also performs any or all of the additional functions of oxygen concentration, drug nebulization, aspiration, and cough stimulation, includes all accessories, components and supplies for all functions

Frequently asked questions

E0470 provides bi-level pressure only. E0471 adds a backup respiratory rate, making it appropriate for central sleep apnea and hypoventilation.

It is usually billed as a capped rental under Medicare, eventually converting to patient ownership after 13 months of continuous use.

Sleep labs for initial setups and periodic assessments of the patient. Since this is a rental device and can be owned after a certain amount of time, it's mostly used at the patient's residence.