Question 1

What is HCPCS code E0472?

Accepted Answer

HCPCS code E0472 is "Rad w backup invasive intrfc". Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pressure device)

Question 2

What category is E0472 in?

Accepted Answer

E0472 belongs to HCPCS Category E (Durable Medical Equipment (DME)).

Question 3

When should I use HCPCS code E0472?

Accepted Answer

Use E0472 when billing for rad w backup invasive intrfc. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is E0472 covered by Medicare?

Accepted Answer

Coverage for E0472 (Rad w backup invasive intrfc) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for E0472?

Accepted Answer

Documentation for E0472 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).