According to the Centers for Medicare & Medicaid Services (CMS), DMEPOS claims exceed $6 billion annually. This significant investment by the federal government confirms the important role durable medical equipment plays in managing chronic medical conditions for millions of Americans. These conditions include chronic respiratory issues, mobility challenges, and diabetes complications.
The accuracy of DME coding has direct effects related to reimbursement timelines, compliance standing, and revenue cycle efficiency for providers and suppliers. The billing structure for the durable medical equipment HCPCS codes differs from standard medical billing. DME billing incorporates both CPT and HCPCS codes. This indicates that the billing includes both CPT codes for professional service and HCPCS Level II codes that distinguish DME and medical supplies.
This reference guide of codes provides billing and coding specialists, physicians, and compliance with a structured coding summary of the most frequently used DME CPT codes for 2026.
What is durable medical equipment (DME)?
Durable Medical Equipment (DME) refers to a type of medical supplies and equipment that a healthcare provider prescribes for a patient’s long-term medical use. Durable medical equipment systems are intended for a patient to manage a chronic disease or for post-operative recovery.
For example, DME can include oxygen systems, canes, wheelchairs, crutches, glucose monitors, infusion pumps, swimming pool lifts, and so on. As chronic disease management becomes the trend in healthcare, the use of DME continues to be in demand.
To qualify as DME under Medicare guidelines, items must satisfy four distinct criteria:
- The equipment must withstand repeated use
- Serve a primarily medical purpose
- Be appropriate for home use
- Lack of utility for individuals without illness or injury
CPT Codes in DME Billing
CPT Code 97760 – Orthotic Management and Training
CPT Code 97760 represents the initial orthotic management and training. This service provides a professional assessment of fit, instructions for the patient regarding donning and doffing, and training on the functional use of the orthotic. This code applies when the complexity of the device requires professional instruction and not just verbal direction.
CPT Code 97762 – Orthotic/Prosthetic Checkout
Code 97762 describes checkout services for established patients using orthotic or prosthetic devices. This evaluation service assesses ongoing device fit, functional performance, and need for adjustments. The provider documents the patient’s use patterns, identifies any complications or fit issues, and implements necessary modifications.
CPT Code 94660 – CPAP Ventilation Initiation
Code 94660 represents initiation and management of continuous positive airway pressure ventilation for respiratory failure. This service documents the professional work of establishing CPAP therapy parameters, monitoring initial patient response, and adjusting settings based on clinical response.
Most Frequently Used HCPCS Codes for DME
HCPCS Codes for Respiratory DME
Respiratory DME equipment stands for the largest share of Medicare DME expenditures and claim volume. The combination of a high prevalence of sleep apnea and chronic respiratory conditions leads to high usage rates of respiratory items in both the Medicare and commercial populations.
CPAP Device: E0601
E0601 remains the highest volume DME code of any code, regardless of product type or category, making up 23.20% of all fulfilled DME Orders in 2024 based on claims data. The E0601 code relates to a continuous positive airway pressure device that is prescribed to assist in the treatment of patients with obstructive sleep apnea.
Oxygen Concentrator: E1390
The E1390 HCPCS code identifies an oxygen concentrator with a single delivery port and is used for home oxygen therapy. The HCPCS code E1390 is used for an oxygen concentrator and requires documentation of hypoxemia, defined by oxygen saturation of 88% or less while breathing room air at rest, or a partial pressure of oxygen of 55mmHg or less on arterial blood gas testing.
Portable Oxygen System: E0431
The E0431 code describes the rental for a portable gaseous oxygen system; it has an appropriate container/supplies/delivery apparatus. The context for use of this code is for a patient requiring oxygen for mobility while not at home. This allows ease for the patient to engage in activities in the community and go to medical appointments.
HCPCS Codes for Mobility and Ambulation Equipment
Mobility aids are an important category of Durable Medical Equipment (DME) for older adults, post-surgical people, and people with permanent mobility limitations. Proper DME wheelchair HCPCS code selection depends on the patient’s functional capacity, anthropometric measurements, and long-term equipment needs.
Standard Wheelchair: K0001
K0001 is defined as a standard wheelchair with fixed full-length arms and swing-away detachable footrests. The HCPCS coding for a standard wheelchair is appropriate when a patient cannot ambulate safely with less supportive devices, such as canes or walkers, with medical justification linked to cardiopulmonary, neurological, or musculoskeletal impairment.
Ultralightweight Wheelchair: K0005
K0005 is defined as an ultralightweight wheelchair designed for long-term users who require high-frequency and continued use with improved ease of use for self-propulsion. This wheelchair code has higher reimbursements than K0001; however, it expects more thorough documentation on medical necessity.
Folding Walker: E0143
E0143 is defined as a folding walker that has an adjustable height. This code is assigned if the person is ambulating and is in need of the walker for support because of balance, weakness in one or both lower extremities, or post-operative weight-bearing conditional restrictions. The walker is more stable than a cane and allows for continued weight-bearing and gait training.
Crutches: E0114
E0114 HCPCS code description defines crutches made from materials other than wood, typically aluminum or steel, with adjustable height. This code represented 16.60% of fulfilled DME orders in 2024, ranking second in overall claim volume. The HCPCS code for cane alternatives like crutches serves patients needing non-weight-bearing or partial weight-bearing ambulation following injury or surgery.
HCPCS Codes for Diabetes Management Equipment
With diabetes affecting over 37 million Americans according to the Centers for Disease Control data, DME codes that support the Management of Diabetes represent a large factor of the billing to durable medical equipment suppliers.
External Insulin Pump: E0784
The E0784 HCPCS code is used to represent an external ambulatory insulin infusion pump used to deliver continuous subcutaneous insulin. Coverage for the E0784 code typically requires prior authorization with documentation to show that other regimens of multiple daily insulin injections have failed to achieve adequate glycemic control.
Home Blood Glucose Monitor: E0607
E0607 describes a home blood glucose monitor that has been prescribed by a physician for use by a diabetic patient, who will perform glucose monitoring regularly. Coverage for E0607 may be applied when patients receive a diagnosis of diabetes and are in need of glucose monitoring to support ongoing treatment decisions.
Glucose Test Strips: A4253
A4253 describes blood glucose test strips in quantities of 50 test strips. A4253 is billed separately from the monitor itself and usually is processed separately as a recurring supply order, which has been authorized under the durable medical supply category.
Medicare has established quantity limits based on the individual patient’s order of therapy, typically allowing for 1 test daily for the patient not using insulin, and a maximum of 3 tests per day for the patient using insulin, with coverage subject to additional factors related to clinical circumstances on a case-by-case basis.
Insulin Infusion Supplies: A4239
A4239 identifies monthly insulin infusion that includes infusion sets, insertion devices, or any other components to be utilized in a disposable fashion to allow for the infusion of insulin. These supplies are billed separately from the pump itself (E0784) and require recurring monthly prescriptions.
HCPCS Codes for Pain Management and Physical Therapy Equipment
Durable Medical Equipment (DME) to support rehabilitation and pain management utilizes medical equipment for patients with musculoskeletal pathology, chronic pain syndromes, and orthopedic conditions that require conservative management before surgical management.
TENS Unit, Two Leads: E0720
E0720 describes a transcutaneous electrical nerve stimulation unit with two leads used for pain management in musculoskeletal conditions. Coverage requires documentation that conservative therapies, including medication management and physical therapy, have been attempted before prescribing TENS therapy.
TENS Unit, Four Leads: E0730
The HCPCS code E0730 identifies a TENS unit with four leads that provides a broader area of anatomical coverage for pain management. The E0730 TENS code is used for all patients who, due to the severity of injury, require stimulation of multiple locations or larger areas of treatment than would be possible with a two-lead TENS unit and the E0720 code.
TENS Electrodes: A4557
The HCPCS code A4557 identifies replacement electrodes for use with TENS devices that are billed by the pair. A4557 replacement electrodes are disposable supplies and should be billed separately from the TENS device. They are typically billed as a recurring monthly delivery.
Osteogenesis Stimulator: E0747
The HCPCS code E0747 identifies an electrical osteogenesis (bone growth) stimulator utilized to promote bone healing with non-union fractures or fractures in the delayed-union phase of healing. This code represents high-cost equipment with stringent coverage criteria requiring radiographic documentation of fracture non-union despite conservative treatment.
HCPCS Codes for Home and Hospital Equipment
Home care equipment is helpful for safety measures and rehabilitation in patients with loss of mobility, disability, or recovery from surgical procedures that require equipment for home adaptation.
Semi-Electric Hospital Bed: E0260
E0260 is used for a semi-electric hospital bed with electrically operated head and foot adjustment. This HCPCS hospital bed code requires documentation that the patient requires frequent position changes that cannot be safely achieved using a standard hospital bed.
Pediatric Hospital Bed: E0305
E0305 is used for a pediatric hospital bed with a crib-style enclosure. Coverage for pediatric hospital beds differs by the payer and requires information about the medical necessity for specialized pediatric equipment as opposed to a standard hospital bed or crib.
Bath/Shower Chair: E0240
E0240 is an example of a bath/shower chair that is used when the patient is unable to bathe safely without the use of a seating surface. Bathing chairs are generally low-cost items; however, due to a lack of medical necessity documentation, bath or shower chairs often have frequent denials.
Commode Chair: E0163
E0163 is used for a commode chair when the patient is unable to safely access bathroom facilities due to impaired mobility. This CPT code for commode equipment requires documentation of impaired mobility in the patient’s home or an unavailable bathroom for the patient.
HCPCS Codes for Miscellaneous DME and Daily Living Aids
Beyond those major equipment categories supporting daily living activities and preventative health care support, there is specialty DME for medical needs that do not fit into a designated category.
Electric Breast Pump: E0602
E0602 describes an electric breast pump that may be covered as part of the Affordable Care Act provision for preventive services. The coverage can also apply to those who are pregnant or postpartum, and are not subject to cost-sharing requirements under most commercial plans.
Raised Toilet Seat: E0244
E0244 is a raised toilet seat that is used to assist a patient with a mobility limitation in being able to transfer to or from a level that is standard-height toilet fixture. This raised toilet seat HCPCS code experiences frequent denials despite low cost when documentation inadequately establishes medical necessity.
Home Ventilator: E0466
E0466 describes a home ventilator with an invasive interface for patients who need long-term mechanical ventilation in the home environment. The cost of a home ventilator is high, and it requires extensive documentation, including pulmonary function studies, arterial blood gas results, the underlying diagnosis, and a comprehensive care plan.
DME Repair and Servicing: K0739
K0739 refers to repairs or servicing on durable medical equipment, including labor & parts. K0739 is applicable when durable medical equipment needs repair or servicing, rather than replacing the current equipment for the patient.
Humidifier for Respiratory Equipment: E0562
E0562 HCPCS code description defines a humidifier for use with respiratory equipment, which is mainly used with CPAP and BiPAP devices. This code accounted for 12.60% of filled DME orders for 2024, which was the third-highest overall volume for claims.
Modifiers in DME Billing
Modifiers are important in DME billing to identify what type of equipment is being billed. The following modifiers are commonly used:
- RR: Rental — This modifier tells us that the equipment is rented, not purchased.
- NU: New equipment — Used to indicate that the equipment is new and has never been used.
- KX: Documentation on file — This modifier tells us that all documentation required for medical necessity for this piece of equipment is present.
- GA/GZ: ABN issued or not issued — This is used every time we have an Advance Beneficiary Notice (ABN).
Modifiers such as KX are often required for Medicare coverage, so it is important to add them to claims. Incomplete or incorrect use of modifiers can result in claim denials, which is why proper documentation is essential.
DME Procedure Codes with the Highest Volume of Claims
Analysis of benefits data demonstrates distinct patterns in the use of DME, with specific categories of equipment leading the charge in billing across payers. Identifying utilization patterns can assist providers in anticipating documentation opportunities and compliance audits.
- E0601 (CPAP devices) – 23.20% of all fulfilled DME orders, the highest-volume code, driven by rising obstructive sleep apnea cases.
- E0114 (non-wood crutches) – 16.60% of fulfilled orders, reflecting high orthopedic injury and post-operative mobility needs.
- E0562 (humidifiers for respiratory equipment) – 12.60% of fulfilled orders, commonly paired with CPAP therapy to support comfort and adherence.
Types of DME Covered by Insurance
Insurance coverage for durable medical equipment varies depending on the payer, but Medicare and Medicaid generally cover equipment that meets the following criteria:
- Durability: The equipment must withstand repeated use.
- Medical necessity: The equipment must be used for a medical condition.
- In-home use: The equipment must be suitable for in-home use.
- Not useful to healthy individuals: The equipment should only benefit those with a medical need.
Commonly covered types of DME include:
- Oxygen devices and accessories
- Walking aids (e.g., canes, crutches)
- Hospital beds and related supplies
- Orthotics and prosthetics
- Breast pumps
- Infusion pumps
These items are essential for managing chronic conditions and supporting patients’ independence in daily life.
Conclusion
The use of DME HCPCS codes, like oxygen concentrators and mobility aids, is increasing as more patients engage in the management of chronic conditions. DMEs are a lifesaver as they can improve their quality of life. Each CPT code for durable medical equipment carries specific billing protocols that determine if the claims are processed successfully or trigger denials.
However, when billing for DME, providers may find the extensive and often complicated relationships among the multitude of CPT and HCPCS codes to pose a significant challenge. If you’re new to DME billing or lack the resources to manage it in-house, outsourcing to specialized DME billing services can be an effective solution. Consider outsourcing DME billing services to professionals at Nexus io. These experts can guide you through the process and help you maintain compliance while optimizing your revenue cycle.
