DME Billing CPT and HCPCS Codes 

Last Updated on September 22, 2025

Durable Medical Equipment (DME) supports millions of patients across the U.S. with long-term health needs ranging from respiratory support and diabetes management to mobility and home safety. Medicare alone spends over $6 billion annually on DMEPOS claims (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies), according to the Centers for Medicare & Medicaid Services (CMS).

For providers and suppliers, accurate billing is not optional, it is the foundation of timely reimbursement, compliance, and smooth revenue cycle management. 

Unlike other specialties that rely heavily on CPT codes, DME billing depends on a combination of CPT (services) and HCPCS Level II (equipment and supplies) codes. Understanding the right code for the right scenario helps practices avoid denials and deliver equipment to patients without delays.

CPT Codes in DME Billing (Service-Related)

CPT codes play a smaller but still vital role in DME billing. These codes apply when healthcare professionals provide fitting, education, or management services associated with durable medical equipment.

• 97760 – Orthotic Management and Training – Used when a provider fits or trains a patient in the use of orthoses such as leg braces, spinal supports, or upper extremity devices. Documentation must specify the device, the duration of the session, and the training provided.
• 97762 – Checkout for Orthotic/Prosthetic Use – This code applies when a provider evaluates the effectiveness of a device after delivery. It’s often used during follow-up visits when adjustments or modifications are necessary.
• 94660 – CPAP Initiation and Management – Applied when setting up and training a patient in the use of a CPAP device. Because CPAP therapy is heavily monitored by payers, detailed notes about patient education and compliance are essential.

Trainer tip: Think of CPT codes as describing the service of helping the patient use DME, while HCPCS codes describe the actual equipment or supplies provided.

HCPCS Codes in DME Billing 

HCPCS Level II codes form the backbone of DME billing. These codes describe the physical equipment and consumable supplies, and they often require modifiers like RR (Rental), NU (New), or KX (Documentation on file) for approval.

Respiratory Equipment

Respiratory equipment accounts for some of the most frequently billed DME codes under Medicare.

• E0601 – Continuous Positive Airway Pressure (CPAP) device – The most common DME code. Must be supported by a sleep study confirming obstructive sleep apnea. Requires modifier NU (new) or RR (rental).
• E1390 – Oxygen concentrator, single delivery port – Coverage requires documented hypoxemia (oxygen saturation ≤88%). KX modifier is mandatory for Medicare.
• E0431 – Portable gaseous oxygen system – Often billed for patients requiring mobility. Documentation must show oxygen use beyond the home.

Key note: Respiratory claims are among the most audited, making complete documentation critical.

Mobility Aids

Mobility aids represent another high-volume DME category.

• K0001 – Standard wheelchair – Typically covered when patients cannot ambulate with a cane or walker. Requires documentation of medical necessity and inability to use lesser devices.
• K0005 – Ultralightweight wheelchair – Designed for long-term, high-use patients. Higher reimbursement than K0001 but requires strong documentation.
• E0143 – Folding walker, adjustable height – Often prescribed post-surgery or for elderly patients. Must show the patient is unsafe ambulating without support.

Documentation must always note why a less costly alternative would not meet the patient’s needs.

Diabetes Management

With diabetes affecting over 37 million Americans (CDC), DME codes for diabetes equipment are a major billing category.

• E0784 – External insulin pump – Coverage often requires prior authorization. Documentation must show uncontrolled diabetes despite multiple daily injections.
• A4239 – Insulin infusion supplies, per month – Supplies billed separately from the pump itself, typically on a recurring basis.
• E0607 – Home blood glucose monitor – Covered when prescribed for diabetic patients with clear documentation of need.
• A4253 – Blood glucose test strips, per 50 – Requires documentation of frequency of testing. Medicare usually limits coverage to once per day for non-insulin patients and three times per day for insulin patients depending on eligibility Coverage.

Therapy & Pain Management

DME also supports rehabilitation and pain management.

• E0720 – TENS unit, two leads – Used for pain relief, often in musculoskeletal conditions. Documentation must show conservative therapies were attempted before prescribing.
• E0730 – TENS unit, four leads – Similar to E0720 but for broader coverage.
• A4557 – Electrodes for TENS unit, per pair – Billed separately, typically on a monthly basis.
• E0747 – Osteogenesis stimulator, electrical – Used for non-union fractures. Coverage is strict and requires imaging and clinical documentation.

Beds and Home Equipment

DME also includes home care equipment designed to support patient safety and recovery.

• E0260 – Semi-electric hospital bed – Coverage requires documentation that the patient needs frequent positioning that cannot be achieved with a standard bed.
• E0305 – Pediatric hospital bed, crib style – Coverage varies; must demonstrate medical necessity and inability to use a standard bed safely.
• E0240 – Bath/shower chair – Often denied unless documentation proves the patient is unable to bathe safely without it.
• E0163 – Commode chair – Coverage requires documentation of impaired mobility or lack of access to bathroom facilities.

Miscellaneous / Daily Living

These codes represent specialized equipment that improves quality of life.

• E0602 – Breast pump, electric – Covered under Affordable Care Act provisions for preventive services.
• E0244 – Raised toilet seat – Simple but frequently denied if documentation is weak. Must clearly show patient mobility impairment.
• E0466 –  Home ventilator, invasive interface – High-cost equipment requiring intensive documentation. Often requires prior authorization.
• K0739 – Repair or servicing of DME – Used when equipment is repaired, requiring labor and parts documentation. Coverage generally applies only if the equipment is still considered medically necessary.

Modifiers in DME Billing

Modifiers are essential in DME billing because they define whether equipment is rented, purchased, or documented correctly.

• RR – Rental
• NU – New equipment
• UE – Used equipment
• KX – Documentation on file
• GA/GZ – ABN issued or not issued

Example: A CPAP device billed as E0601-RR signals rental, while E0601-NU signals purchase. Without the right modifier, claims are automatically denied.

Documentation Checklist

Every DME claim should include:

• Detailed Written Order (DWO) signed by the physician.
• Relevant ICD-10 diagnosis code to support necessity.
• Duration of need (temporary rental vs long-term purchase).
• Proof of failed alternatives (e.g., why a cane cannot replace a wheelchair).
• Patient’s functional limitations described clearly in clinical notes.
  

FAQs on DME Billing

1. Do DME claims usually require prior authorization?
Yes. High-cost items like insulin pumps, ventilators, and hospital beds almost always require prior authorization. Always verify payer policy before submission.

2. Can supplies be billed separately from equipment?
Yes. For example, CPAP machines (E0601) are billed separately from supplies like tubing (A7037) or masks (A7030). Failing to bill supplies separately can result in lost revenue.

3. How long does Medicare cover rentals before requiring purchase?
Typically 13 continuous months of rental, after which ownership transfers to the patient.

4. What are the most commonly denied DME claims?
Respiratory equipment (E0601, E1390) and mobility aids (K0001) see frequent denials, usually due to incomplete documentation of medical necessity.

5. How often can DME equipment be replaced under Medicare?
Generally every 5 years, unless equipment is lost, stolen, or irreparably damaged.