Top 20 durable medical equipment procedure codes
There are over 500 Healthcare Common Procedure Coding System (HCPCS) codes for Durable Medical Equipment (DME) for patients’ every day use.
What is durable medical equipment (DME)?
DME describes medical equipment and supplies ordered by a healthcare provider for a patient’s routine, long-term use. The coverage for DME may include oxygen systems and accessories, canes, wheelchairs, crutches, infusion pumps, and glucose monitors. As the incidence of chronic diseases increases, there will be a growing need for devices to support patients.
Based on data from the Definitive Healthcare ClaimsMx product, we reviewed the DME codes for 2021. The following are the top DME procedure codes with the highest number of claims.
DME procedure codes with most claims in 2021
|Rank||HCPCS code||HCPCS description||Total procedures 2021|
|1||E0601||Continuous positive airway pressure (CPAP) device||232,241|
|2||E0114||Crutches underarm, other than wood, adjustable or fixed pair, with pads, tips and handgrips||112,128|
|3||E0562||Humidifier, heated, used with positive airway pressure (PAP) device||59,553|
|5||E1399||Durable medical equipment, miscellaneous||24,381|
|6||E0604||Hospital grade electric breast pump||19,009|
|8||E0470||Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface||17,684|
|9||E0570||Nebulizer with compression||17,155|
|10||E0730||Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation||16,872|
|11||E0143||Walker folding wheeled||14,823|
|12||E0486||Oral device/appliance used to reduce upper airway collapsibility, adjustable or non-adjustable, custom fabricated, includes fitting and adjustment||14,043|
|13||E0431||Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing||13,653|
|14||E0791||Parenteral infusion pump, stationary, single or multi-channel||13,610|
|16||E0100||Cane adjust/fixed with tip||11,673|
|17||E0600||Respiratory suction pump, home model, portable or stationary, electric||10,565|
|18||E0780||Ambulatory infusion pump, mechanical, reusable, for infusion less than 8 hours||8,376|
|20||E0781||Ambulatory infusion pump||6,812|
Fig. 1 Data from the Definitive Healthcare ClaimsMx product for calendar year 2021. Claims data is sourced from multiple medical claims clearinghouses in the United States and updated monthly. Data accurate as of August 2022.
Which DME procedure codes have the highest number of claims?
Codes for continuous positive airway pressure (CPAP) devices (E0601) top the DME list with 232,000 claims. Crutches (E0114), and humidifiers (E0562) complete the top three.
Eight of the top 20 DME codes are related to respiratory needs including oxygen concentrators (E1390), nebulizers (E0570), and portable oxygen systems (E0431). The COVID-19 pandemic most likely contributed to the high number of claims for respiratory DME codes.
What types of DME does insurance cover?
While levels of insurance coverage vary based on payors, including Medicare and Medicaid coverage of DME, the main types of DME are:
- Oxygen devices and accessories
- Humidifier equipment
- Walking aids
- Hospital beds and related supplies
- Wheelchairs and mobility devices
- Infusion supplies
- Breast pumps
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