Top durable medical equipment procedure codes
What is durable medical equipment (DME)?
Durable medical equipment refers to 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 instances of chronic disease increase, there is a growing need for devices to support patients in managing their conditions.
What HCPCS codes are used for DME?
HCPCS codes come from a code set developed by CMS for reporting medical procedures and services. These codes are grouped by a leading letter, and each letter represents a different group of healthcare-related supplies. Durable medical equipment is represented by the letter “E” code group.
Using data from the Definitive Healthcare Atlas All-Payor Claims dataset, we have identified the top 20 most fulfilled durable medical equipment orders in 2022. This data represents the percentage of fulfilled DME orders in the U.S. and is based on physician ordering activity.
Because the chart below was built using claims data, it only includes orders by physicians that were billed through insurance. Some patients may opt to buy some equipment without submitting through insurance.
|Rank||HCPCS Code||HCPCS Description||Percent of fulfilled durable medical equipment orders in the U.S.||Explore dataset|
|2||E0601||Continuous positive airway pressure (CPAP) device||15.37%||Explore|
|3||E0431||Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing||12.06%||Explore|
|4||E0562||Humidifier, heated, used with positive airway pressure (PAP) device||7.35%||Explore|
|5||E0570||Nebulizer with compression||4.58%||Explore|
|6||E1392||Portable oxygen concentrator||4.38%||Explore|
|7||E0260||Hospital bed, semi-electric, with mattress||2.26%||Explore|
|8||E0143||Walker folding wheeled||2.18%||Explore|
|9||E0470||Respiratory assist device, without backup rate feature||1.69%||Explore|
|10||E0466||Home ventilator, with non-invasive interface||1.36%||Explore|
|11||E0114||Crutches underarm, other than wood, adjustable or fixed pair, with pads, tips and handgrips||1.02%||Explore|
|12||E0603||Electric breast pump||0.94%||Explore|
|13||E1028||Wheelchair accessory, manual swing away, retractable/removable mounting hardware for joystick||0.90%||Explore|
|14||E0971||Manual wheelchair accessory, anti-tipping device||0.88%||Explore|
|15||E1399||Durable medical equipment, miscellaneous||0.70%||Explore|
|16||E0156||Walker seat attachment||0.68%||Explore|
|17||E0163||Commode chair with fixed arm||0.67%||Explore|
|18||E0630||Patient lift, hydraulic or mechanical||0.66%||Explore|
|19||E0973||Wheelchair accessory, adjustable height, detachable armrest||0.58%||Explore|
|20||E0781||Ambulatory infusion pump||0.57%||Explore|
Which DME procedure codes have the highest volume of claims?
The top DME procedure code by the percentage of fulfilled DME orders was for oxygen concentrators (E1390). Oxygen concentrators are medical devices that give the user extra oxygen. They are typically prescribed to patients with conditions that cause low levels of oxygen. This DME code accounts for nearly a quarter of all fulfilled DME orders.
The second top DME code by the percentage of fulfilled orders was for continuous airway pressure devices (E0601), at 15.37%. Continuous airway pressure devices, more commonly called CPAP machines, are used to treat sleep apnea by delivering pressurized air through a mask that is worn during sleep.
In third place was portable gaseous 02 (E0431), accounting for 12.06% of all fulfilled DME orders. Like oxygen concentrators, portable gaseous tanks provide supplemental oxygen to those with low oxygen levels. These portable devices allow people to receive oxygen while outside of the home.
The following three DME codes – humidifiers (E0562), nebulizers with compression (E0570), and portable oxygen concentrators (E1392) – are also related to respiratory needs. The COVID-19 pandemic likely contributed to the high number of respiratory-related DME codes topping the list.
What types of DME does insurance cover?
Insurance coverage of durable medical equipment may vary based on payors, including Medicare/Medicaid DME coverage. Medicare requires that DME meet four criteria points: durability, utilized for medical needs, acceptable for in-home use, and generally not useful to someone uninjured or in good health.
Despite varying coverage, generally, the main types of covered DME include:
Oxygen devices and accessories
Hospital beds and related supplies
Healthcare Insights are developed with healthcare commercial intelligence from the Definitive Healthcare platform. Want even more insights? Start a free trial now and get access to the latest healthcare commercial intelligence on hospitals, physicians, and other healthcare providers.