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Fee Schedule Category: Inexpensive and Routinely Purchased Items
Short Description for E0486: Oral device/appliance cusfab
Long Description for E0486: ORAL DEVICE/APPLIANCE USED TO REDUCE UPPER AIRWAY COLLAPSIBILITY, ADJUSTABLE OR NON-ADJUSTABLE, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT

Rural ZIP Code Checker


Beneficiary State of Residence Modifier Modifier Rural Fee Non-Rural Fee Effective From Effective To
CA NU $0.00 01/01/2023 03/31/2023
AK NU $0.00 01/01/2023 03/31/2023
FL NU $0.00 01/01/2023 03/31/2023
AL NU $0.00 01/01/2023 03/31/2023
IN NU $0.00 01/01/2023 03/31/2023
DC NU $0.00 01/01/2023 03/31/2023
KS NU $0.00 01/01/2023 03/31/2023
CT NU $0.00 01/01/2023 03/31/2023
MA NU $0.00 01/01/2023 03/31/2023
GA NU $0.00 01/01/2023 03/31/2023
AZ NU $0.00 01/01/2023 03/31/2023
ID NU $0.00 01/01/2023 03/31/2023
OH NU $0.00 01/01/2023 03/31/2023
DE NU $0.00 01/01/2023 03/31/2023
ME NU $0.00 01/01/2023 03/31/2023
IA NU $0.00 01/01/2023 03/31/2023
MS NU $0.00 01/01/2023 03/31/2023
MO NU $0.00 01/01/2023 03/31/2023
AR NU $0.00 01/01/2023 03/31/2023
HI NU $0.00 01/01/2023 03/31/2023
NJ NU $0.00 01/01/2023 03/31/2023
VI NU $0.00 01/01/2023 03/31/2023
MD NU $0.00 01/01/2023 03/31/2023
IL NU $0.00 01/01/2023 03/31/2023
CO NU $0.00 01/01/2023 03/31/2023
PR NU $0.00 01/01/2023 03/31/2023
NH NU $0.00 01/01/2023 03/31/2023
LA NU $0.00 01/01/2023 03/31/2023
NC NU $0.00 01/01/2023 03/31/2023
KY NU $0.00 01/01/2023 03/31/2023
SD NU $0.00 01/01/2023 03/31/2023
NY NU $0.00 01/01/2023 03/31/2023
RI NU $0.00 01/01/2023 03/31/2023
TN NU $0.00 01/01/2023 03/31/2023
OR NU $0.00 01/01/2023 03/31/2023
MN NU $0.00 01/01/2023 03/31/2023
SC NU $0.00 01/01/2023 03/31/2023
NV NU $0.00 01/01/2023 03/31/2023
TX NU $0.00 01/01/2023 03/31/2023
NE NU $0.00 01/01/2023 03/31/2023
MI NU $0.00 01/01/2023 03/31/2023
MT NU $0.00 01/01/2023 03/31/2023
VA NU $0.00 01/01/2023 03/31/2023
OK NU $0.00 01/01/2023 03/31/2023
VT NU $0.00 01/01/2023 03/31/2023
ND NU $0.00 01/01/2023 03/31/2023
UT NU $0.00 01/01/2023 03/31/2023
PA NU $0.00 01/01/2023 03/31/2023
WA NU $0.00 01/01/2023 03/31/2023
WI NU $0.00 01/01/2023 03/31/2023
WY NU $0.00 01/01/2023 03/31/2023
NM NU $0.00 01/01/2023 03/31/2023
WV NU $0.00 01/01/2023 03/31/2023
HI RR $0.00 01/01/2023 03/31/2023
AL RR $0.00 01/01/2023 03/31/2023
AK RR $0.00 01/01/2023 03/31/2023
DC RR $0.00 01/01/2023 03/31/2023
AR RR $0.00 01/01/2023 03/31/2023
CT RR $0.00 01/01/2023 03/31/2023
CA RR $0.00 01/01/2023 03/31/2023
MA RR $0.00 01/01/2023 03/31/2023
GA RR $0.00 01/01/2023 03/31/2023
FL RR $0.00 01/01/2023 03/31/2023
CO RR $0.00 01/01/2023 03/31/2023
ID RR $0.00 01/01/2023 03/31/2023
KS RR $0.00 01/01/2023 03/31/2023
AZ RR $0.00 01/01/2023 03/31/2023
KY RR $0.00 01/01/2023 03/31/2023
MN RR $0.00 01/01/2023 03/31/2023
NV RR $0.00 01/01/2023 03/31/2023
NC RR $0.00 01/01/2023 03/31/2023
LA RR $0.00 01/01/2023 03/31/2023
IL RR $0.00 01/01/2023 03/31/2023
IA RR $0.00 01/01/2023 03/31/2023
MD RR $0.00 01/01/2023 03/31/2023
ND RR $0.00 01/01/2023 03/31/2023
NY RR $0.00 01/01/2023 03/31/2023
MI RR $0.00 01/01/2023 03/31/2023
SD RR $0.00 01/01/2023 03/31/2023
DE RR $0.00 01/01/2023 03/31/2023
MO RR $0.00 01/01/2023 03/31/2023
OH RR $0.00 01/01/2023 03/31/2023
MT RR $0.00 01/01/2023 03/31/2023
NJ RR $0.00 01/01/2023 03/31/2023
IN RR $0.00 01/01/2023 03/31/2023
RI RR $0.00 01/01/2023 03/31/2023
VI RR $0.00 01/01/2023 03/31/2023
OR RR $0.00 01/01/2023 03/31/2023
VT RR $0.00 01/01/2023 03/31/2023
NM RR $0.00 01/01/2023 03/31/2023
OK RR $0.00 01/01/2023 03/31/2023
ME RR $0.00 01/01/2023 03/31/2023
NH RR $0.00 01/01/2023 03/31/2023
NE RR $0.00 01/01/2023 03/31/2023
WI RR $0.00 01/01/2023 03/31/2023
TX RR $0.00 01/01/2023 03/31/2023
WA RR $0.00 01/01/2023 03/31/2023
MS RR $0.00 01/01/2023 03/31/2023
SC RR $0.00 01/01/2023 03/31/2023
UT RR $0.00 01/01/2023 03/31/2023
VA RR $0.00 01/01/2023 03/31/2023
TN RR $0.00 01/01/2023 03/31/2023
WV RR $0.00 01/01/2023 03/31/2023
PA RR $0.00 01/01/2023 03/31/2023
PR RR $0.00 01/01/2023 03/31/2023
WY RR $0.00 01/01/2023 03/31/2023
CT UE $0.00 01/01/2023 03/31/2023
AL UE $0.00 01/01/2023 03/31/2023
ME UE $0.00 01/01/2023 03/31/2023
CA UE $0.00 01/01/2023 03/31/2023
AK UE $0.00 01/01/2023 03/31/2023
AR UE $0.00 01/01/2023 03/31/2023
ID UE $0.00 01/01/2023 03/31/2023
CO UE $0.00 01/01/2023 03/31/2023
MD UE $0.00 01/01/2023 03/31/2023
IL UE $0.00 01/01/2023 03/31/2023
IN UE $0.00 01/01/2023 03/31/2023
IA UE $0.00 01/01/2023 03/31/2023
FL UE $0.00 01/01/2023 03/31/2023
HI UE $0.00 01/01/2023 03/31/2023
LA UE $0.00 01/01/2023 03/31/2023
MI UE $0.00 01/01/2023 03/31/2023
KY UE $0.00 01/01/2023 03/31/2023
GA UE $0.00 01/01/2023 03/31/2023
DC UE $0.00 01/01/2023 03/31/2023
AZ UE $0.00 01/01/2023 03/31/2023
DE UE $0.00 01/01/2023 03/31/2023
KS UE $0.00 01/01/2023 03/31/2023
NM UE $0.00 01/01/2023 03/31/2023
MT UE $0.00 01/01/2023 03/31/2023
PR UE $0.00 01/01/2023 03/31/2023
MO UE $0.00 01/01/2023 03/31/2023
MA UE $0.00 01/01/2023 03/31/2023
NJ UE $0.00 01/01/2023 03/31/2023
RI UE $0.00 01/01/2023 03/31/2023
TX UE $0.00 01/01/2023 03/31/2023
ND UE $0.00 01/01/2023 03/31/2023
PA UE $0.00 01/01/2023 03/31/2023
NC UE $0.00 01/01/2023 03/31/2023
NV UE $0.00 01/01/2023 03/31/2023
TN UE $0.00 01/01/2023 03/31/2023
WV UE $0.00 01/01/2023 03/31/2023
UT UE $0.00 01/01/2023 03/31/2023
VT UE $0.00 01/01/2023 03/31/2023
MN UE $0.00 01/01/2023 03/31/2023
OR UE $0.00 01/01/2023 03/31/2023
NE UE $0.00 01/01/2023 03/31/2023
MS UE $0.00 01/01/2023 03/31/2023
NY UE $0.00 01/01/2023 03/31/2023
WA UE $0.00 01/01/2023 03/31/2023
OK UE $0.00 01/01/2023 03/31/2023
SD UE $0.00 01/01/2023 03/31/2023
VA UE $0.00 01/01/2023 03/31/2023
NH UE $0.00 01/01/2023 03/31/2023
OH UE $0.00 01/01/2023 03/31/2023
WY UE $0.00 01/01/2023 03/31/2023
VI UE $0.00 01/01/2023 03/31/2023
WI UE $0.00 01/01/2023 03/31/2023
SC UE $0.00 01/01/2023 03/31/2023

Note: A blank cell in the Rural Fee column designates the Rural Fee is the same as the Non-Rural Fee.

Note: This HCPCS code may be subject to a single payment amount (SPA) under the Medicare DMEPOS Competitive Bidding Program. For information on when the SPA applies, specific rates for the SPA, please check the website for the Competitive Bidding Implementation Contractor (CBIC) at https://www.dmecompetitivebid.com.

Note: PDAC provides the CMS quarterly fee schedule amounts directly from the CMS website. If CMS updates the fee schedule within a quarter, DMECS will display the most current fee schedule.