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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
AR RR $0.00 01/01/2022 03/31/2022
DC RR $0.00 01/01/2022 03/31/2022
AZ RR $0.00 01/01/2022 03/31/2022
FL RR $0.00 01/01/2022 03/31/2022
HI RR $0.00 01/01/2022 03/31/2022
CA RR $0.00 01/01/2022 03/31/2022
AL RR $0.00 01/01/2022 03/31/2022
IL RR $0.00 01/01/2022 03/31/2022
AK RR $0.00 01/01/2022 03/31/2022
GA RR $0.00 01/01/2022 03/31/2022
IN RR $0.00 01/01/2022 03/31/2022
LA RR $0.00 01/01/2022 03/31/2022
NM RR $0.00 01/01/2022 03/31/2022
MS RR $0.00 01/01/2022 03/31/2022
KS RR $0.00 01/01/2022 03/31/2022
IA RR $0.00 01/01/2022 03/31/2022
CT RR $0.00 01/01/2022 03/31/2022
KY RR $0.00 01/01/2022 03/31/2022
CO RR $0.00 01/01/2022 03/31/2022
MO RR $0.00 01/01/2022 03/31/2022
DE RR $0.00 01/01/2022 03/31/2022
NC RR $0.00 01/01/2022 03/31/2022
MD RR $0.00 01/01/2022 03/31/2022
ME RR $0.00 01/01/2022 03/31/2022
ID RR $0.00 01/01/2022 03/31/2022
MA RR $0.00 01/01/2022 03/31/2022
NE RR $0.00 01/01/2022 03/31/2022
NV RR $0.00 01/01/2022 03/31/2022
MN RR $0.00 01/01/2022 03/31/2022
SC RR $0.00 01/01/2022 03/31/2022
ND RR $0.00 01/01/2022 03/31/2022
NH RR $0.00 01/01/2022 03/31/2022
OR RR $0.00 01/01/2022 03/31/2022
PA RR $0.00 01/01/2022 03/31/2022
WA RR $0.00 01/01/2022 03/31/2022
MT RR $0.00 01/01/2022 03/31/2022
OK RR $0.00 01/01/2022 03/31/2022
PR RR $0.00 01/01/2022 03/31/2022
VI RR $0.00 01/01/2022 03/31/2022
RI RR $0.00 01/01/2022 03/31/2022
MI RR $0.00 01/01/2022 03/31/2022
NJ RR $0.00 01/01/2022 03/31/2022
WI RR $0.00 01/01/2022 03/31/2022
VA RR $0.00 01/01/2022 03/31/2022
OH RR $0.00 01/01/2022 03/31/2022
VT RR $0.00 01/01/2022 03/31/2022
WY RR $0.00 01/01/2022 03/31/2022
NY RR $0.00 01/01/2022 03/31/2022
TX RR $0.00 01/01/2022 03/31/2022
WV RR $0.00 01/01/2022 03/31/2022
TN RR $0.00 01/01/2022 03/31/2022
SD RR $0.00 01/01/2022 03/31/2022
UT RR $0.00 01/01/2022 03/31/2022
LA NU $0.00 01/01/2022 03/31/2022
CT NU $0.00 01/01/2022 03/31/2022
AL NU $0.00 01/01/2022 03/31/2022
DC NU $0.00 01/01/2022 03/31/2022
KS NU $0.00 01/01/2022 03/31/2022
KY NU $0.00 01/01/2022 03/31/2022
AK NU $0.00 01/01/2022 03/31/2022
GA NU $0.00 01/01/2022 03/31/2022
AR NU $0.00 01/01/2022 03/31/2022
AZ NU $0.00 01/01/2022 03/31/2022
CA NU $0.00 01/01/2022 03/31/2022
HI NU $0.00 01/01/2022 03/31/2022
FL NU $0.00 01/01/2022 03/31/2022
IL NU $0.00 01/01/2022 03/31/2022
MI NU $0.00 01/01/2022 03/31/2022
ID NU $0.00 01/01/2022 03/31/2022
MT NU $0.00 01/01/2022 03/31/2022
IA NU $0.00 01/01/2022 03/31/2022
CO NU $0.00 01/01/2022 03/31/2022
ND NU $0.00 01/01/2022 03/31/2022
MS NU $0.00 01/01/2022 03/31/2022
MN NU $0.00 01/01/2022 03/31/2022
TN NU $0.00 01/01/2022 03/31/2022
NV NU $0.00 01/01/2022 03/31/2022
IN NU $0.00 01/01/2022 03/31/2022
ME NU $0.00 01/01/2022 03/31/2022
MO NU $0.00 01/01/2022 03/31/2022
VT NU $0.00 01/01/2022 03/31/2022
NY NU $0.00 01/01/2022 03/31/2022
OK NU $0.00 01/01/2022 03/31/2022
UT NU $0.00 01/01/2022 03/31/2022
MD NU $0.00 01/01/2022 03/31/2022
NH NU $0.00 01/01/2022 03/31/2022
NJ NU $0.00 01/01/2022 03/31/2022
DE NU $0.00 01/01/2022 03/31/2022
OR NU $0.00 01/01/2022 03/31/2022
OH NU $0.00 01/01/2022 03/31/2022
NM NU $0.00 01/01/2022 03/31/2022
VA NU $0.00 01/01/2022 03/31/2022
NC NU $0.00 01/01/2022 03/31/2022
MA NU $0.00 01/01/2022 03/31/2022
NE NU $0.00 01/01/2022 03/31/2022
PA NU $0.00 01/01/2022 03/31/2022
WA NU $0.00 01/01/2022 03/31/2022
TX NU $0.00 01/01/2022 03/31/2022
SC NU $0.00 01/01/2022 03/31/2022
WI NU $0.00 01/01/2022 03/31/2022
SD NU $0.00 01/01/2022 03/31/2022
RI NU $0.00 01/01/2022 03/31/2022
WY NU $0.00 01/01/2022 03/31/2022
VI NU $0.00 01/01/2022 03/31/2022
PR NU $0.00 01/01/2022 03/31/2022
WV NU $0.00 01/01/2022 03/31/2022
AR UE $0.00 01/01/2022 03/31/2022
KY UE $0.00 01/01/2022 03/31/2022
IN UE $0.00 01/01/2022 03/31/2022
CA UE $0.00 01/01/2022 03/31/2022
AK UE $0.00 01/01/2022 03/31/2022
HI UE $0.00 01/01/2022 03/31/2022
MA UE $0.00 01/01/2022 03/31/2022
AL UE $0.00 01/01/2022 03/31/2022
MD UE $0.00 01/01/2022 03/31/2022
ME UE $0.00 01/01/2022 03/31/2022
KS UE $0.00 01/01/2022 03/31/2022
GA UE $0.00 01/01/2022 03/31/2022
IA UE $0.00 01/01/2022 03/31/2022
LA UE $0.00 01/01/2022 03/31/2022
AZ UE $0.00 01/01/2022 03/31/2022
CT UE $0.00 01/01/2022 03/31/2022
DC UE $0.00 01/01/2022 03/31/2022
MI UE $0.00 01/01/2022 03/31/2022
MN UE $0.00 01/01/2022 03/31/2022
MT UE $0.00 01/01/2022 03/31/2022
FL UE $0.00 01/01/2022 03/31/2022
ID UE $0.00 01/01/2022 03/31/2022
MS UE $0.00 01/01/2022 03/31/2022
IL UE $0.00 01/01/2022 03/31/2022
DE UE $0.00 01/01/2022 03/31/2022
ND UE $0.00 01/01/2022 03/31/2022
OK UE $0.00 01/01/2022 03/31/2022
CO UE $0.00 01/01/2022 03/31/2022
MO UE $0.00 01/01/2022 03/31/2022
OR UE $0.00 01/01/2022 03/31/2022
NY UE $0.00 01/01/2022 03/31/2022
RI UE $0.00 01/01/2022 03/31/2022
PR UE $0.00 01/01/2022 03/31/2022
OH UE $0.00 01/01/2022 03/31/2022
VI UE $0.00 01/01/2022 03/31/2022
UT UE $0.00 01/01/2022 03/31/2022
NV UE $0.00 01/01/2022 03/31/2022
NC UE $0.00 01/01/2022 03/31/2022
WI UE $0.00 01/01/2022 03/31/2022
VT UE $0.00 01/01/2022 03/31/2022
NJ UE $0.00 01/01/2022 03/31/2022
NH UE $0.00 01/01/2022 03/31/2022
NE UE $0.00 01/01/2022 03/31/2022
NM UE $0.00 01/01/2022 03/31/2022
WA UE $0.00 01/01/2022 03/31/2022
TX UE $0.00 01/01/2022 03/31/2022
WV UE $0.00 01/01/2022 03/31/2022
WY UE $0.00 01/01/2022 03/31/2022
TN UE $0.00 01/01/2022 03/31/2022
VA UE $0.00 01/01/2022 03/31/2022
PA UE $0.00 01/01/2022 03/31/2022
SC UE $0.00 01/01/2022 03/31/2022
SD UE $0.00 01/01/2022 03/31/2022

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.