What is the appropriate HCPCS (Healthcare Common Procedure Coding System) code for a patient with Chronic Obstructive Pulmonary Disease (COPD) requiring home oxygen therapy?

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Last updated: January 9, 2026 • View editorial policy

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HCPCS Codes for Home Oxygen Therapy

The primary HCPCS codes for home oxygen therapy depend on the delivery system: E0424-E0425 for stationary oxygen concentrators, E0430-E0431 for portable oxygen systems, E0433-E0434 for portable liquid oxygen systems, and E1390-E1392 for oxygen concentrators (portable). Additional codes include E0555 for humidifiers, E0560 for humidifier bottles, and A4608 for transtracheal oxygen catheters.

Equipment-Based HCPCS Coding

Stationary Oxygen Systems

  • E0424: Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing
  • E0425: Stationary compressed gas system, purchase; includes regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing
  • E0439: Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing

Portable Oxygen Systems

  • E0431: Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing
  • E0433: Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing
  • E0434: Portable liquid oxygen system, purchase; includes portable container, supply reservoir, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing

Oxygen Concentrators

  • E1390: Oxygen concentrator, single delivery port, capable of delivering 85% or greater oxygen concentration at the prescribed flow rate
  • E1391: Oxygen concentrator, dual delivery port, capable of delivering 85% or greater oxygen concentration at the prescribed flow rate, each
  • E1392: Portable oxygen concentrator, rental

Clinical Context for Coding

Indications for Long-Term Oxygen Therapy (LTOT)

  • Severe chronic resting hypoxemia: PaO2 ≤55 mmHg (7.3 kPa) with or without hypercapnia qualifies patients for home oxygen 1, 2
  • Moderate hypoxemia with complications: PaO2 55-59 mmHg (7.3-8.0 kPa) in the presence of pulmonary hypertension, peripheral edema, polycythemia, or severe nocturnal hypoxemia 1, 2
  • Minimum usage requirement: At least 15 hours per day including during sleep to achieve survival benefits 1, 3

Equipment Selection Criteria

  • Oxygen concentrators (E1390-E1392): Recommended for flows up to 4 L/min as first-line stationary systems 1
  • Portable liquid oxygen (E0433-E0434): Conditionally recommended for patients mobile outside the home requiring >3 L/min continuous-flow oxygen during exertion 2
  • Nasal cannulas: First choice delivery device for most patients 1
  • Venturi masks: Consider for patients with hypercapnic respiratory failure concerns, high respiratory rate, or cognitive impairment 1

Medicare Documentation Requirements

Medical Necessity Certification

  • Form HCFA-484 completion: Must be completed by the physician or physician's employee; failure to complete prevents supplier reimbursement 4
  • Required documentation: Patient data, diagnostic reasons for oxygen, arterial blood gas measurements, system type, and liter-flow settings for rest, sleep, and exertion 5, 4
  • Blood gas criteria: Document PaO2 ≤55 mmHg or oxygen saturation ≤88% on room air at rest, or PaO2 56-59 mmHg with evidence of cor pulmonale or polycythemia 4

Monitoring and Follow-Up Requirements

  • Initial follow-up: Within 3 months after LTOT initiation, including blood gas assessment and flow rate verification 3
  • Ongoing follow-up: Every 6-12 months with home visits by specialist healthcare professionals 3, 1
  • Home visit timing: Within 4 weeks of oxygen initiation to check compliance, smoking status, symptoms of hypercapnia, and therapeutic oxygen saturations 3

Common Coding Pitfalls

Avoid These Errors

  • Prescribing without proper assessment: 27% of oxygen cylinder users had not been assessed by a hospital physician, and many lacked proper evaluation for LTOT 6
  • Inadequate oxygen prescription specificity: Must specify oxygen settings for wakeful rest, sleep, and exertion separately 5
  • Missing blood gas documentation: Arterial blood gases must be performed before and after 1 hour on the intended therapeutic flow rate, targeting SpO2 >90% and <94% 3
  • Inappropriate humidification coding: Home oxygen humidification should not be prescribed for patients without a tracheostomy 1

Safety and Compliance Documentation

  • Patient education requirement: Formal education by specialist home oxygen assessment team is essential for compliance 3
  • Oxygen safety education: Patients and caregivers must receive education on oxygen equipment and safety as a best-practice statement 2
  • Smoking status verification: Must be documented and monitored during follow-up visits 3

References

1
Guideline

Home Oxygen Therapy in COPD

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

3
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

5
Research

Long-term home oxygen therapy.

Clinics in chest medicine, 1990

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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