R13808CP: Noninvasive Positive Pressure Ventilation (NIPPV) in the Home for the Treatment of Chronic Respiratory Failure (CRF) Consequent to Chronic Obstructive Pulmonary Disease (COPD)
Summary
Already effective June 9, 2025, Medicare claims for Respiratory Assist Devices (RADs), with or without a backup rate feature, use HCPCS codes E0470 and E0471 with the KX modifier, and claims for Home Mechanical Ventilators (HMVs) use HCPCS codes E0466, E0467 or E0468, when the items are furnished in the home as treatment for chronic respiratory failure consequent to COPD under NCD 240.9. The multifunction ventilators E0467 and E0468 require that the beneficiary meet the ventilator criteria plus the criteria for one of the other functions. Patients who receive a RAD or HMV must be evaluated at least twice within the first year, by the end of the six-month initial coverage period and again during months 7 to 12.
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