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Excellus BlueCross BlueShieldAll Plans · Coverage · Sleep Medicine · Pulmonology, Sleep MedicineMedium impact

Home Non-Invasive Positive Pressure Ventilation (NIPPV) Devices for Respiratory Insufficiency and Failure - (Effective Date - 2026-10-15) 1.01.57

Effective date
Oct 15, 2026
Identified
Jul 16, 2026

Summary

Excellus issued a new home non-invasive positive pressure ventilation policy effective October 15, 2026, and the criteria for BPAP devices were moved over from policy 1.01.06 Positive Airway Pressure Devices: CPAP and APAP. The policy sets medical necessity criteria for BPAP without a backup rate (E0470) and with a backup rate (E0471), and for home ventilators (E0466, E0467, E0468) in neuromuscular and thoracic restrictive disease, hypoventilation syndrome, COPD-related chronic respiratory failure, obstructive sleep apnea, central sleep apnea, and hospital discharge. It also sets rules for continuation of use, DME repair, and DME replacement.

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What to do

Action · 5 steps
01Already effective 2026-10-15: Claims for BPAP need documentation that the patient meets the criteria in the policy statements for the diagnosis, including the FVC, MIP, sleep oximetry, PaCO2 and spirometry values named there.
02Claims for dual or multifunction ventilators (E0467, E0468) need documentation supporting the need for an oxygen concentrator, cough stimulator, suction pump or nebulizer function, and showing that the patient has not received any one of these devices individually.
03Claims for continued use for COPD, OSA and hypoventilation syndrome need documentation of use for four or more hours on 70% of the nights during a consecutive 30-day period.
04Repair of equipment not under warranty needs physician documentation of the DME initiation date, manufacturer warranty information if applicable, and an attestation that the patient has been compliant and will continue to benefit.
05Replacement of a properly functioning device is considered not medically necessary, and equipment damaged by patient neglect, theft or abuse is ineligible for coverage.

Codes mentioned

E0466E0467E0468E0470E0471E0472E0561E0562A9279E66.2G35G47.00G47.10G47.20G47.35G47.8G47.9I50.9J39.8J44.1J44.9J95.2J98.4J98.8

Original notice

Home Non-Invasive Positive Pressure Ventilation (NIPPV) Devices for Respiratory Insufficiency and Failure - (Effective Date - 2026-10-15) 1.01.57
excellusbcbs.com · Always check the source before changing claims.
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Related changes

See all Excellus BlueCross BlueShield changes →
Continuous Positive Airway Pressure (CPAP) and Auto-Adjusting Positive Airway Pressure (APAP) Devices - (Effective Date - 2026-10-15) 1.01.06MediumEffective Oct 15, 2026 · Sleep MedicineMedical Management Obstructive Sleep Apnea (OSA) 1.01.07MediumEffective Oct 22, 2026 · Lungs (Respiratory)Medical Management Obstructive Sleep Apnea (OSA) 1.01.07MediumEffective Oct 22, 2026 · Lungs (Respiratory)Positive Airway Pressure Devices CPAP BiPAP APAP and Noninvasive Positive Pressure Ventilators (NIV) 1.01.06HighEffective Jul 17, 2025 · Sleep MedicineBrowse every Excellus BlueCross BlueShield change in the policy list

Related policy hubs

Excellus BlueCross BlueShield policiesPulmonologySleep MedicineCode E0466Code E0467Code E0468Code E0470Code E0471Code E0472Code E0561Code E0562Code A9279Code E66.2Code G35Code G47.00Code G47.10Code G47.20Code G47.35Code G47.8Code G47.9Code I50.9Code J39.8Code J44.1Code J44.9Code J95.2Code J98.4Code J98.8

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