Reimbursement

NGS: Use Ventilator Codes, Even When Device Used Solely as CPAP

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In a reminder email, National Government Services (NGS) states that ventilator codes must be used for Medicare ventilator claims, even if the ventilator is being used only on CPAP or bi-level mode. Claims for ventilators used in CPAP or bi-level PAP scenarios will be denied as incorrect coding, NGS says.

The HCPCS codes for ventilators are:

E0450 – VOLUME CONTROL VENTILATOR, WITHOUT PRESSURE SUPPORT MODE, MAY INCLUDE PRESSURE CONTROL MODE, USED WITH INVASIVE INTERFACE (E.G., TRACHEOSTOMY TUBE)
E0460 – NEGATIVE PRESSURE VENTILATOR; PORTABLE OR STATIONARY
E0461 – VOLUME CONTROL VENTILATOR, WITHOUT PRESSURE SUPPORT MODE, MAY INCLUDE PRESSURE CONTROL MODE, USED WITH NON-INVASIVE INTERFACE (E.G. MASK)
E0463 – PRESSURE SUPPORT VENTILATOR WITH VOLUME CONTROL MODE, MAY INCLUDE PRESSURE CONTROL MODE, USED WITH INVASIVE INTERFACE (E.G. TRACHEOSTOMY TUBE)
E0464 – PRESSURE SUPPORT VENTILATOR WITH VOLUME CONTROL MODE, MAY INCLUDE PRESSURE CONTROL MODE, USED WITH NON-INVASIVE INTERFACE (E.G. MASK)

Choice of an appropriate device, ie, a ventilator versus a bi-level PAP device is made based upon the severity of the condition. CMS distinguished the use of respiratory product types in a National Coverage Analysis Decision Memo (CAG-00052N) in June 2001.