Effective for claims received on or after August 1, 2020, from-through billing for monthly rental is not required for HCPCS codes E0465 (home ventilator, any type, used with invasive interface, [e.g., tracheostomy tube]), E0466 (home ventilator, any type, used with noninvasive interface, [e.g., mask, chest shell]) or E0467 (home ventilator, multi-function respiratory device, also performs any or all of the additional functions of oxygen concentration, drug nebulization, aspiration, and cough stimulation, includes all accessories, components and supplies for all functions).
No action is required of providers. An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims.
Providers are reminded that a back-up ventilator is reimbursable for recipients who meet the established criteria. Claims billed for back-up ventilators must list the model number in the Additional Claim Information field (Box 19) of the claim or on an attachment. These claims must also include the following statement in the Additional Claim Information field (Box 19): “This is a back-up ventilator.”