Corrections on Medi-Cal Benefit for Multi-Function Ventilator

August, 27, 2020

On July 16, 2020, a Medi-Cal Update article was released titled “Multi-function Ventilator a New Medi-Cal Benefit.” This article contained errors that may have caused confusion for some providers when billing 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). This article attempts to clarify the erroneously published policy.

Corrections are below:

  • The previous article had an incorrect policy effective date of July 1, 2020.

    • The correct policy effective date is August 1, 2020.

  • The article listed from-through billing for monthly rentals of HCPCS codes E0465 and E0466 as allowable effective on or after July 1, 2020.

    • From-through billing for monthly rentals HCPCS codes E0465, E0466, and E0467 is, in fact, required.

  • The article omitted that a Treatment Authorization Request (TAR) and modifier RR (rental) are required when billing for HCPCS codes E0465, E0466 and E0467.

    • A TAR and modifier RR are, in fact, required when billing for HCPCS codes E0465, E0466 and E0467.

Providers are encouraged to check the Medi-Cal Provider website for future updates.