As of January 1, 2016 there are two new HCPCS for ventilators: E0465 (invasive vent e.g. via trach) and E0466 (non-invasive vent). CMS consolidated the five previous ventilator HCPCS (E0450, E0460, E0461, E0463 and E0464) into these two new generic HCPCS. We have provided a simple coding map below:
The monthly allowance for either code is fixed and depending on the state of residence, the allowance is now between $896.95 and $1,055.23. To avoid claims processing errors, you must update your active rentals to reflect the new codes and ensure that your fee schedules and pricing reflects the updated allowable. If claims are billing with the old codes after January 1st, the claims will be rejected. If the allowables are not updated, your AR will be less accurate and payment staff will be required to make additional adjustments as these claims process.
MiraVista performed an analysis on the pricing changes and determined that on average suppliers billing the original E0460 will receive an increase in the monthly allowance of $249.83. For invasive ventilator codes E0450 & E0461, the average monthly allowable will decrease approximately $4.08. However, for the most commonly billed non-invasive ventilator codes E0464 & E0463, the average monthly allowable will decrease approximately $551.96 each month from this point forward.
It’s no secret that CMS has been monitoring the increase in utilization for this product and auditors have been reviewing and denying more claims. The increased scrutiny, pricing changes, and coding updates present several vulnerabilities with supplying this product.
We know suppliers are frustrated by operating in an environment that offers little to no guidance on coverage. But there are guidelines we can use, and lessons we have learned along the way. Andrea Stark will be hosting a webcast to bring it all together and call out the proverbial elephant in the room. During this event, she will expound upon educational bulletins, FAQs, audit findings and more. These resources, and our discussion throughout the event, will insulate your revenue stream for this product line. For more information on this event click here.
It’s no secret that CMS has been monitoring the increase in utilization for this product and auditors have been reviewing and denying more claims. The increased scrutiny, pricing changes, and coding updates present several vulnerabilities with supplying this product.
We know suppliers are frustrated by operating in an environment that offers little to no guidance on coverage. But there are guidelines we can use, and lessons we have learned along the way. Andrea Stark will be hosting a webcast to bring it all together and call out the proverbial elephant in the room. During this event, she will expound upon educational bulletins, FAQs, audit findings and more. These resources, and our discussion throughout the event, will insulate your revenue stream for this product line. For more information on this event click here.
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