CBIC BACKTRACKS & REMOVES VENTILATORS FROM ROUND 1 2017

In a listserve posted on June 4th, 2015, the CBIC announced the removal of Non-Invasive Pressure Support Ventilators from Round 1 2017.  The E0464 was introduced as a stand-alone product category for this particular round of bidding in April 2015. Bidding for this round has not yet begun, which allows the CBIC to process these kinds of changes.

CMS has recently released a number of educational bulletins and Joint DME MAC publications to inform suppliers that Ventilators are not appropriate for the treatment of OSA and those conditions covered in the Respiratory Assist Device (RAD) policy (Complex Sleep Apnea, Central Sleep Apnea, Hypoventilation Syndrome, etc).  Because of advancements in technology, some ventilators are able to operate in PAP or RAD modes, therefore suppliers are incorrectly utilizing these ventilators in place of a PAP or RAD device...

With the announcement, CMS also announced plans to consolidate current ventilator codes into two codes effective December 31, 2015.  As of December 31st, the following codes will be obsolete:

• 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)

CMS will replace the above codes with two new codes that have yet to be assigned, but will be effective January 1, 2016:

• Exxx1 – Home ventilator, any type, used with invasive interface (e.g., tracheostomy tube)
• Exxx2 – Home ventilator, any type, used with non-invasive interface (e.g., mask, chest shell)

Exxx1 will be used in place of HCPCS E0450 and E0463, while Exxx2 will be used for HCPCS E0460, E0461, and E0464.  In terms of fee schedule, CMS will establish the fee schedule amounts for the new codes using the current fee schedule for E0450, which varies in allowable (depending on state) from $868.40 to $1,761.50.  CMS also noted in this bulletin that they “intend to closely monitor” the use of the newly established codes to ensure that items used for the treatment of OSA are not being billed under these codes.

CMS is accepting comments for consideration on these changes through 5pm on June 25, 2015 at codingcomments@cms.hhs.gov.  Suppliers that wish to submit a comment should make the subject line “Ventilator Comments”. See the official notice here.