Respiratory groups seek changes to ventilator NCD

Thursday, April 7, 2016

WASHINGTON – The American Association of Respiratory Care, the American College of Chest Physicians and the National Association for Medical Direction of Respiratory Care have submitted a request for a reconsideration of the current Medicare National Coverage Determination for home ventilators, including bi-level devices. The groups would like Medicare to establish specific definitions for chronic respiratory failure, as well as for mechanical ventilators/ventilation, and to create objective, consistent criteria for providing these products. Their suggested definition of respiratory failure is the inability of the respiratory system to maintain gas exchange within normal limits; oxygenation failure is the inability to maintain PaO2 of 60mmHg or greater on room air; and ventilatory failure is the inability to maintain PaCO2 of 45mmHg or below. Late last year, CMS overhauled the vent product category, reducing the number of codes from five to two, and reducing reimbursement by about 33%.