CMS proposes coding change for NPPV

Monday, September 15, 2003

September 16, 2003

WASHINGTON - CMS issued a proposed rule change earlier this month that would change the payment category for non-invasive positive pressure ventilation from frequent and substantial to capped rental.

CMS believes that units in the K0533 category were improperly coded as therapeutic ventilators when the code was first created. CMS also believes that the switch in payment levels will not result in a decrease in current patient service levels.

The industry disagrees.

Ever since CMS raised the threshold for who qualifies for respiratory-assist devices (RAD) in the K0533 code several years ago, the therapy has become more or less a niche market for patients with degenerative neuromuscular diseases, patients whose conditions will continue to worsen. Switching the code to capped rental would removed the incentive for providers to furnish the necessary ongoing care such patients require once the capped rental period ends, say industry sources.

“Most of these patients need to be seen monthly and evaluated,” Bob Fary, Apria’s corporate director of respiratory service, told HME News last month. “Who responds at 1 a.m. if the device fails and there is not a rental relationship between the provider and patient?”

AAHomecare plans to work patients, doctors, suppliers and manufacturers to develop a response to the proposed change.