Tag: Bi-level PAP

WASHINGTON - In highly anticipated clarifications on coding and coverage requirements for ventilators, the DME MACs have acknowledged that coverage for the product category isn't quite black and white.While the National Coverage Determination stipulates that vents are covered for neuromuscular diseases, thoracic restrictive diseases and chronic respiratory failure, the DME MACs acknowledge that these disease groups overlap conditions described in the local coverage determination for respiratory assist...

YARMOUTH, Maine - HME providers are struggling with how to get paid for COPD patients who fail Bi-level PAP therapy but don't require nearly around-the-clock ventilation.In April, CMS issued several bulletins clarifying the coding and coverage criteria for Bi-level devices vs. vents and the aftermath, for some providers, has been denials.“What Medicare is saying is that it needs to be a life or death situation, so if they are not on the ventilator for an extended period of time they die,”...