CMS allows upgrades to multi-function vents

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Tuesday, April 7, 2020

WASHINGTON – CMS has allowed for expanded use of multi-function ventilators (E0467), according to an MLN Matters article.

“Effective immediately, you may provide and bill for multi-function ventilators described by code E0467 as an upgrade in situations where beneficiaries only meet the coverage for a ventilator,” the article states.

Previously, to meet the medical necessity coverage for multi-function vents, CMS required beneficiaries to need a ventilator and at least one of the four additional functions (oxygen concentrator, cough simulator, suction pump and nebulizer).

If providers want to collect the additional charge for the upgrade, they must obtain a properly completed advance beneficiary notice (ABN) and bill using the GA and GK modifiers. If not, they must bill with a GL modifier.