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Tag: Coverage


Diabetes & CGMs: ‘A rapid-fire changing environment’ 

Specialty Providers

Diabetes & CGMs: ‘A rapid-fire changing environment’ 

March 17, 2023Theresa Flaherty, Managing Editor

WASHINGTON – Industry stakeholders say Medicare’s newly expanded coverage guidelines for continuous glucose monitors (CGMs) are a big win, but there’s still work to do to process that and other changes made to the benefit in the past few months.  CMS in March published an updated LCD and policy article that, among other things, expands coverage for CGMs to beneficiaries with Type 2 diabetes and allows follow-up visits to be conducted via telehealth.   “Medicare...

Continuous Glucose Monitor (CGM), Coverage, Diabetes, Guidelines


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Also Noted

CMS reviews NIV therapy for chronic respiratory failure

June 24, 2020HME News Staff

WASHINGTON - CMS on July 22 will conduct a virtual Medicare Evidence Development & Coverage Advisory Committee meeting to review the evidence specific to the home use of non-invasive ventilators by patients with chronic respiratory failure consequent to COPD. The agency seeks the committee's recommendations on the characteristics that define patient selection and usage criteria, and concomitant services, as well as the equipment parameters necessary to best achieve positive patient health outcomes...

Chronic Respiratory Failure, COPD, Coverage, Criteria, Non-invasive vents


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Specialty Providers

CMS makes change to multi-function vents permanent

June 9, 2020HME News Staff

WASHINGTON - Starting April 20, CMS permanently suspended claims editing for multi-function ventilators when there are claims for separate devices in history that have not met their reasonable useful lifetime, according to a revised MLN Matters article.Effective immediately, DME suppliers may provide and bill for multi-function vents described by code E0467 as an upgrade in situations where beneficiaries only meet the coverage criteria for a vent.Ventec Life Systems, which makes the VOCSN multi-function...

Coverage, Multi-function ventilators, Ventec, VOCSN


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News

CMS allows upgrades to multi-function vents

April 7, 2020HME News Staff

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...

Coverage, Multi-function vents


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News

CMS opens access to respiratory therapy

March 31, 2020HME News Staff

WASHINGTON - Medicare will cover respiratory related devices and equipment for any medical reason determined by clinicians during the coronavirus pandemic, CMS announced last night.Previously, Medicare only covered them under certain circumstances.“Clinicians now have maximum flexibility in determining patient needs for respiratory related device and equipment and the flexibility for more patients to manage their treatments at the home,” the agency states. “The current NCDs and...

Coverage, respiratory devices


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Also Noted

Inspire touts coverage win

August 27, 2019HME News Staff

MINNEAPOLIS - Two Medicare Administrative Contractors, Noridian and Palmetto, have published draft local coverage determinations that propose coverage for Inspire Medical Systems' obstructive sleep apnea therapy, according to the company. Both draft LCDs state that for individuals with OSA who are treated with hypoglossal nerve stimulation, the evidence is sufficient to determine that neurostimulation technology results in a meaningful improvement in the net health outcomes when used as outlined....

Coverage, Inspire, Sleep Therapy


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Also Noted

Inspire racks up more coverage by private payers

April 26, 2019HME News Staff

MINNEAPOLIS - Inspire Medical Systems has added 10.4 million covered lives with several new coverage policies. Two new Blue Cross Blue Shield Association plans, including Blue Cross Blue Shield Service Benefit Plan, also known as the Federal Employee Program, and BCBS of Tennessee have issued positive coverage policies for the Inspire therapy. Additionally, Medical Mutual of Ohio has issued positive coverage. There have now been 18 positive coverage policies issued by BCBSA healthcare plans, covering...

Coverage, Inspire Medical Systems, Sleep Apnea


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On the Editor's Desk

What's up with this 'What's Covered' app?

January 31, 2019Liz Beaulieu, Editor

CMS this week has made much ado about its new “What's Covered” app that allows beneficiaries to see whether Medicare covers a specific medical item or service, which of course includes HME. The launch of the app paralleled the agency's CMS Quality Conference, or #CMSQualCon19 as it's known on twitter. CMS's coverage of the event on the social media platform has included photos of attendees, including these patient advocates, giving the app a whirl.   Screen...

CMS, Coverage, Medicare


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Specialty Providers

Don't expect CMS to remain silent on vents, Stark says

July 1, 2016Liz Beaulieu, Editor

COLUMBIA, S.C. - CMS is not done tinkering with coverage guidelines for vents, predicts consultant Andrea Stark.Discussing the National Association for Medical Direction of Respiratory Care's recent request that CMS reconsider its national coverage determination for vents, Stark said during a recent webcast: “CMS is not obligated to agree or institute any changes. However, in light of many 'quiet' changes behind the scenes, we do not expect CMS to remain silent on ventilators.”NAMDRC's...

Andrea Stark, Coverage, Policy, Vents


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News

DME MACs clarify vent requirements

May 6, 2016HME News Staff

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...

Bi-Level PAP, Coding, Coverage, CPAP, Vents


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