On June 9, 2025, the Centers for Medicare & Medicaid Services (CMS) published a national coverage determination (NCD) memo for noninvasive positive pressure ventilation (NIPPV) in the home for chronic respiratory failure (CRF) due to chronic obstructive pulmonary disease (COPD). This decision introduces several significant policy changes that will affect sleep medicine physicians involved in respiratory care. Key changes include:

New national coverage for respiratory assist devices and home mechanical ventilators

Previously, coverage for respiratory assist devices (RADs) and home mechanical ventilators (HMVs) was left to the discretion of Medicare administrative contractors (MACs), resulting in inconsistent access and requirements across regions. However, under the new policy, CMS now nationally covers:

  • RADs with and without a backup rate for chronic hypercapnic respiratory failure due to COPD
  • HMVs in volume-targeted modes for select patients with COPD

New HMV coverage criteria for COPD

Hospital discharge criteria are included for both RADs and HMVs if \the device is used within 24 hours prior to discharge. HMVs are now covered for COPD patients who meet the following stricter criteria:

  • PaCO₂ ≥ 52 mmHg
  • Need for ≥ 36% FiO₂ or ≥ 4L nasal O₂, more than 8 hours of ventilatory support per day, or safety features such as alarms
  • Documentation that a RAD is insufficient

Trial of RAD without backup no longer required

The previous requirement for a trial of RAD without a backup rate before escalating to a device with a backup has been removed.

Due to these changes, physicians and other health care professionals can now follow a clear national policy rather than navigating inconsistent local coverage determinations (LCDs) from multiple MACs. The updated policy enables greater focus on adherence and outcomes and provides supply coverage clarity.

Members are encouraged to review the full NCD decision memo. Special thanks to the AASM members who participated in the development of the request for reconsideration for this national coverage determination.

Questions regarding this policy can be directed to coding@aasm.org.