The AASM submitted a comment letter to the Centers for Medicare & Medicaid Services (CMS) in response to the proposed addition of three classes of ventilators to the Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) Competitive Bidding Program. CMS proposes adding the following ventilation products to the program:

  • E0465: Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube)
  • E0466: Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell)
  • E0467: Home ventilator, multifunction respiratory device, also performs any or all of the additional functions of oxygen concentration, drug nebulization, aspiration, and cough stimulation, includes all accessories, components and supplies for all functions

The intent of the Competitive Bidding Program is to improve the effectiveness of the Medicare methodology for setting DMEPOS payment amounts, in an effort to allow CMS to reduce out-of-pocket expenses and ensure access to items and services for patients while ultimately controlling the cost of Medicare.

AASM provided several suggestions that may assist CMS in these efforts, specifically in relation to sleep-disordered breathing, including:

  1. Review any potential revision of the Respiratory Assist Device (RAD) guidelines, in order to ensure that they are aligned with the medical literature and current standards of care
  2. Continue providing ongoing in-home Respiratory Therapist (RT) support for the life of these devices
  3. Prioritize the use of E0466 for those who are not appropriate candidates for a bilevel positive airway pressure (BPAP) device
  4. Ensure that all bids include support for humidification, electronic monitoring and multiple interfaces.

Get more Coding and Reimbursement resources from the AASM.