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Official Description

Home ventilator, multi-function 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
Short Descr Home vent multi-function
Coverage Special coverage instructions apply
Pricing Indicator(s) 31 – Supplies And Surgical Dressings - Frequently serviced DME (price subject to floors and ceilings)
MPI A – Not applicable, as HCPCS priced under one methodology
CIM 60.9
Processing Note PUBLICATION 100-03, CHAPTER 1, SECTION 280.1 (100.03, 1, 280.1).
BETOS D1E – Other DME
TOS Code(s) R – Rental of DME
Added Date 1/1/2019
APC Status Indicator Non-Implantable Durable Medical Equipment
MUE 0
MUE 2
OTS Orthotic No
RR Rental (use the 'rr' modifier when dme is to be rented)
KX Requirements specified in the medical policy have been met
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
CR Catastrophe/disaster related
QF Prescribed amount of stationary oxygen while at rest exceeds 4 liters per minute (lpm) and portable oxygen is prescribed
RA Replacement of a dme, orthotic or prosthetic item
Date
Action
Notes
2019-01-01 Added Added
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