CMS Updates Policy for Multi-Function Ventilators

BOTHELL, Wash. (June 10, 2020)—On May 29, 2020, the Centers for Medicare & Medicaid Services (CMS) updated its policy for HCPCS E0467 (Multi-Function Ventilator) removing “same or similar” restrictions and paving the way for increased access to integrated respiratory care for ventilator users regardless of their device billing history. Previously, same or similar restrictions precluded many patients from qualifying for a multi-function ventilator if they had previously billed for an oxygen, cough, suction or nebulizer device. This permanent change is effective immediately and provides access to a multi-function ventilator for all ventilator users.

The updated CMS guidance states: “the Centers for Medicare & Medicaid Services (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.” Read the MLN Matters from CMS here.

Ventec Life Systems CEO Chris Kiple applauded the announcement saying, “We thank CMS for making this impactful change to E0467 to ensure access to the benefits of integrated respiratory care for ventilator users and their care partners.”

“VOCSN is designed to free families from the complexity of managing and transporting five separate medical devices by providing everyday mobility and the convenience to complete every therapy in seconds at the touch of a button. Every family now has the right to benefit from this technology” continued Kiple. 

VOCSN, together with E0467, streamlines care for durable medical equipment providers (DME), physicians, caregivers, and most importantly, patients and their families. Eligibility for VOCSN multi-function ventilator billing HCPCS E0467 requires a physician prescription for ventilation (invasive or non-invasive) plus one additional therapy (oxygen, cough, suction or nebulizer) according to existing medical necessity coverage criteria.

VOCSN is the first and only multi-function ventilator that meets the standard set for HCPCS reimbursement code E0467 which was introduced on Jan. 1, 2019. Suppliers providing VOCSN generally see a 15%-20% higher payment amount for HCPCS E0467 than traditional ventilator-only codes (E0465 and E0466).

“We are working with state Medicaid and commercial payers to ensure these CMS changes to E0467 are implemented across all payers,” said Nick Macmillan, Director of Market Access, Ventec Life Systems. “We are grateful that 46 states have recognized E0467 and look forward to continuing to work with our payer partners across the country.”

More information about E0467 is available at venteclife.com/E0467.