E0461 — Volume control ventilator, without pressure support mode, may include pressure control mode, used with non-invasive interface (e.g., mask)
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Key Coverage Criteria
- The use of a back-up (second) ventilator in the home setting is consideredmedically necessarywhenallof the following criteria are met:
- The individual cannot maintain spontaneous ventilations for 4 or more consecutive hours;and
- The individual lives in an area where a replacement ventilator cannot be provided within 2 hours.
- The use of a back-up (second) ventilator in the home setting is consideredmedically necessaryfor the following additional indication, when applicable:
- For individuals who require mechanical ventilation during mobility, as prescribed in their plan of care.
1 Active Policy
ANTHEM-CG-DME-26 — CG-DME-26 Back-Up Ventilators in the Home Setting
Related Codes
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