Payer PolicyActive
CG-DME-26 Back-Up Ventilators in the Home Setting
ANTHEM-CG-DME-26
Anthem
Effective: October 1, 2025
Updated: December 30, 2025
Policy Summary
This policy addresses coverage for a back-up (second) ventilator for individuals using mechanical ventilation in the home. It is medically necessary when the patient cannot sustain spontaneous ventilation for at least 4 consecutive hours and lives where a replacement ventilator cannot be provided within 2 hours; it is also covered if the patient requires mechanical ventilation during mobility as prescribed in the plan of care. It is not medically necessary when these criteria are not met.
Coverage Criteria Preview
Key requirements from the full policy
"The use of a back-up (second) ventilator in the home setting is consideredmedically necessarywhenallof the following criteria are met:"
Sign up to see full coverage criteria, indications, and limitations.