CG-DME-26 Back-Up Ventilators in the Home Setting

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.

"The use of a back-up (second) ventilator in the home setting is consideredmedically necessarywhenallof the following criteria are met:"

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