Home Mechanical Ventilation Devices - DME.O2.104.A

Home ventilators (E0465, E0466) and multi‑function ventilators (E0467) are covered for chronic respiratory failure from qualifying obstructive, restrictive, neuromuscular, obesity hypoventilation or other chronic hypoventilation conditions (including pediatric OSA and chronic lung disease of infancy) and for E0467 when integrated oxygen/suction/nebulizer/cough stimulator functions are required; they are not covered when criteria are unmet (e.g., chronic stable COPD without hypercapnia, central sleep apnea of heart failure). Coverage requires documentation that CPAP/BiPAP is inappropriate or ineffective, stable respiratory status, a safe home environment with trained caregiver support, required device functionality/alarms, an initial 12‑month rental with re‑evaluation and documented continued benefit for extensions, and duplicate ventilators only when each serves a different medical/functional purpose.

"CPAP or BiPAP treatment is not appropriate as indicated by any of the following: [E0466]"