Noninvasive Home Ventilators - Medicare Advantage

This policy covers noninvasive home mechanical ventilators (HMVs)/noninvasive ventilation (NIV) for home use. It supports NIV for conditions including obesity hypoventilation syndrome (often requiring volume‑targeted mode with initial 180‑day/6‑month coverage), neuromuscular and restrictive chest‑wall disorders (eg, kyphoscoliosis, asphyxiating thoracic dystrophy), and sleep‑disordered breathing (eg, AHI≥5 or nocturnal O2 <88%) when CPAP is unsuccessful; continued coverage requires documented device use at specified follow‑ups (6 months, 7–12 months, ongoing), compliance with LCD L33800/CMS documentation, and noninvasive oscillatory ventilation (NIOV) is not considered medically reasonable and necessary.

"Document is an LCA (Local Coverage Article) establishing standard documentation requirements for claims submitted to DME MACs rather than a clinical coverage LCD/NCD; no clinical coverage indicatio..."