Respiratory Assist Devices

This LCD covers respiratory assist devices (E0470, E0471) for specific disorders — restrictive thoracic disorders, central or complex sleep apnea, hypoventilation syndrome, and chronic respiratory failure consequent to COPD — when defined physiologic thresholds and diagnostic testing (ABG, spirometry, PSG/HST, nocturnal oximetry) and documentation requirements are met. Initial coverage for E0470/E0471 is generally granted for the first three months (with re-evaluation no sooner than 61 days and required practitioner attestation of ≥4 hours/day use for continued coverage), accessory supply frequencies and refill, delivery, and documentation rules apply; ventilators used to deliver CPAP/bi-level PAP or miscoded items will be denied.

"An item is covered only if it is an eligible Medicare benefit category, is reasonable and necessary for diagnosis or treatment or to improve function of a malformed body member, and meets all other..."