The Centers for Medicare and Medicaid Services (CMS) has updated its policy for HCPCS code E0467 (multifunction ventilator) removing “same or similar” restrictions and paving the way for increased access to integrated respiratory care for ventilator users regardless of their device billing history, according to Ventec Life Systems.
Previously, same or similar restrictions precluded many patients from qualifying for a multi-function ventilator if they had previously billed for an oxygen, cough, suction, or nebulizer device, Ventec reports. This permanent change is effective immediately and provides access to a multifunction ventilator for all ventilator users.
The updated CMS guidance states: “the Centers for Medicare & Medicaid Services (CMS) permanently suspended claims editing for multifunction ventilators when there are claims for separate devices in history that have not met their reasonable useful lifetime.”
Ventec Life Systems CEO Chris Kiple applauded the announcement saying, “We thank CMS for making this impactful change to E0467 to ensure access to the benefits of integrated respiratory care for ventilator users and their care partners.”
“VOCSN is designed to free families from the complexity of managing and transporting five separate medical devices by providing everyday mobility and the convenience to complete every therapy in seconds at the touch of a button. Every family now has the right to benefit from this technology” continued Kiple.
VOCSN, together with E0467, streamlines care for durable medical equipment providers (DME), physicians, caregivers, and most importantly, patients and their families. Eligibility for VOCSN multifunction Ventilator billing HCPCS E0467 requires a physician prescription for ventilation (invasive or noninvasive) plus one additional therapy (oxygen, cough, suction, or nebulizer) according to existing medical necessity coverage criteria.
VOCSN is the first and only multifunction ventilator that meets the standard set for HCPCS reimbursement code E0467 which was introduced on January 1, 2019. Suppliers providing VOCSN generally see a 15-20% higher payment amount for HCPCS E0467 than traditional ventilator-only codes (E0465 and E0466).
“The removal of ‘same or similar’ restrictions for multifunction ventilators by CMS is welcome news for the ventilator patients we serve every day,” said Tom Voorhees, President and CEO, The PromptCare Companies. “The numerous benefits of integrated respiratory care will be more widely available and provide access to the latest ventilator technology.”
“The recent changes made by CMS to remove regulatory hurdles to increase access to respiratory devices is a breath of fresh air for our industry,” said Ryan Sullivan, Executive Vice President, VieMed Healthcare. “In particular, eliminating the ‘same or similar’ restrictions for Multi-Function Ventilators will have an immediate impact for the many patients who require multiple devices to treat their respiratory condition. The diseases we treat can progress rapidly and these regulatory changes open up a pathway for patients to utilize the right technology at the right time as their treatment needs change. We thank CMS for supporting the needs of our industry, and we are proud to be on the forefront of innovations in respiratory care by using the VOCSN multifunction ventilator.”
“We are working with state Medicaid and commercial payers to ensure these CMS changes to E0467 are implemented across all payers,” said Nick Macmillan, Director of Market Access, Ventec Life Systems. “We are grateful that forty-six states have recognized E0467 and look forward to continuing to work with our payer partners across the country.”