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Billing Reminder for Secondary Ventilators

We continue to see a high number of reopenings for secondary ventilators. Patients may qualify for both a primary ventilator and a secondary ventilator in certain situations. Below are examples of when a patient will qualify:

  • A patient requires one type of ventilator (e.g., a negative pressure ventilator with a chest shell) for part of the day and needs a different type of ventilator (e.g., positive pressure ventilator with a nasal mask) during the rest of the day.
  • A patient who is confined to a wheelchair requires a ventilator mounted on the wheelchair for use during the day and requires a stationary ventilator of the same type for use while in bed. Without two pieces of equipment the patient may be prone to certain medical complications, may not be able to achieve certain appropriate medical outcomes, or may not be able to use the medical equipment effectively.

As a reminder, Medicare does not pay separately for backup equipment but Medicare will make a separate payment for a second piece of equipment if it is required to serve a different purpose that is determined by the patient’s medical needs.

When billing for a secondary ventilator, suppliers must enter the reason for medical necessity of the secondary ventilator in the NTE 2400 loop, which is available on the line level segment of the electronic claim. For paper claims, this information can be added to Item 19 on the CMS-1500 form. We encourage you to bill one claim with both ventilators reported via two claim lines. The secondary ventilator information should only be reported on the secondary ventilator, not both claim lines.

For more information regarding ventilators, please reference the CMS IOM Publication 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 4, Section 280.1, Durable Medical Equipment Reference List. (904 KB)

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Billing Reminder for Secondary Ventilators
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