CMS Establishes New Reimbursement Code for Multi-Function Ventilator

vocsn ventec life systems

On November 1, 2018, the Centers for Medicare & Medicaid Services (CMS) released the final 2019 payment rule announcing a new Medicare Part B reimbursement policy for multi-function ventilators. The agency also established a new billing code, HCPCS code E0467. Beginning on January 1, 2019, Medicare suppliers can bill for VOCSN using the new code and beneficiaries who are eligible for the integrated system will be able to benefit from a device that provides ventilator patients truly integrated care from the hospital to the home.

Multi-Function Ventilator
The final rule defines a multi-function ventilator as a single device that integrates a ventilator, portable oxygen concentrator, cough stimulator, suction, and nebulizer, which traditionally would have required a separate piece of equipment for each therapy. VOCSN is the only device that integrates all five therapies and qualifies as a multi-function ventilator.

VOCSN integrates five separate devices including a ventilator, oxygen concentrator, cough assist, suction, and nebulizer into one unified respiratory system. Patent pending technology includes the Ventec One-Circuit™ which offers continuous, uninterrupted ventilation designed to reduce the risk of circuit disconnects. Lightweight for easy transport, VOCSN is controlled with an intuitive touchscreen operating system enabling exclusive functionality to switch between therapies with the touch of a button. VOCSN is simple, mobile, and care-changing for pediatric and adult patients and caregivers from the hospital to home.

Any patient that qualifies for a ventilator and at least one of the four additional functions of the device may be eligible for VOCSN under Medicare Part B.

The Medicare Part B reimbursement rate for a multi-function ventilator is set annually by CMS according to a 5-step formula. Under the formula, payment to suppliers is a monthly rental amount for the ventilator plus an additional average amount that takes into account the four integrated functions (oxygen, cough, suction, and nebulizer). CMS is expected to publish the 2019 Fee Schedule prior to January 1, 2019. The supplier will retain ownership of VOCSN and, therefore, can subsequently furnish the equipment to other beneficiaries for separate rental periods.

Other payers may have their own coverage policies or payment rates for a multi-function ventilator. Suppliers should refer to these other coverage and/or payment policies for their non-Medicare patients covered by insurance programs.

Ownership and Billing
The Medicare Part B final rule classifies multi-function ventilators in the “frequent and substantial servicing” payment category, meaning suppliers providing VOCSN to eligible beneficiaries would receive a monthly rental fee that covers the ventilator and its integrated therapies. Some of the advantages of this policy include:

Single HCPCS Code and Single Payment Methodology: VOCSN will be reimbursed according to a lump-sum monthly payment for as long as the device is medically necessary (similar to how a traditional ventilator is reimbursed today), rather than the current system that reimburses suppliers for a separate HCPCS code for each of the five therapies, with each code reimbursed under a different methodology (including capped items, which are reimbursed for up to 13 months (cough, suction, nebulizer); and oxygen equipment reimbursed up to 36 months). VOCSN is not classified as a capped rental item or as oxygen equipment.

Single Owner of Equipment: The DME supplier will own all five therapies. This is a change from the current system, which allows the supplier to own only the ventilator and oxygen concentrator whereas the beneficiary, after 13 months, would own and maintain the cough, suction, and nebulizer items.
This information is intended to serve as general reference and does not constitute reimbursement or legal advice. Ventec Life Systems makes no promise or guarantee that the information provided is comprehensive, will remain timely, will be appropriate for the specific services provided, or will result in reimbursement. For all coding, coverage, and reimbursement matters or questions, Ventec Life Systems recommends that you consult with certified coders, payers, and/or reimbursement specialists. To view the full text of the rule, click here.


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