Ventilators: Payment & Billing for a Second Ventilator Fact Sheet
You may bill and be paid separately for a primary and secondary ventilator. The second ventilator must be required to serve a different medical purpose than the primary based on the patient’s medical needs.
Examples:
- A patient needs one type of ventilator (example: a negative pressure ventilator with a chest shell) for part of the day and needs a different type of ventilator (example: positive pressure ventilator with a nasal mask) for the rest of the day.
- A patient confined to a wheelchair requires a ventilator mounted on the wheelchair for use during the day and needs another ventilator of the same type for use while in bed.
Billing a Primary & Secondary Ventilator
- Add a note in the NTE segment of the Loop 2400 on the electronic claim (Item 19 of the CMS-1500 claim form) for the secondary ventilator claim line only.
- Give a brief reason why the secondary ventilator is medically necessary specific to the patient.
- Bill both ventilators on the same claim and two claim lines.
Example:
Line | From Date | To Date | HCPCS | Charges | Number of Units |
---|---|---|---|---|---|
Line 1 | 110124 | 110124 | E0466RR | 1000.00 | 001 |
Line 2 | 110124 | 110124 | E0466RR | 1000.00 | 001 |
NTE Note for Line 2: 2nd vent on wheelchair for use during the day–life sustaining |
See the Correct Billing and Coding of Ventilators article for questions about coverage and coding of ventilators.
Published: November 11, 2024