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July 7, 2023

Ventilator Resources

Coverage and Coding Information:

There is not a Local Coverage Determination (LCD) for home ventilators (HCPCS codes E0465, E0466, and E0467). Coverage is based on a CMS National Coverage Determination (NCD).

The CMS National Coverage Determination Manual (Internet-Only Manual, Publ. 100-3) Chapter 1, Part 4, Section 280.1External PDF stipulates that ventilators are covered for the following conditions:

  • Neuromuscular diseases
  • Thoracic restrictive diseases
  • Chronic respiratory failure consequent to chronic obstructive pulmonary disease

See Joint DME MAC Publication Correct Coding and Coverage of Ventilators for additional information.

Other LCDs and Policy Articles that include information about ventilators:

RR Modifier Requirement

Ventilators coded E0465, E0466, and E0467 are in the category of items requiring Frequent and Substantial Servicing (FSS). Equipment in this category is paid on a rental basis only. The RR modifier must be appended to the claim.

Resources for modifier requirements:

Documentation Information

You must receive a standard written order (SWO) for the ventilator before you submit the claim to Medicare. You should also obtain documentation from the patient's medical record to assure the beneficiary meets coverage criteria.

Standard Documentation Requirements for All Claims Submitted to DME MACs Policy Article (A55426)External Website provides guidelines about documentation that may be requested by Medicare contractors.


CGS offers a Ventilators Online Education Course. Learn about coverage criteria, correct coding, documentation requirements, and Comprehensive Error Rate (CERT). All our online courses are available whenever you find it most convenient and are self-paced.

Other Resources:

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