The Centers for Medicare & Medicaid Services (CMS) has issued a change request to the Medicare Administrative Contractors (MACs) for noninvasive positive pressure ventilation (NIPPV) used at home to treat chronic respiratory failure (CRF) as a result of chronic obstructive pulmonary disease (COPD).
CMS released the change request on Aug. 21 with an effective date of June 9, 2025, and an implementation date of Oct. 22, 2025.
The agency is instructing its contractors to pay claims for respiratory assist devices (RADs) with or without a backup rate feature, and home mechanical ventilators (HMVs) for at-home treatment for patients with CRF following COPD.
“Effective for services performed on or after June 9, 2025, CMS has determined that the evidence is sufficient to cover RADs, with or without a backup rate feature, and HMVs in the home to deliver high-intensity noninvasive ventilation (NIV) as treatment for patients with CRF consequent to COPD as long as certain patient criteria is met,” the change request said.
In an Aug. 21 bulletin, the American Association for Homecare (AAHomecare) said the change request “released today to Medicare Administrative Contractors covers initial use and continued coverage criteria for respiratory assist devices and home mechanical ventilators. The DME MACs will use this additional guidance to revise the RAD LCD [local coverage determination]. AAHomecare has reached out to the DME MACs on the timing of additional guidance.”
CMS added that its Medicare Learning Network “will develop and release national provider education content and market it through the MLN Connects newsletter shortly after we issue the CR [change request].”
