Have questions about multi-function vents? Nick Macmillan has answers

What is a multi-function ventilator?

CMS defines a multi-function ventilator as a single device that integrates a ventilator, portable oxygen concentrator, cough stimulator, suction and nebulizer, which traditionally requires 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.

Who is eligible for a multi-function ventilator?

Any new ventilator user that qualifues for a ventilator and at least one of the four additional functions of the device (oxygen, cough, suction, nebulizer) is eligible for VOCSN. Specifically, current ventilator users that meet one of the equipment rental schedules below are eligible for VOCSN:

• Ventilator users that have used cough, suction, and nebulizer for less than 13 months, meaning title of the capped rental item has not transferred to the patient.
• Ventilator users that have used oxygen therapy for less than 36 months, meaning title has not transferred to the patient.
• Ventilator users that own one of the rental items (or reached the 36-month cap for oxygen) but have exceeded the reasonable useful life of five years and are eligible for a new device.

How does this ventilator code differ from existing HCPCS codes for invasive and non-invasive ventilators?

E0467 provides a higher monthly reimbursement rate than E0465 (invasive) and E0466 (non-invasive) and can be applied to patients using the multi-function ventilator for invasive, non-invasive, and/or mouthpiece ventilation.  

What are the benefits of billing E0467?

DME providers can bill a single code that is uncapped and no longer need to track different rental schedules for the different devices that transfer ownership after 13 or 36 months. For example, a DME in Arkansas billing multiple codes for a patient using a traditional ventilator, portable suction pump, and nebulizer would see an increase in reimbursement of $3,222.15 after the first 12 months and an increase of $10,988.26 after 36 months when billing a single code for a multi-function ventilator under E0467.

What payers are covering the VOCSN multi-function ventilator?

VOCSN is billable under HCPCS E0467 as a multi-function ventilator and reimbursable under the Medicare fee schedule. TRICARE uses the same Medicare reimbursement rates established by CMS. Adoption of E0467 for reimbursement by private payors and Medicaid is rapidly expanding and new payers are added weekly. Generally, both Medicaid and commercial payers follow the E0467 reimbursement guidance to pay approximately 20% more than their current ventilator reimbursement.

Can you bill for a second purpose ventilator?

Billing for a secondary multi-function ventilator also follows the same eligibility guidance that requires medical necessity for the secondary multi-function ventilator to serve a different medical purpose that is determined by the beneficiary's medical needs (i.e. a beneficiary who is confined to a wheelchair and 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).

Is E0467 subject to competitive bidding?

Even though VOCSN can provide invasive, non-invasive, and mouthpiece ventilation, E0467 is not subject to the competitive bidding process.

For more information, join an upcoming webinar on August 14.  

Nick Macmillan is director of market access and strategy for Ventec Life Systems.