The Changing Landscape of Adult Home Noninvasive Ventilation Technology, Use, and Reimbursement in the United States

• Published in: Chest Vol. 145; no. 5; pp. 1134 - 1140
• Main Authors: Sunwoo, Bernie Y., MBBS, Mulholland, Mary, MHA, BSN, RN, CPC, Rosen, Ilene M., MD, MSCE, Wolfe, Lisa F., MD, FCCP
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2014
• Subjects: Adult; Durable Medical Equipment - economics; Equipment Design; Home Care Services; Humans; Noninvasive Ventilation - economics; Noninvasive Ventilation - instrumentation; Noninvasive Ventilation - utilization; Pulmonary/Respiratory; Reimbursement Mechanisms - economics; Sleep Apnea Syndromes - economics; Sleep Apnea Syndromes - therapy; United States; United States; E/M; Evaluation and Management; Local Coverage Determination; Complex Chronic Care Coordination; American Medical Association; CPT; Transitional Care Management; Durable Medical Equipment, Prosthetics, Orthotics, and Supplies; AMA; Healthcare Common Procedure Coding System; OHS; DME; CCCC; BPAP; respiratory assist device; noninvasive ventilation; bilevel positive airway pressure; CMS; Current Procedural Terminology; LCD; obesity hypoventilation syndrome; positive airway pressure; critical care ventilator; PA; Centers for Medicare and Medicaid Services; HCPCS; RAD; CCV; NIV; Durable Medical Equipment; DMEPOS; TCM
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.13-0802

There has been an exponential increase in the use of home noninvasive ventilation (NIV). Despite growing use, there is a paucity of evidence-based guidelines and practice standards in the United States to assist clinicians in the initiation and ongoing management of home NIV. Consequently, home NIV practices are being influenced by complicated local reimbursement policies and coding. This article aims to provide a practice management perspective for clinicians providing home NIV, including Local Coverage Determination reimbursement criteria for respiratory assist devices, Durable Medical Equipment coding, and Current Procedural Terminology coding to optimize clinical care and minimize lost revenue. It highlights the need for further research and development of evidence-based clinical practice standards to ensure best practice policies are in place for this rapidly evolving patient population.