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Fact Sheet

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

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