License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

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POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

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August 23, 2018 – Reviewed: 11.23.21

Billing Reminders for Secondary Ventilators

CGS has seen a recent upsurge in the number of ventilator (E0465 and E0466) claims with incorrect, invalid, or unnecessary notes. Please take a few moments to review these billing reminders…

If you are billing one ventilator only: A note in the NTE segment of the Loop 2300 (claim level) or Loop 2400 (line level) (Item 19 on the CMS-1500 claim for a paper claim) is not required and should NOT be added.
If you are billing both primary and secondary ventilators: 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. Provide a brief explanation of why the secondary ventilator is medically necessary for the beneficiary (mobility issues or wheelchair bound). Here are two common scenarios when a secondary ventilator is billed to the Medicare program:
- Scenario 1: The beneficiary requires one type of ventilator part of the day (i.e., negative pressure ventilator with a chest shell) and another type of ventilator the rest of the day (i.e., positive pressure ventilator with nasal mask).
- Scenario 2: The beneficiary requires a ventilator mounted to a wheelchair during the day and needs another ventilator of the same type in bed at night.
Bill BOTH ventilators on the same claim on two claim lines. Billing both ventilators on the same claim will help expedite claim adjudication.

Here is an example how a claim with two billed ventilators should look (notes are necessary for the secondary ventilator only):

Line	From	To	Procedure	Submitted $$	NOS (No. of Services)
Line 1	080118	080118	E0466RR	1000.00	001
Line 2	080118	080118	E0466RR	1000.00	001
NTE Note for Line 2: Secondary vent on wheelchair for use during the day–life sustaining

If you have questions about coverage and coding for a ventilator, please refer to our "Correct Coding for Ventilators" article on the CGS website.

License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

AMA Disclaimer of Warranties and Liabilities.

CMS Disclaimer

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

Billing Reminders for Secondary Ventilators

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