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August 23, 2018Reviewed: 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.


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