M.47 MA Non-Invasive Home Mechanical Ventilator (Preauthorization Required)
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Policy governing preauthorization and coverage-related information for non-invasive home mechanical ventilators (delivered via mask or nasal interface) for Blue Cross Blue Shield - Nebraska members.
No material clinical or coverage changes in this revision.
Coverage Criteria
Coverage criteria overview
Coverage and preauthorization for non‑invasive home mechanical ventilators are governed by this BCBSNE policy and reference the Medicare NCD on home NIPPV for COPD-related chronic respiratory failure.
Coding (HCPCS)
| E0466 | Home ventilator, any type, used with non-invasive interface (e.g., mask, chest shell) |
| E0467 | Home ventilator, multi-function respiratory device, also performs any or all of the additional functions of oxygen concentration, drug nebulization, aspiration, and cough stimulation, includes all accessories, components and supplies for all functions |
| E0468 | Home ventilator, dual-function respiratory device, also performs additional function of cough stimulation, includes all accessories, components and supplies for all functions |
Provider Actions & Prior Authorization
Prior authorization required; Medicare NCD referenced
Preauthorization is required for non-invasive home mechanical ventilators under this BCBSNE medical policy. The policy explicitly references the Medicare National Coverage Determination: “Noninvasive Positive Pressure Ventilation (NIPPV) in the Home for the Treatment of Chronic Respiratory Failure (CRF) Consequent to Chronic Obstructive Pulmonary Disease (COPD) (240.9).”
- Submit prior authorization before initiating or furnishing non-invasive home mechanical ventilators.
- Policy aligns with and uses the Medicare NCD for home NIPPV in COPD-related chronic respiratory failure as a reference.
Definitions
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