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Issue Number - Name
0069 - Respiratory Assist Device
Review Type
Automated
Claim Type
DME by supplier; DME by physician
Region and State
RAC 5
All States
Date Approved
2017-12-12

Description

 Medical necessity: Documentation will be reviewed to determine if Respiratory Assist Devices meet coverage criteria.

Affected Code(s)

  • E0470, E0471

Applicable Policy References

  • 42 C.F.R. Sections 405.980 (b)&(c) and Section 405.986
  • CMS Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 110
  • CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 4, Section 4.26
  • CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 5, Section 5.2.4 – 5.2.8, 5.7, 5.8, and 5.9
  • CGS and Noridian Healthcare Solutions LCD, L33800, Effective 10/01/2015
  • CGS LCD, L5023, Effective date 10/01/1999, Retired 09/30/2015
  • NGS LCD, L27228, Effective date 10/01/1999, Retired 09/30/2015
  • NHIC LCD, L11504, Effective date 10/01/1999, Retired 09/30/2015
  • Noridian LCD, L11493, Effective date 10/01/1999, Retired 09/30/2015
  • CGS and Noridian Healthcare Solutions Article, A52517, Effective 10/01/2015
  • CGS Article, A23974, Effective date 01/01/2005, Retired 09/30/2015
  • NGS Article, A47231, Effective date 01/01/2005, Retired 09/30/2015
  • NHIC Article, A23659, Effective date 01/01/2005, Retired 09/30/2015
  • Noridian Article, A23902, Effective date 01/01/2005, Retired 09/30/2015
  • CMS Policy Article, A55426, Effective date 01/01/2017