Escalating Medicare Billing for Ventilators Raises Concerns

CMS has expressed concerns about the recent substantial increase in Medicare billing for noninvasive pressure support ventilators. Ventilator technology has evolved so that it is possible for a single device to treat numerous conditions by operating in several different modes-i.e., basic continuous positive airway pressure (CPAP) mode, respiratory assist device (RAD) mode, and traditional ventilator mode. Medicare covers ventilators and RADs for similar respiratory diagnoses, but the selection of the appropriate device is based on the severity of the beneficiary's condition. RADs are covered for beneficiaries with less severe conditions, whereas ventilators are covered for more severe conditions. CPAP devices are covered for the treatment of obstructive sleep apnea. The emergence of this multimodal device, when combined with Medicare coverage and payment policies that favor reimbursement for ventilators, may create incentives for suppliers to provide and bill for a ventilator when the device is actually being used as a RAD or CPAP device.