Article Detail - JD DME

Suppliers may bill for two ventilators if it is required to serve a different medical purpose that is determined by the beneficiary’s medical needs. Examples include:

• When a beneficiary requires one type of ventilator for part of the day and needs a different type of ventilator during the rest of the day.
• When a beneficiary who is confined to a wheelchair requires a ventilator mounted on the wheelchair for use during the day and needs another ventilator of the same type for use while in bed.

The second ventilator may deny as same or similar as there is one ventilator already on file. Same or similar denials may be appealed with all documentation to support the medical necessity for the second ventilator. When submitting the claim, we would encourage a narrative that states "mounted". We recommend this to help avoid initial denials.