RETIRED - Respiratory Assist Devices Policy Revised


Content Provided on this page contains outdated information and instruction and should not be considered current. Noridian is providing this archived information for research purposes only. This archived article contains previously issued instructions that have since been updated or are no longer applicable for Medicare billing purposes.

Article retired due to content incorporation into the applicable Local Coverage Determination or related Policy Article.

Original Effective Date: 01/01/2000
Revision Effective Date: 11/01/2013

Elements of the Respiratory Assist Device policy have been revised as outlined below:

  • The PaCO2 coverage and payment criterion for "Group II Chronic Obstructive Pulmonary Disease" (COPD) is reduced from > 55 mm Hg to > 52 mm Hg.
  • Two elements (B and D) of the coverage and payment criteria for "Group III Central Sleep Apnea" have also been revised. The revised criteria now read:
    • The exclusion of obstructive sleep apnea (OSA) as the predominant cause of sleep-associated hypoventilation,
    • Oxygen saturation < 88 percent for at least five continuous minutes, done while breathing the patient's usual FIO2.  

The Respiratory Assist Devices (RAD) DMERC Medical Review policy contains several provisions to reimburse code K0533 (Respiratory assist device, bi-level pressure capability, with backup rate feature, used with noninvasive interface) comparable to the least costly medically appropriate alternative code K0532 (Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface) when various coverage and payment criteria are not met. Since the K0533 is in the "Frequent and Substantial Servicing" payment category and K0532 is in the "Capped Rental" payment category, a least costly medically appropriate alternative payment cannot be made. Consequently, K0533 will be denied as not medically necessary when the policy criteria are not met.

These revisions are effective with the original effective date of the policy. The revised policy is published in the accompanying Winter 1999 Supplier Manual update.


Last Updated Dec 11 , 2023