Attend a Webinar

Respiratory Assist Devices

Coverage

Documentation

Reviews/Audits

  • Medical Review - View notifications/findings of pre/post claim reviews completed by Noridian Medical Review

Tips

Topic Details
RAD VS. PAP Compliance
  • RAD- To reach compliance in the beneficiaries 90-day window, the beneficiary needs to be consistently using and benefiting from a RAD device for greater than or equal to 4 hours in a 24-hour window. This criteria is different from the PAP policy for obstructive sleep apnea (OSA).The phrase consistently is determined ONLY by the treating practitioner.
  • For both PAP and RAD you cannot bill for the 4th month until the beneficiary has reached compliance. PAP and RAD use the same supplies and the usage and utilization criteria is the same.
Diagnosis Categories

A RAD (E0470, E0471) is covered for those beneficiaries with one of the following clinical disorders:

  • Restrictive thoracic disorders (i.e., neuromuscular diseases or severe thoracic cage abnormalities)
  • Severe chronic obstructive pulmonary disease (COPD)
  • CSA or CompSA,
  • Hypoventilation syndrome

RAD is a diagnosis driven policy each with their own coverage criteria requirements outlined in the LCD.

Replacement
  • If an E0470 or E0471 device is replaced during the 5-year reasonable useful lifetime (RUL) because of loss, theft, or irreparable damage due to a specific incident, there is no requirement for a new clinical evaluation or testing.
  • If an E0470 or E0471 device is replaced following the 5-year RUL, there must be an in-person evaluation by their treating practitioner that documents that the beneficiary continues to use and benefit from the device. There is no requirement for new testing. A new order is required.

 

Last Updated Fri, 18 Mar 2022 14:46:18 +0000

The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime.

paginationType noridian