Ventilators
Revised: 01-12-2016
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Overview
Eligible Providers
Eligible Recipients
Covered Services
Noncovered Services
Authorization
Billing
Overview
Ventilators are used to move air in and out of the lungs.
Eligible Providers
The following providers may provide ventilators:
 Medical suppliers
 Home health agencies
 Indian Health Services
 Federally Qualified Health Centers
 Rural Health Clinics
Because ventilators are life-sustaining equipment, providers must:
 Conduct an in-home environmental assessment to confirm the patient’s residence will safely sustain
the ventilator and auxiliary equipment, along with routine household appliances and activities. The
assessment includes, but is not limited to, checking for grounded electrical outlets and functional
smoke detectors, emergency protection planning and escape route planning.
 Train the recipient and caregivers in proper use of the ventilator, including infection control,
alternative ventilation, and emergency ventilation procedures
 Have 24 hour/day support for troubleshooting and ventilator exchange due to unresolved malfunction
 Ensure critical alarms are appropriately set on the ventilator
 Ensure a backup alarm system is in place for when the patient is not directly observed by a fully
trained caregiver
 Perform periodic maintenance at least as frequently as recommended by the manufacturer
TPL and Medicare
Providers must meet any provider criteria, including accreditation, for third party insurance or for Medicare
in order to assist recipients for whom MHCP is not the primary payer.
MHCP quantity limits and thresholds apply to all recipients unless only Medicare co-insurance or
deductible is requested.
Eligible Recipients
Ventilators are covered for all eligible MHCP recipients who meet coverage criteria.
Covered Services
Codes: E0465, E0466
Ventilators are covered for recipients who have been determined by a physician to need a ventilator.
Both a portable and a stationary ventilator may be covered when documentation in the medical supplier’s
files establishes that a portable ventilator alone does not meet the recipient’s needs.
Noncovered Services
Back-up ventilators are noncovered because it is a duplication of equipment.
Authorization
Authorization is not required.
Billing
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Included with rental:
 Battery
 Breathing circuits (effective 1/1/2014)
 Carrying case
 Cart
 Electric cord
 Exhaustion valves
 High/low/disconnect alarms
 High pressure hoses
 IMV devices
 PEEP valve
 Pressure manometers
 Spirometer, any kind
 Stand
 Water traps
Separately billable:
 Humidifier
 Manual resuscitation bags
 Oxygen
 Oxygen analyzers
Use X12 Batch or MN–ITS 837P Professional electronic claim
Report the ordering provider in the Other Provider Types section of the MN–ITS Interactive claim
If the recipient has Medicare, MHCP will pay only the deductible and co-insurance on any item for
which Medicare made payment, regardless of any MHCP prior authorization
If the recipient has Medicare, any items for which Medicare denies payment must meet MHCP
coverage and authorization requirements
Shipping and delivery costs are included in the MHCP maximum allowable payment and may not be
separately billed to MHCP or the recipient
Ventilators have been determined by Medicare to require frequent and substantial servicing. MHCP
will not purchase ventilators, and rented ventilators do not convert to purchase.
Refer to Non-Mobility Equipment Repairs for billing requirements for repairs and maintenance to
patient-owned equipment