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October 2014 Texas Medicaid Provider Procedures Manual

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook : 2. Texas Medicaid (Title XIX) Home Health Services : 2.2 Services, Benefits, Limitations and Prior Authorization : 2.2.19 Respiratory Equipment and Supplies : 2.2.19.14 Negative Pressure Ventilators

2.2.19.14
Negative Pressure Ventilators
The ventilator rental includes all component parts (pillow, mattress, gaskets, etc.).
Providers must use procedure code E0460 when requesting prior authorization for the rental of a negative pressure ventilator.
Application devices may be purchased following the initial three-month rental period depending on the physician’s predicted length of treatment and the client’s compliance.
The purchase of a chest shell (cuirass) and chest wrap is limited to a maximum of 1 every 5 years. Reimbursement for rental is limited to once per month for a total of 4 months.
2.2.19.14.1 Prior Authorization
Negative pressure ventilators may be prior authorized for rental only for individuals who have the ability to speak, eat, drink, and do not have a tracheostomy. One of the following devices may be prior authorized with a portable negative pressure ventilator using procedure codes E0457 and E0459. These devices may be reimbursed for an initial three-month rental period. Application devices may be prior authorized for rental of an initial period of three months.

Texas Medicaid & Healthcare Partnership
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