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2012 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 : Volume Ventilators
Volume Ventilators
A volume ventilator may be operated in any of the following: Ventilation Modes Breath Types
The monthly ventilator rental includes all ventilator supplies, such as (but not limited to):
Note: Prior Authorization
The volume ventilator may be prior authorized for rental only for those clients who have a tracheostomy. Providers must use procedure codes E0450, E0463, and E0464 when requesting prior authorization for the rental of a volume ventilator.

Texas Medicaid & Healthcare Partnership
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