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Elizabeth M. Whitehorn, Director

Provider Notice issued 11/30/04

Policy Changes Regarding Oxygen and Respiratory Care Services

To:​

Participating Durable Medical Equipment and Supply Providers ​
Date:​ November 30, 2004​
Re:​ Policy Changes Regarding Oxygen and Respiratory Care Services​

As a result of Public Act 93-841, effective January 1, 2005, the department will provide for the purchase of durable medical equipment used for the purpose of respiratory care. Any new prior approval requests for respiratory equipment received after January 1, 2005, will be reviewed on a rent-to-purchase basis. The department will continue to honor cases that are on a rental basis only until the prior approval end date has been reached. Durable medical equipment that requires ongoing maintenance and is used in the delivery of oxygen and respiratory care services (ventilators/oxygen concentrators) will continue to be reimbursed on a rental basis only.

This notice includes a list of the HCPC codes that will be reimbursed on a rent-to-purchase basis and a list of HCPC codes that will be covered on a rental only basis. Equipment reimbursed on a rent-to-purchase basis will be considered purchased after 10 months, except for apnea monitors (HCPC codes E0618 and E0619), which will be purchased following 12 months of rental.

The department will pay for repairs of respiratory equipment that is purchased and becomes patient owned. Refer to the Handbook for Providers of Medical Equipment and Supplies Topic M-210.4 for the department’s policies on repairs to equipment and items owned by the patient at http://www2.illinois.gov/hfs/MedicalProvider/Handbooks/Pages/Chapter200.aspx

Providers wishing to receive e-mail notification, when new provider information has been posted by the department, may register at the following IDPA Web sites:

http://www.dpaillinois.com/provrel/

Questions regarding this notice should be directed to the Bureau of Comprehensive Health Services toll-free at 1-877-782-5565.

 

Anne Marie Murphy, Ph.D.

Administrator

Division of Medical Programs

 

 

Effective January 1, 2005

Respiratory Care Durable Medical Equipment

Reimbursed on a Rent-to-Purchase Basis

 

HCPC Code Description
A9999 Respiratory Suction Pump (Back Up)
E0425 Oxygen Compressed Gas – Stationary
E0431 Oxygen Compressed Gas – Portable with humidifier tubing, mask/cannula
E0445 Oximeter Device
E0470 BiPap without Back Up Rate
E0471 BiPap with Back Up Rate, Non-Invasive
E0472 BiPAP with Back Up Rate, Invasive
E0480 Cough Stimulator Device
E0482 Cough Stimulator Device
E0500 IPPB Machine
E0550 Humidifier, Durable for Extensive Supplemental Humidification
E0562 Humidifier, Heated, for CPAP/BiPAP
E0565 Compressor, Air Power Source
E0574 Nebulizer, Ultrasonic, Small Volume
E0575 Nebulizer, Ultrasonic, Large Volume
E0600 Respiratory Suction Pump (Primary)
E0601 CPAP Unit
E0618 Apnea Monitor, without recording
E0619 Apnea Monitor, with recording
E1372 Humidifier Accessory; External Heater

Respiratory Care Durable Medical Equipment

Reimbursed on a Rental Only Basis

HCPC Code Description
A9900 Ventilator (Back Up)
E0434 Oxygen Liquid Portable with humidifier tubing, mask/cannula
E0439 Oxygen Liquid Stationary with humidifier tubing, mask/cannula
E0450 Volume Ventilator
E0454 Pressure Ventilator (Code obsolete 12/31/04)
E0460 Negative Pressure Ventilator
E0461 Stationery/Portable Ventilator
E0463 Pressure/Volume Ventilator Invasive Interface
E0464 Pressure/Volume Ventilator Non-invasive Interface
E1390 Oxygen Concentrator
S8183 Humidifier Heated User with vent dual servo control with temp monitor ( Code obsolete 12/31/04)