During the extended rental period for procedure codes E0450, E0461, E0463, E0464, and E0472, providers may be reimbursed up to one half of the rental max fee per month to cover the costs associated with long-term rental. To receive this reimbursement:
After the purchase price max fee of the equipment has been reached, ownership of the equipment remains with the provider. The provider is responsible for long-term support (repairs and necessary supplies) over the life of the DME. Providers may continue to receive up to one half of the rental max fee monthly, for as long as the member continues to use the equipment. Extended rental status carries from one provider to the next provider.
Reimbursement using modifier 52 is intended to cover all provider costs associated with repairs and service including temporary replacement equipment, supplies, and provider-installed accessories including, but not limited to the following:
Usual and necessary accessories and supplies remain included even if a current PA for a ventilator or respiratory assist device is not on file.
Additional payment is not made for repair, maintenance, or replacement during the rental of this equipment. It is the provider's responsibility to ensure there is an emergency plan in place to address mechanical failure of the equipment.
Disposable medical supplies for the member, such as face masks or tracheostomy suction catheters, continue to be covered and reimbursed separately.
The following table outlines service guidelines for ventilators and respiratory assist devices:
| Procedure code | Description | Initial rental period modifier* | Extended rental period modifiers* |
|---|---|---|---|
| E0450 | Volume control ventilator, without pressure support mode, may include pressure control mode, used with invasive interface (e.g., tracheostomy tube) | RR | RR and 52 |
| E0461 | Volume control ventilator, without pressure support mode, may include pressure control mode, used with non-invasive interface (e.g., mask) | RR | RR and 52 |
| E0463 | Pressure support ventilator with volume control mode, may include pressure control mode, used with invasive interface (e.g. tracheostomy tube) | RR | RR and 52 |
| E0464 | Pressure support ventilator with volume control mode, may include pressure control mode, used with non-invasive interface (e.g. mask) | RR | RR and 52 |
| E0472 | Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pressure device) | RR | RR and 52 |
*The following are the modifiers and their definitions for the table above: