Mountain State Medical Policy Bulletin
Section: Visits
Number: V-11
Topic: Ventilatory Assistance (Respirator Care)
Effective Date: July 16, 2007
Issued Date: September 10, 2007
Date Last Reviewed: 04/2007

General Policy Guidelines

Indications and Limitations of Coverage

Ventilatory assistance is applicable to patients of all ages, as well as neonates who are on respirators.

Claims reporting only ventilatory assistance or respirator care should be processed under codes 94002-94004, 94660 and 94662. However, when critical care (codes 99291-99292), pediatric critical care (codes 99293-99294), pediatric critical care transport (codes 99289-99290), neonatal critical care (codes 99295-99296), or subsequent intensive care (codes 99298-99300) and ventilatory assistance are reported on the same day by the same doctor, the charges for the ventilatory assistance should be denied, with payment being made for the critical care or neonatal intensive care, only. A participating, preferred, or network provider may not bill the patient separately for the ventilatory assistance.

Description

Ventilatory assistance is a form of critical care not to be distinguished from other forms of prolonged detention or critical care for other conditions.

Procedure Codes

940029400394004946609466299289
992909929199292992939929499295
99296992989929999300  

Traditional Guidelines

Refer to General Policy Guidelines

FEP Guidelines

This medical policy may not apply to FEP.  Medical policy is not an authorization, certification, explanation of benefits, or a contract.  Benefits are determined by the Federal Employee Program.

PPO Guidelines

Refer to General Policy Guidelines

Managed Care POS Guidelines

Refer to General Policy Guidelines

Publications

References

View Previous Versions

[Version 004 of V-11]
[Version 003 of V-11]
[Version 002 of V-11]
[Version 001 of V-11]

Table Attachment

Text Attachment

Procedure Code Attachment


Glossary




This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.

Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Mountain State Blue Cross Blue Shield plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.

Mountain State Blue Cross Blue Shield (MSBCBS) retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of MSBCBS. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.