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Home Health & Hospice Week

Know Your Facts:

Respiratory Assist Devices

Published on Fri Aug 29, 2003

A proposed change to the payment category for certain respiratory equipment could mean $30,000 less in payments for one device.

Over five years, a supplier receives $36,751.20 from Medicare for a respiratory assist device with bi-level capability and a back-up rate under the frequent and substantial servicing payment category, the Centers for Medicare & Medicaid Services says in its proposed rule to change the device's category to capped rental. Under the rental category, payment for that same period of time would be only $7,778.99, CMS notes.

Following are some other facts CMS cites in its proposed rule for reducing payment for these RADs:

  • Medicare payments for HCPCS code K0533, which covers these devices, reached $77 million in 2002.

  • An $11.5 million reduction to that figure translates to a 15 percent cut in payments for the devices.

  • Medicare beneficiaries use between 10,000 and 12,000 of these RADs per year.

  • The average length of use is 16 months.

  • The top five suppliers of these devices receive $4 million in Medicare payments for them per year.

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