Presenters to share insights into new ventilation reimbursement criteria

In June, the US Centers for Medicare and Medicare Services (CMS) released a long-awaited major revision of coverage guidelines for noninvasive positive pressure ventilation (NIPPV) devices for patients with COPD.

This announcement followed more than a decade of advocacy by CHEST, including organizing and leading technical expert panels to produce comprehensive recommendations for the use of noninvasive ventilation across respiratory conditions.

Experts from those panels will discuss how the details of this new policy might affect the treatment of COPD, hypoventilation, and restrictive lung disease during the CHEST 2025 session New Bilevel PAP Reimbursement Criteria: Getting the Right Device on Monday, October 20, at 4:30 pm CT in McCormick Place, South Building, Room 502.

Session Chair Peter Gay, MD, FCCP, and others in the field championed several of the adopted changes, including dropping overnight oximeter reading requirements and allowing patients direct access to higher-level ventilators. During the session, Dr. Gay will explain the implications for clinicians and caregivers—such as the importance of applying for ventilation devices immediately following release from hospital to facilitate reimbursement payments. He will also provide updates on the ongoing feedback process, where medical experts and regional Medicare area contractor directors are shaping the policy based on their initial interactions with it.

“The optimistic view is that all of these directors seem engaged,” Dr. Gay said in summarizing the positive and negative developments from the feedback consultations that he will share at the session. “They all wanted to help their beneficiaries, and they clearly have thought about the issues.”

The final COPD ventilation guidelines—its wording, as well as how it is interpreted, and how much leeway is given to clinicians—will set important precedents for anticipated CMS guidelines of ventilation coverage for other conditions, Dr. Gay said.

Babak Mokhlesi, MD, FCCP, will break down his interpretation of how that process is playing out for hypoventilation guidelines, depending on if guidelines have been issued or are still under consideration at the time of the annual meeting.

Lisa Wolfe, MD, FCCP, will review the present state of CMS guidelines for use of ventilation devices by patients with restrictive lung diseases.

Each of the three presentations has been billed with a dance theme: “COPD Mambo,” “Hypoventilation Syndrome Twist and Shout,” and “Restrictive Lung Disease Waltz.” Dr. Gay said the wording was chosen to represent the steps—sometimes frivolous, sometimes convoluted, but ultimately essential—that clinicians and caregivers must learn to take to ensure reimbursement and to guarantee that the right patient can receive the right device at the right time. “You have to know the rules to know how to dance,” he said.