A Guide to the New NCD for NIPPV

Published in Member Communities on August 06, 2025

A Quick Guide to the New NCD for Non-Invasive Positive Pressure VentilationBy Ronda Buhrmester, Sr. Director of Payer Relations and Reimbursement, VGM & Associates

Medicare’s New NCD for CRF consequent to COPD 

The Centers for Medicare & Medicaid Services (CMS) has finalized a National Coverage Determination (NCD) that significantly expands access to non-invasive positive pressure ventilation (NIPPV) for patients with chronic respiratory failure (CRF) secondary to chronic obstructive pulmonary disease (COPD). Effective June 9, 2025, this decision introduces new coverage criteria for both respiratory assist devices (RADs) and home mechanical ventilators (HMVs) specific to the diagnosis of CRF consequent to COPD. 

Remains the Same 

The payment categories remain unchanged. This means the RAD device remains as a capped rental for 13 months of payment, where supplies are separately billable and payable. The NIV remains in the frequent and substantial servicing category, meaning it rents until the device is no longer needed, and supplies are included with the monthly allowable. 

Wins and Challenges 

There are wins with the new NCD, which include clearer clinical criteria for NIV and no oximetry or sleep study requirements for RAD devices. 

With wins come challenges. This includes increased documentation, no additional reimbursement, and the need for education for the suppliers’ referrals. In addition, there is a greater emphasis on patient outcomes and monitoring adherence to compliance requirements. 

Points of Attention 

The DME MACs are diligently developing language for an LCD that will be released in time that will include additional clarity to areas left up to their discretion. 

In the meantime, the biggest area of concern that suppliers need to discuss with their team and industry experts is the continued compliance requirements for each paid rental month. The NCD states that the patient must be using the device at least four hours per 24-hour period on 70% of days in each paid rental month. The discussion needs to be around how a supplier can manage this internally with staff and effectively to meet the policy requirements. If this is not sustainable, then consider outsourcing the monitoring to a reputable company. 

In Summary 

This NCD marks a pivotal shift in Medicare support for COPD-related CRF. The shift is not just for Medicare FFS. Suppliers need to monitor all other payers’ updates that may incorporate this NCD into their respective policies. This has already started with some payers. Suppliers need to prepare through education, training, and workflow adjustments to align with the new standards.  

Ronda Buhrmester 
Ronda.Buhrmester@vgm.com

From Our Experts

VGM & Associates Launches “IM: Unfiltered” Podcast Series thumbnail VGM & Associates Launches “IM: Unfiltered” Podcast Series VGM & Associates is proud to announce the launch of its new podcast series, IM: Unfiltered, created with members of the VGM community in mind. This dynamic new series delivers candid conversations, expert insights, and timely updates that matter most to home medical equipment (HME) providers. Expanding Your DME Offerings for Breastfeeding Awareness Month thumbnail Expanding Your DME Offerings for Breastfeeding Awareness Month Discover how DME providers can celebrate Breastfeeding Awareness Month in August 2025 by expanding their offerings to include mother/baby products. Key Insights from MedPAC's July Data Book for DME Providers thumbnail Key Insights from MedPAC's July Data Book for DME Providers Learn about the evolving Medicare landscape, the impact of an aging population, and the shift towards home healthcare from MedPAC's July 2025 Data Book. Announcing the Finalists for the 2025 O&P Woman of the Year Award thumbnail Announcing the Finalists for the 2025 O&P Woman of the Year Award OPGA is thrilled to announce the finalists for the 2025 O&P Woman of the Year Award. These remarkable women will be honored during the AOPA National Assembly, taking place on Thursday, Sept. 4, at 9:50 a.m. in the Product Preview Theater (PPT) within the exhibit hall. Revolutionizing Independent Living: How Smart Home Technologies Are Reshaping Accessibility thumbnail Revolutionizing Independent Living: How Smart Home Technologies Are Reshaping Accessibility As the global population ages and the demand for accessible housing accelerates, smart home technologies are emerging as essential tools, not just for convenience, but for safety, autonomy, and well-being. Today's smart products, like Autoslide's automatic door systems and Yale's smart locks, are more than gadgets. They are assistive technologies designed to empower people with limited mobility. A Letter from the President: Clarity, Connection, & Champions of Change thumbnail A Letter from the President: Clarity, Connection, & Champions of Change This letter explores the importance of clarity, simplicity, and strategic partnerships, while providing insights on strengthening customer relationships. NAAOP Hosts First Ever In-Person Legislative Fly-In thumbnail NAAOP Hosts First Ever In-Person Legislative Fly-In Last week, 33 stakeholders, advocates, and leaders from around the O&P industry convened at the offices of Powers Pyles Sutter & Verville PC in Washington, D.C., as part of The National Association for the Advancement of Orthotics and Prosthetics's (NAAOP) first ever in-person legislative fly-in. Co-sponsored by OPGA, the fly-in kicked off with an in-depth discussion and strategy session surrounding several legislative priorities affecting O&P providers and patients. Unlocking the Power of Marketing Tools: Create and Deliver Compelling Content thumbnail Unlocking the Power of Marketing Tools: Create and Deliver Compelling Content In today's fast-paced digital landscape, effective marketing hinges on the strategic use of tools that streamline content creation, distribution, and performance tracking.