Understanding CMS's New COPD Coverage: What HME Providers Need to Know

Published in Member Communities on July 02, 2025

Ronda BuhrmesterBy Ronda Buhrmester, Sr. Director of Payer Relations and Reimbursement, VGM & Associates

On June 9, 2025, CMS released the implications of the newly finalized National Coverage Determination (NCD) for home mechanical ventilation (HMV) and respiratory assist devices (RAD). While the final NCD has an effective date of June 9, 2025, implementation instructions are yet to come!

The final NCD introduces expanded coverage for RADs and HMVs for patients with chronic respiratory failure due to COPD.

Key changes include: 

  • Clearer Initial and Continuing Coverage Criteria: CMS now outlines specific PaCO₂ with an arterial blood gas (ABG) and continued usage metrics for both RADs and HMVs. 
  • Compliance Demands: New documentation, usage tracking, and patient re-evaluation requirements will increase operational oversight—without added reimbursement. 
  • Hospital Discharge Provisions: Immediate post-discharge coverage is available for patients meeting defined clinical criteria. 
  • Grandfathering: Existing patients on HMV and RADs for COPD are grandfathered in.  
  • MAC Discretion: For cases outside the NCD scope, the DME Medicare Administrative Contractors (DME MACs) retain authority to determine coverage. 

Emphasis needs to be on the importance of proactive education and compliance monitoring with referral sources, staff, and patients. Suppliers are encouraged to prepare for increased documentation demands, patient re-evaluations, and tighter monitoring—without additional reimbursement. 

As the industry awaits further CMS instructions, one message was clear: educate, adapt, and stay ahead. 

We recently held a webinar with myself and industry experts Kim Cuce’, Noel Neil, and Zach Gantt about the key changes of this decision, the operational and financial impact on DME suppliers, and actionable strategies to navigate the new landscape. Click here to view the recording

For any questions, please reach out to me at ronda.buhrmester@vgm.com


TAGS

  1. billing & reimbursement
  2. cms
  3. oxygen
  4. reimbursement
  5. respiratory

From Our Experts

The Role of DMEPOS in Value-Based Healthcare thumbnail The Role of DMEPOS in Value-Based Healthcare Explore how DMEPOS providers contribute to value-based care by enhancing patient outcomes, reducing costs, and promoting healthcare transformation. VGM Expands Expertise with Industry Consultants thumbnail VGM Expands Expertise with Industry Consultants VGM & Associates is excited to announce the expansion of its VGM Professional Services team with the addition of Steve Baker, Brian Bersano, & Tonya Williams. A Data-Driven Approach to Unlocking Growth in the HME Industry thumbnail A Data-Driven Approach to Unlocking Growth in the HME Industry Discover how to enhance your HME business growth with data-driven strategies with actionable tools and resources. 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.